Health problems of the aged

1. SOCIAL GERIATRICS:
Problems of the Aged and
Identification of
Predisposing Factors
DR. OSAHON OTAIGBE
Department of Community Medicine
Irrua Specialist Teaching Hospital
13th January 2020

2. Outline
• Definition of terms
• Introduction
• Problems of the aged
• Global response
• Healthy ageing
• Case study
• The ICOPE package of tools
• Awareness days
• Individual response
• Breaking limits
• References
2

3. Definition of terms…1
•Geriatrics –The branch of medicine
specializing in the health and illnesses of
older age and their appropriate care and
services
•Gerontology –The study of the social,
psychological and biological aspects of
ageing
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4. •Healthy ageing –The process of developing
and maintaining the functional ability that
enables well-being in older age
•Functional ability –The health-related
attributes that enable people to be and to
do what they have reason to value
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Definition of terms…2

5. •Intrinsic capacity –The composite of all
the physical and mental capacities of an
individual
•Ageism –The stereotyping and
discrimination against individuals or
groups on the basis of their age
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Definition of terms…3

6. •Long-term care –The activities undertaken
by others to ensure that people with or at
risk of a significant ongoing loss of intrinsic
capacity can maintain a level of functional
ability consistent with their basic rights,
fundamental freedoms and human dignity.
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Definition of terms…4

7. Introduction…1
•People worldwide are living longer. Most
people today can expect to live into their
sixties and beyond.
•By 2050, the world’s population aged 60
years and older is expected to total 2 billion,
up from 900 million in 2015. (WHO, 2015)
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8. •With longer life comes opportunities as
well as problems.
•This presentation will highlight the
problems of the aged, the predisposing
factors and how these problems can be
managed.
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Introduction…2

9. Who is an older person?
•No general agreement
•Chronological age/biological age vs sociocultural
markers
•WHO: ≥ 65 years
•UN: ≥ 60 years
•Developed countries vs less developed countries
•Eligibility for retirement pensions
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10. Demography –The Global Picture
•Between 2015 and 2050, the proportion of the
world’s population over 60 years will nearly
double from 12% to 22%. (UN, 2017)
•By 2020, the number of people aged 60 years and
older will outnumber children younger than 5
years. (WHO, 2015)
•By 2050, one in every five persons will be 60
years of age or older (WHO, 2015)
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11. Demography –The Nigerian Picture
•According to the 2006 census, there are
6,987,047 older persons ≥ 60 years (4.98% of
total population).
•This is projected to rise to 6% in 2025 and 9.9% in
2050, representing a doubling within 45 years.
•The 2018 NDHS estimates that 3.9% are in the 65
and above dependency age group. (NPC and ICF,
2019)
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12. Different classifications exist
•Health problems
➢Medical problems
➢Psychiatric/psychological problems
•Social problems
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Problems of the aged

13. •Biologically, ageing is associated with the
gradual accumulation of a wide variety of
molecular and cellular damage
•Over time, this damage leads to
➢a gradual decrease in physiological reserves,
➢an increased risk of many diseases, and
➢a general decline in the capacity of the individual
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Health problems

14. • Senile cataract (from denaturation of lens protein)
• Arcus senilis – corneal clouding
• Presbyopia – loss of accommodation
• Ptosis
• Glaucoma
• Blindness
• Presbycusis – degeneration of cochlear hair cells
• Nerve deafness
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Eye/Ear

15. •Loss of teeth
•Gum diseases
•Poorly fitted dentures
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Dental

16. •Osteoporosis
•Osteoarthritis
•Rheumatoid athritis
•Pathological fractures
•Myositis
•Fibrositis
•Spondilitis
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Musculoskeletal system

17. •Impaired cognition and behavior
•Alzheimer’s disease and other dementias
•Parkinson’s disease
•Bradykinesia
•Impaired thermoregulation
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Central nervous system

18. •Hypertension
•Atherosclerosis
•Cardiac failure
•Ischemic heart disease
•Cardiomyopathies
•Strokes
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Cardiovascular system

19. •Reduced cough reflex and ciliary action
giving rise to RTIs
•Reduced lung elasticity giving rise to
COPD and asthma
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Respiratory system

20. •Wrinkling
•Scaly dermatosis
•Alopecia
•Brittleness of fingernails
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Skin and its appendages

21. •Peptic ulcer
•Constipation
•Ulcerative colitis
•Nutritional deficiency states
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Gastrointestinal system

22. •Urinary incontinence
•Faecal incontinence
•Urinary tract infection
•Prostatic hyperplasia
•Uterovaginal prolapse
•Atrophic vaginitis
•Ca cervix
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Genitourinary system

23. •Alzheimer’s disease
•Depression
•Anxiety
•Delirium
•Suicide and deliberate self harm
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Psychiatric problems

24. Geriatric giants (6Is)
•Instability: Falls, gait problems, CNS problems
•Immobility: Arthritis
•Iatrogenia: Polypharmacy/ADRs
•Intellectual impairment: Cognitive impairment
•Incontinence: Urinary, faecal and dual incontinence
•Infection: UTI, pneumonia, skin infections, GIT
infections, septicaemia
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25. Social problems…1
•Elder Abuse
•Unemployment
•Poverty
•Loneliness
•Accommodation problems
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26. Social problems…2
•Insecurity
•Loss of status
•Loss of friends
•Prejudice, stereotyping and
discrimination
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27. Elder abuse…1
•Elder abuse is a single or repeated act, or
lack of appropriate action, occurring
within any relationship where there is an
expectation of trust, which causes harm
or distress to an older person. (WHO,
2018)
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28. •It can be:
➢Physical abuse
➢Psychological/emotional abuse
➢Financial abuse
➢Sexual abuse
➢Neglect
•Each type may be intentional or unintentional; it can
occur at home or in institutions
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Elder abuse…2

29. Risk factors…1
Victim risk factors
•Poor physical and mental health
•Gender: female
•Age: increased risk in those > 74 years
•Significant disability
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30. Victim risk factors contd.
•Social isolation
•Low socioeconomic status
•Financial dependence
•Living alone with abuser
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Risk factors…2

31. Risk factors…3
Abuser risk factors
•Mental disorders
•Substance abuse
•Dependence on the abused
•Living alone with victim
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32. Family/Societal risk factors
•Long history of poor family relationships
•Ageist stereotypes
•Cultural norms
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Risk factors…4

33. Institutional risk factors
•Poorly trained staff
•Poorly motivated staff
•Low standards for health care
•Deficient physical environment
•Policies operating in the interest of the
institution rather than the residents
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Risk factors…5

34. 34

35. Global response to problems of the
aged…1
•International legal and policy frameworks
➢International human rights law (UN, 1966)
➢The Madrid international plan of action
on ageing (UN, 2002)
➢Active ageing concept (WHO, 2002)
➢Healthy ageing concept (WHO, 2016)
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36. •The new global focus for health care in
older age is on healthy ageing
•Healthy ageing aims to optimize people’s
intrinsic capacity and functional ability as
they age.
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Global response to problems of the
aged…2

37. Fig 1: A public health framework for healthy ageing: opportunities for
public health action across the life course 37

38. Healthy ageing
•Health systems should be designed to
encourage healthy ageing.
➢Adapting interventions to individuals and
their levels of capacity
➢Implement older-person-centred and
integrated care
➢Align health systems
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39. Age-friendly health systems…1
•Age-friendly hospitals built with the elderly
in mind e.g. elevators, ramps, suitable stairs
with hand railings, non-slip flooring, rest
areas with comfortable seats, signs that are
large, clear and well lit.
•Geriatric services
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40. •A workforce transformed to respond to
the needs of the aged
➢Changes in preservice training
➢Training and retraining of health workers
➢Multidisciplinary teams
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Age-friendly health systems…2

41. •Ensuring access to appropriate medical products,
vaccines and technologies
•Addressing the problem of polypharmacy
•Readjustment of essential medicines list
•Availability and affordability of assistive devices
•Advanced technologies e.g. wearable devices,
robotic assistance, virtual social networks etc
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Age-friendly health systems…3

42. •Policy reforms
•Health-financing policies in line with
universal health coverage
•Evolution of formal long-term care services
designed in a way that facilitates older
people’s autonomy and dignity and also
maintains their social networks
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Age-friendly health systems…4

43. Addressing the social problems…1
Financial security
•Pensions, assets, social safety net
•Social protection is a fundamental human right.
•Reliance on social protection should not be
stigmatizing
•Example – social pension in Chile, universal
pension in Namibia
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44. Housing problems
•Market-driven housing
•Social housing schemes
•Assisted-living facilities
•Continuing-care communities
•Shared-living arrangements
•Family
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Addressing the social problems…2

45. •The United Nations’ Convention on the
rights of persons with disabilities and
optional protocol recognizes the equal right
of all persons with disabilities to live in their
community, to choose where and with
whom they want to live, and to not be
obliged to reside in a particular living
arrangement. (UN, 2006)
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Addressing the social problems…3

46. •Home modifications
➢Physical accessibility e.g. removing obstacles
, providing mobility and safety aides (such as
grab bars in showers and near toilets)
➢Comfort
➢Safety e.g. nonslip flooring in bathrooms
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Addressing the social problems…4

47. Elder abuse
•Multidisciplinary teams
•Helplines
•Monitoring of bank use
•Support for caregivers – training, information,
respite care
•Emergency shelter for victims
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Addressing the social problems…5

48. Elder abuse
•Professional awareness campaigns
•Residential care policies to define and
improve standards of care
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Addressing the social problems…6

49. Loneliness and social isolation
•Identification of those at risk e.g. those recently
bereaved or recently retired
•Create opportunities for meaningful social roles
and reciprocal relationships e.g. Experience
Corps in USA
•Improve access to information and
communication technologies
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Addressing the social problems…7

50. Loss of status/social roles (ability to contribute)
•Volunteering
•Challenge ageism and create inclusive
environments that embrace age diversity
•Abolish mandatory retirement ages
•Support gradual retirement options and flexible
work arrangements
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Addressing the social problems…8

51. •Consider incentives that encourage
employers to retain, train, hire, protect
and reward older workers
•Help older adults plan for the second half
of life and invest in lifelong learning
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Addressing the social problems…9

52. Key requirements for healthy ageing
•A change in the way we think about ageing
and older people
•Creation of age-friendly environments
•Alignment of health systems to the needs of
older people
•Development of systems for long-term care
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53. Case Study: AgeWell Programme,
CapeTown, South Africa…1
•A pilot project to develop community based
peer-to-peer support in CapeTown, South
Africa
•In Khayelitsha – South Africa’s largest
township and one of the poorest areas of
CapeTown – 28 older community members
were trained as peer supporters.
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54. Case Study: AgeWell Programme,
CapeTown, South Africa…2
•Working in pairs, they made home visits
to 211 older people in their community.
•The visits aimed to foster companionship
and social support, and generate a sense
of community; they were also used to
identify health and social needs.
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55. Case Study: AgeWell Programme,
CapeTown, South Africa…3
•Where needs were identified, older people
were referred to health-care providers or
social services.
•Referrals were generated using a
smartphone loaded with a screening
instrument that included basic questions in
addition to the observations made by the
peer supporters during the home visit
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56. •A study assessed the benefits of this pilot
project and found multiple benefits (Besser
and Rohde, 2015)
•Older people who received home visits
showed significant improvements
•Older people’s ability to meet their basic
needs was enhanced
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Case Study: AgeWell Programme,
CapeTown, South Africa…4

57. •Peer supporters’ abilities to learn, grow and
make decisions were enhanced
•Older people’s abilities to build and maintain
relationships were strengthened
•Older people’s ability to contribute to their
communities was enhanced
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Case Study: AgeWell Programme,
CapeTown, South Africa…5

58. The ICOPE package of tools…1
•Integrated Care for Older People
•Launched on the International Day of
Older Persons 1 October 2019
•Purpose – to help health care and social
workers provide better care and support
for older people
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59. •It provides evidence-based guidance on
interventions to manage common
declines in capacity in older age
•Recommendations were made based on
appraisal and synthesis of available best
evidence.
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The ICOPE package of tools…2

60. •Recommendations were made in 3 major
areas
➢Declining physical and mental capacities
➢Geriatric syndromes associated with care
dependency
➢Caregiver support
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The ICOPE package of tools…3

61. 61
Fig 2: ICOPE recommendations for declining physical and mental capacities

62. 62
Fig 3: ICOPE recommendations for declining physical and mental capacities

63. Awareness days for the elderly
•World Elder Abuse Awareness Day – June
15
•International Day for Older Persons –
October 1
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64. 64
Fig 4: World Elder Abuse Awareness Day

65. 65
Fig 5: International Day of Older Persons

66. The decade of healthy ageing (2020
– 2030)…1
•An opportunity for ten years of global
concerted, catalytic and collaborative
action to improve the lives of older
people, their families, and the
communities in which they live.
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67. •The proposal for the decade shall be
discussed byWHO’s Executive Board at
their 147th meeting to be held in Geneva
in February 2020.
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The decade of healthy ageing (2020
– 2030)…2

68. Individual response…1
•Adopt a healthy lifestyle
➢Be physically active
➢Eat a healthy diet
➢Avoid the harmful use of alcohol
➢Avoid smoking or using tobacco products
➢Have a positive outlook
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69. •The earlier people adopt these
behaviours, the better their chances of
enjoying a healthy old age.
•“If I knew I was going to live this long, I’d
have taken better care of myself.” Mickey
Mantle
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Individual response…2

70. “Good health adds life to years”
(World health day 2012 slogan)
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71. Breaking limits
On 16 October 2011, Fauja Singh became
the first 100 year old to complete a
marathon
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72. 72
Fig 6: Fauja Singh

73. “My face is old but my heart is young.”
Johanna Quaas, a 94 year old gymnast
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74. 74
Fig 7: Johanna Quaas

75. Kimani Nganga Maruge – a Kenyan,
started primary school at 84 years
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76. 76
Fig 8: Kimani Nganga Maruge

77. •“Once I step into that boxing ring at the
young age of 63, win, lose or draw, I
would make history as the oldest boxer
to fight and defend his title.”
•Bashiru LawrenceAli (aka BashAli)
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78. 78
Fig 9: Bash Ali

79. Conclusion
•There are myriads of problems that come
with ageing.
•The problems as well as the solutions are
complex and demand a paradigm shift
that looks at old age as a privilege rather
than a predicament.
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80. References
• Besser M and Rohde S, 2015. World Health Organization, Kobe Centre; Case study in South Africa:
AgeWell, a peer-support service in a community setting to improve well-being and health among
older persons living in a peri-urban township of CapeTown.
• National Population Commission (NPC) [Nigeria] and ICF, 2019. Nigeria Demographic and Health
Survey 2018. Abuja, Nigeria, and Rockville, Maryland, USA: NPC and ICF.
• United Nations, 2006. Convention on the Rights of Persons with Disabilities and Optional Protocol.
NewYork: United Nations available at http://www.un.org/development/desa/disabilities/convention-
on-the-rights-of-persons-with-disabilities [accessed 12 January 2020).
• United Nations, 2017. Department of Economic and Social Affairs.World Population Ageing 2017:
Highlights. NewYork: United Nations available at
http://www.un.org/en/development/desa/population/publications/pdf/ageing/WPA2017_Highlights.p
df [accessed 2 January 2020).
• World Health Organization, 2015. World report on ageing and health. Geneva: World Health
Organization available at https://apps.who.int/iris/handle/10665/186463 [accessed 2 January 2020]
• World Health Organization, 2018. Elder abuse fact sheets available at https://www.who.int/news-
room/fact-sheets/detail/elder-abuse [accessed 12 January 2020]
80

81. Thanks for listening!