What is Geriatrics Geriatrics is the branch of medicine that focuses on health care of the elderly. It aims to promote health and to prevent and treat diseases and disabilities in older adults. Geriatrics was separated from internal medicine as a distinct entity in the same way that pediatrics is separated from adult internal medicine and neonatology is separated from pediatrics Gerontology Gerontology is the branch of biomedical sciences that studies aging. The term “geriatrics” is used to refer specifically to the medical study of diseases and problems of the elderly. Changes with ageing Skin Epidermis thinner and fragile Dermis less elastin and flexible Hypodermis thinner and less padding UV light accelerates skin ageing Senile purpura Eye Ptosis Dry eye Tearing Flatten & uneven cornea with light scattering Hyperopia (farsightedness) Smaller pupil requiring brighter light to read Slower dark adaptation Reduced contrast sensitivity Ear Reduced sweat glands with increased ear wax affecting hearing Cochlea degeneration causing high tone loss Kidneys Reduced ability to excrete water, waste products and drugs Less tolerate water depletion Loss of circulation rhythm with nocturia Smaller and less expansible bladder with frequency of urine Less contractable bladder with hesitancy Bigger prostate with fair urine stream Bone Continual loss of bone mass from the 4th decade Hormonal change with more bone resorption than formation Less Ca absorption Shorter and stoop Brittle with easy fracture New bone formation at the verge of joints Cartilage thinner Nervous system 30,000-50,000 neurons die each day with diminishing reserve IQ slowly decline after the age of 25 Reduced short term memory Decreases retrieval ability Interrupted and less deep sleep Reduced pain, touch, temperature, and vibration sensations Reduced postural control and balance heart Heart becomes more rigid with decreased output Heartbeat less responsive to stress Heartbeat less variable with each breathing Irregular heart beat more common with ageing Systolic blood pressure increases with age Pulse pressure widened with hardened vessels Less efficient venous return prone to postural hypotension Lungs Lungs become more rigid with early closure of small airways Less efficient blood gas exchange Chest wall becomes more rigid too Reduced lung volume and vital capacity Bronchial villi thinner and cough reflex less effective Reduced ability to cope with challenges like climbing stairs, running Reduced immunity prone to chest infection GIT Saliva glands secret less with dry mouth Taste and smell senses decline Less healthy teeth affecting chewing/nutrition Stomach muscle weakened and less hungry Small intestine villi absorb less calcium, vitamin B12, folic acid Large intestine muscle weakened and secrets less mucus prone to constipation Less liver blood flow and function with fall in toxic substance/drug clearance Bile thicker with cholesterol prone gallstone Diseases in old age Geriatri

1. Resource Person -
Prof. Satyen Bhattacharyya
Associate Professor : BIMLS, Bardhaman
8348050005 www.fitofine.in
Geriatric Physiotherapy

2. What is
Geriatrics
• Geriatrics is the branch of medicine
that focuses on health care of the
elderly. It aims to promote health
and to prevent and treat diseases
and disabilities in older adults.
• Geriatrics was separated from
internal medicine as a distinct entity
in the same way that pediatrics is
separated from adult internal
medicine and neonatology is
separated from pediatrics

3. Gerontology
• Gerontology is the branch of biomedical
sciences that studies aging. The term
“geriatrics” is used to refer specifically to
the medical study of diseases and
problems of the elderly.

4. Changes with ageing

5. Skin
• Epidermis thinner and fragile
• Dermis less elastin and
flexible
• Hypodermis thinner and less
padding
• UV light accelerates skin
ageing
• Senile purpura

6. Eye
• Ptosis
• Dry eye
• Tearing
• Flatten & uneven cornea with
light scattering
• Hyperopia (farsightedness)
• Smaller pupil requiring brighter
light to read
• Slower dark adaptation
• Reduced contrast sensitivity

7. Ear
• Reduced sweat glands with
increased ear wax affecting
hearing
• Cochlea degeneration causing
high tone loss

8. Kidneys
• Reduced ability to excrete water, waste products
and drugs
• Less tolerate water depletion
• Loss of circulation rhythm with nocturia
• Smaller and less expansible bladder with
frequency of urine
• Less contractable bladder with hesitancy
• Bigger prostate with fair urine stream

9. Bone
• Continual loss of bone mass from the 4th decade
• Hormonal change with more bone resorption than
formation
• Less Ca absorption
• Shorter and stoop
• Brittle with easy fracture
• New bone formation at the verge of joints
• Cartilage thinner

10. Nervous system
• 30,000-50,000 neurons die each day with diminishing
reserve
• IQ slowly decline after the age of 25
• Reduced short term memory
• Decreases retrieval ability
• Interrupted and less deep sleep
• Reduced pain, touch, temperature, and vibration
sensations
• Reduced postural control and balance

11. heart
• Heart becomes more rigid with decreased
output
• Heartbeat less responsive to stress
• Heartbeat less variable with each breathing
• Irregular heart beat more common with ageing
• Systolic blood pressure increases with age
• Pulse pressure widened with hardened vessels
• Less efficient venous return prone to postural
hypotension

12. Lungs
• Lungs become more rigid with early closure
of small airways
• Less efficient blood gas exchange
• Chest wall becomes more rigid too
• Reduced lung volume and vital capacity
• Bronchial villi thinner and cough reflex less
effective
• Reduced ability to cope with challenges like
climbing stairs, running
• Reduced immunity prone to chest infection

13. GIT
• Saliva glands secret less with dry mouth
• Taste and smell senses decline
• Less healthy teeth affecting chewing/nutrition
• Stomach muscle weakened and less hungry
• Small intestine villi absorb less calcium, vitamin B12, folic acid
• Large intestine muscle weakened and secrets less mucus prone
to constipation
• Less liver blood flow and function with fall in toxic
substance/drug clearance
• Bile thicker with cholesterol prone gallstone

14. Diseases in
old age

16. Geriatric
Physiotherapy
• Geriatric physiotherapy became a
specialty of physical therapy study in
1989. since then, physiotherapists have
worked to understand the problems of
the aging.
• There is a long list of problems dealt with
in geriatric physiotherapy

17. AGED PEOPLE PROBLEMS
• HEALTH PROBLEMS
• Joint problems
• Impairment of special senses
• Cardiovascular disease
• Hypothermia
• Cancer
• Prostate enlargement
• Diabetes
• Accidental falls
• Alzheimer’s
• Arthritis
• Balance disorder
• Incontinence
• Joint replacement
• Pulmonary disease
• Stroke
• Psychological problems
Emotional problems
Suicidal tendency
Senile dementi
Alzheimer’disease
• Social problems
Poverty
Loneliness
Dependency
Isolation
Elder abuse
Generation Gap

18. 3 major
roups
Deconditioning
Cardiovascular disease
Musculoskeletal
problems

19. Deconditioning
• Problems that happen because
the patient simply does not use
their limbs. These problems can
be addressed by reconditioning
through range of motion and
other exercises

20. Cardiovascular
disease
• Exercise
• Aqua therapy
• Electrical stimulation etc

21. Musculoskeletal
problems
• Such as osteoporosis and
osteoarthritis
• These problems require special
attention as osteoporosis makes
patients frailer, and
osteoarthritis is very painfull

22. fall
• Very common
• Physio increase the
balances and muscle
power

23. Risk factor
of AGED
PRONE FOR INFECTIONS
PRONE FOR INJURIES
NEED SPECIAL ASSISTANCE
PRONE FOR PSYCHOLOGICAL PROBLEMS
PRONE FOR DEGENERATIVE DISORDERS
INCREASED RISK FOR DISEASE
INCREASED RISK OF DISABILITY
INCRASED RISK OF DEATH

24. AIM OF
GERIATRIC
MEDICINE
• Maintenance of health in old age by
high levels of engagement and
avoidance of disease
• Early detection and appropriate
treatment of disease
• Maintenance of maximum
independence consistent with
irreversible disease and disability
• Sympathetic care and support during
terminal illness

25. GERIATRIC
TEAM
Geriatricians
Nurses
Physiotherapist
Social worker
And Health worker

26. PREVENTION
• Primordial prevention
• Pre geriatric care
• Primary prevention
• Health education
• Exercise
• Secondary prevention
• Annual medical check-up
• Early detection ( Universal approach, Selective approach)
• Treatment
• Tertiary prevention
• Counseling and Rehabilitation
• Welfare activities (Sanjay Niradhar Yojana, Vridhashrama)
• Chiropody services
• Improving quality of life
• Cultural programme
• Old age club
• Meals-on wheel service
• Home help
• Old age home

27. What exercise do after age of
50
• Improves oxygen utilization
• Nutrients to muscles
• Transfer of oxygen from the red blood cells to muscle
cells
• Number of mitochondria increases, enhancing aerobic
metabolism
• Improved coronary blood flow
• Stroke volume increases

28. • Raising levels of high-density lipoprotein
cholesterol, the 'cardioprotective' lipid, and
lowering levels of low density lipoprotein
cholesterol
• Exercise lowers blood pressure and reduces obesity
• A combination of these two factors, in addition to
the reduction in cholesterol, decreases the risk of
ischemic heart disease.
• Improve exercise tolerance in older people with
COPD
• Aerobic fitness

29. • Help in diabetes by decreasing
insulin resistance
• Increase bone mass in high
impact activities
• Joint mobility & muscle
strength for osteoarthritis
• Sleep
• Mood

30. Risk
• Sedentary
• Co-morbidity
• Chronic disease

31. How to judge
• myocardial infarction within six
months
• angina or physical signs and
symptoms of congestive heart
failure
• resting systolic blood pressure of
200 mmHg or higher
• A functional test of cardiac capacity
is to ask the patient to walk 15 m (50
ft) or climb a flight of stairs
• ECG

33. Inactive older
people
• Goal is to reduce time spent
of sitting
• Use stairs instead of elevators
• Brisk walk for shorter time &
distance but with several
times in a day
• Functional exercises

34. Generally active
older people
• Aerobic exercises or resistance training
• Aerobic exercises like cycling
(stationary), brisk walking, swimming &
water aquatics
• Add 5 to 10 minutes of warm up & 15
minutes of cool down
• Stretching
• Weight exercises, with less intensity
• Resistance exercises if permits

36. Drugs for
Hypertension
(treated with
ACE inhibitors,
angiotensin 2
receptor
blockers)
Lower peripheral resistance
Exercise related dehydration
Hypotension
Dizziness

37. Angina, tremor,
migrain
(treated with
beta-blockers)
• Prescribed generally
after MI
• Decrease the cardiac
rate
• Older athletes who are
taking, beta-blockers
will have a restricted
exercise capacity,
particularly in
endurance events.
Side effects
• postural hypotension
• Asthma
• excessive tiredness
• Impotence
• hyperkalemia
• lethargy

38. Diuretics
Used in Hypertension & heart failure
May have dehydration in hot climate
as there is more urine output
Side-effects
postural hypotension, light-
headedness or fainting.

39. Prevention
Prevention includes maintaining
adequate hydration and
avoiding standing still
immediately after exertion
Take diuretics after exercise
session, not before that

40. NSAIDs
• Serious side-effects of these
medications include hypertension,
fluid retention and the development
of peptic ulceration
• Can disturb renal function & cardiac
function
• Prevention
• Don’t exert after taking NSAIDs

41. CNS drug
• Benzodiazepines
• nitrazepam and diazepam
• Oxazepam
• temazepam and lorazepam
Effects:
fine motor skills
coordination and reaction time
Thermoregulation
This may lead to an increased risk of injury, especially in
contact sports.
Prevention
Often, people who commence exercise can
reduce their need for these medications.

42. Insulin and oral
hypoglycemic
drugs
• The dosages of insulin and the oral hypoglycemic
drugs may need to be reduced prior to exercise to
avoid hypoglycemia

43. Free hand
exercises

48. Relaxing by
self rubbing

51. Balancing
Exercise

61. Stabilization Exercise

68. Strengthening Exercise, using
own body weight

87. Refrence:
• Clinical Sports Medicine by Karim Khan and Peter Brukner
• Applied Exercise and Sport Physiology, With Labs
• Geriatric Physiotherapy
Photo credit:
• Souvik Samanta
• Dr. Argha Sadhu

88. www.fitofine.in