2. • Geriatrics vs Gerontology:
• Geriatrics deals with the health care and needs of old people, whereas
gerontology deals with the study of old age and process of ageing and
its impact on population.
3. Geriatric Population:
• The cut-off of “60 years” has been accepted by the Senior Citizen Act,
2063 for recognizing a person as a ‘Senior Citizen’.
• Worldwide, it is accepted as >65 Years.
4. Old Age Demographics:
According to the most recent census, there were 2.2 million older adults in
Nepal in 2011.
The older population constituted 6% of the national population in 2011 and is
growing at a rate of 3.5%per year, which is greater than the 1.35% growth rate
for the overall population
5. Key points on Geriatric care:
• Geriatric Medicine is an important branch of Medicine like any other.
• Health prevention and promotion approach rather than curative approach is
the necessity.
• Myths like “all old people are diseased and disabled” and stereotype of
Ageing need to be debunked.
6. From a Clinical Perspective:
• Disease presentation in old age is atypical, often in later stage, with more
complications. . Blunting or absence of classic or common clinical signs and
symptoms is well known.
• Older people and their caregivers often fail to recognize certain symptoms as
abnormal.
• The prevention and early treatment of diseases is thus desirable. The treatment of
hypertension and transient ischemic attack, and immunization for pneumococcal
pneumonia, influenza, zoster and so on are some of the measures which can be
cost-effective in preventing myocardial infarction, stroke, life-threatening
pneumonia, sepsis, meningitis, disabling post-herpetic neuralgia, etc.
7. Healthy Ageing:
• WHO defines healthy ageing as “the process of developing and maintaining
the functional ability that enables wellbeing in older age.”
• Intrinsic capacity comprises all the mental and physical capacities that a
person.(Cognitive capacity, Locomotor capacity ,Vitality ,Sensory capacity
,Psychological capacity)
• Functional Ability = Intrinsic Capacity + Environmental characteristics
• Healthy ageing is the focus of World Health Organization’s work on ageing
between 2015–2030.
8. Efforts for Elderly Health Care in Nepal:
• Senior Citizens Rights Act, 2063
• Geriatric Ward Establishment Program:
• Bipanna Nagarik Ausadhi Upachar Programme: Under this
programme, the impoverished senior citizens can also receive free treatment
up to NPR 100,000 per patient via the listed hospitals for severe diseases
including Alzheimer’s disease, Parkinson’s disease, cancer, heart disease,
traumatic head injuries, traumatic spinal injuries and sickle cell anemia.
11. Assessing Functional Capacity:
• . The most commonly used measures of function evaluate the following
three levels of activity of daily life:
• 1. Basic activities of daily living (BADLs)
• 2. Instrumental activities of daily living (IADLs)
• 3. Advanced activities of daily living (AADLs).
12. ICOPE SCREENING TOOLS:
• Integrated care for older people (ICOPE): 6 Headings
• 1. Cognitive Function
• 2. Limited Mobility
• 3. Malnutrition
• 4. Visual Impairment
• 5. Sensory Impairment
• 6. Depressive Symptoms
13.
14. Nursing Care of Old Age:
• Prevention of pressure sores
• Caregiver stress and Caregiver abuse
• Mobility and Exercise
• Medications rationale (Eg Avoid late night fluid intake, warning patients
about side effects, avoid use of drugs causing postural hypotension,
cholinergic side effects )
• Proper undisturbed sleep
15. Nutrition in Old Age:
Condition Protein requirement
Healthy older adults 1-1.2 g/kg/day
Recovering from weight loss, acute illness or injury Up-to 1.5 g/kg/day
Older patients with pressure sores very high protein diet (Contains 25% of calories as protein)
Exposure to sunlight is necessary to make the skin produce
vitamin D.
Routine prescription of multivitamin supplements is not indicated
for older adults.
The intake of calcium and vitamin D in the form of milk, curd,
cheese, small fish and certain green vegetables should be increased
to compensate for osteoporotic changes.
Quitting smoking, tobacco chewing and alcohol Intake
16. Exercise in Old Age:
• Older adults should perform at least 150 minutes of moderate-intensity aerobic
physical activity throughout the week or at least 75 minutes of vigorous-intensity
aerobic physical activity throughout the week or an equivalent combination of
moderate- and vigorous-intensity activity.
• Aerobic activity should be performed in spells of at least 10 minutes’ duration.
• Muscle-strengthening activities, involving the major muscle groups, should be
done 2 or more days of the week.
17. Vaccination:
• Influenza vaccine:
• The person should be administered 1 dose annually, especially before the onset of winter
• Pneumococcal vaccination
• capsular polysaccharide vaccine (PPSV-23), conjugate vaccine (PCV-13)
• The person should be 65 years of age or older and immunocompetent. He/she should be
administered 1 dose of PCV-13, followed by 1 of PPSV-23 after 1 year.
• Tetanus toxoid: One dose should be administered every 10 years.
• Zoster vaccine: One dose of zoster vaccine live should be administered after the age of 60 years.
• COVID-19 vaccine
18. Cardio- vascular System:
• Hypertension – Individualize medication (Start low; go slow), look for side effects
• Target: 140/90 (130/80 in CVD, DM)
• Drugs causing orthostatic hypotension should be avoided (α-adrenergic
antagonists [prazosin, terazosin], and high-dose diuretics)
• Drugs that cause cognitive dysfunction (clonidine) should also be avoided.
Do not combine ACEI and ARBs
• Prophylactic Aspirin not suggested unless past history of stroke/ MI.
19. Digestive System:
• Avoid use of NSAIDs as much as possible
• Avoid drugs causing Constipation (diuretics, anticholinergics, opiates and
antidepressants)
• Dietary Modification and counselling to avoid indigestion, APD
20. Nervous System:
• Dementia – Donepezil (side effects: loose stool, nausea) , Memantine (side
effects: Headache, constipation)
• Depression- Escitalopram, Fluoxetine
• Behavioural and psychological symptoms of dementia (BPSD): Start
quetiapine 25 mg once a day. Gradually increase to 25 mg twice daily.
21. Delirium
• In a patient of delirium always check for-
• 1. Infection
• 2. Electrolyte imbalance (Hypokalemia, Hypocalcemia, Hypomagnesiemia), Acidosis
• 3. Dehydration
• 4. constipation
• Hypoxia, Sleep Disorder
• Hypothermia
• Toxins
• Heavy metals
• Urinary /Fecal Retention
• Systemic organ failure
22. Renal System:
• Check RFT before prescribing ACEI, ARBs, prolonged use of NSAIDs
• Avoid drugs causing urinary incontinence. Urinary retention
• Drug with maximum cholinergic burden - Amitriptylline
23. Respiratory System:
• Pneumonia: OPD:Azithromycin, Inpatient: 3rd generation Cephalosporin
• TB: atypical presentation, look for adverse effects of drugs
(1 week of cough is adequate for diagnosis)
• COPD: Proper use of inhaler, proper inhaler techniques, ensure patient is
capable of taking inhaler, Foracort, Tiova superior to seroflo use)
24. RED FLAG SYMPTOMS:
• The medical officer should refer the older individual to an expert on observing the following red flag symptoms and signs:
• • haematemesis/malena
• • stool positive for occult blood
• • unexplained weight loss
• • unexplained loss of appetite
• • sensation of early satiety
• • persistent sensation of fullness of abdomen
• • persistent vomiting
• • appearance of jaundice
• • alteration in bowel habit for > 2 weeks • nocturnal diarrhoea • recurrent abdominal pain.
25. OLD AGE FEMALES
• Post- menopausal syndromes: hot flush, mood swings
• Urinary incontinence – Vaginal creams
• Screening for POPs and Malignancy
• PV Bleeding- suspicion of malignancy
26. What can we do in our Hospital
setting?
• Administration
• Helpers
• Lab Technicians
• Health Assistants
• Nursing Care
• Medical Officers
27. Take –Home Messages:
• Geriatric Care is a collective approach.
• ICOPE Screening helps to identify Geriatric problems
efficiently.
• Geriatric Health protection, prevention and promotion is
our prime focus.
