The percentage of elderly people is increasing worldwide. We ought to prepare the health infrastructure to accommodate this group of the population

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The Elderly:
The Future Impact
Prof Faisal AbdulLatif Alnasir
FPC, MICGP, FRCGP, FFPH, PhD
Chairman; Family & Community Medicine Dept
Arabian Gulf University, Bahrain
President; Scientific Council Family & Com. Medicine
Arab Board for Health Specialties
28-2-2014

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The world is turning grey.
WHO

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•Anybody who reach 60 years
WHO
Who is Old?

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•Young Old 60-69 years
•Middle Old 70-79 years
•Old Old <80 years
Who is Old?

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‫األربعين‬ ‫سن‬ ‫في‬ ‫اإلنسان‬ ‫إن‬‫طفل‬
‫الخمسين‬ ‫سن‬ ‫وفي‬‫مراهق‬
‫الستين‬ ‫سن‬ ‫وفي‬‫شاب‬
‫السبعين‬ ‫سن‬ ‫وفي‬‫خضراء‬ ‫وجنة‬ ‫مخضرم‬ ‫شيخ‬
Who is Old?

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Forecast to 2050
Growth 223% by 2025
1.2 Billion in 2025
2 Billion in 2050 >60 years

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• Poor raw material (resources)
• Prevailing poverty
• Lack of national strategies
• Fast ageing in parallel with rapid social changes
– urban vs. rural ageing
– changes in family structure
The reality in the developing world

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Feminization of ageing
Developed countries:
678 men for every 1000 women
Developing Countries:
869 men for every 1000 women
WHO, 2002

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Feminization of ageing
Older women more disabled and poor

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U.S.A.
in 1970: 9.9%
MAXICO
in 1970: 6%
BAHRAIN
in 1981 : 3.9%, 2000: 5.8%, 2050: 25%

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26. 0
10
20
30
40
50
60
70
80
90
100
1860 1880 1900 1920 1940 1960 1970
Age
Percent
Under 20 20-44 45-64 65&Over
51.2%35.7%10.4%
USA Population Trend since 1860
2.7% 3.4% 4.1% 4.7% 6.8% 9.2% 9.9%
48.1%35.9%12.6%
44.4%37.8%13.7%
40.8%38.9%16.1%
34.4%38.9%19.8%
38.5%32.3%20.2%
37.8%31.7%20.6%

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Population Pyramid
Kingdom of Bahrain
For the years 1950-2000-2050
1950 2000 2050
60+
0-59
Male Female
Age

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* IS IT A PROBLEM IN BAHRAIN & GCC?
* WHY?
-MODERNIZATION !!!!
-NUCLEAR FAMILIES
-SMALLER HOUSES
-NO FAMILY SUPPORT
-COUPLE EMPLOYMENT
-STRESS
FA Alnasir

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The developed world became
rich before it became old.
Developing countries are
becoming old
before they become rich.
WHO

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Economical pressure and social demands

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End of Life
Ageing is good for you – remember: there is
only one alternative to it!
Death

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End of Life
Ageing is good for you – remember: there is
only one alternative to it!
Death!!!

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Every person is different, and
the paths to death will vary.

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Ageing is not a disease.
“Anderson, 1981”

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Ageism
Definition: even among good social classes
 Internal changes in the body of all living kinds.
 The process which changes a healthy individual
into a fragile one.
 Continuous changes in different organs’ functions.
Coni etal.

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Ageing is a complex biological process
leading to;
- decrease cell abilities for auto repair.
- continuous cell death.
- decrease body immunity.
- disturbance in homeostasis.

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When does ageing starts?

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How does it happens
 Biological clock
 No way for measuring ageing

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Facts
Fact (1)
Physiological changes due ageing are common
among mammals (e.g. hair whitening, decrease
immunity) but severity differs from one mammal
to other
e.g.;
-Rodents Renal failure
-Humans CNS atrophy “Alzheimer”
“Coni, N.elal”

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Fact (2)
- Ageing is controlled by genetic factors no way
of measuring it.
- But MLP (Maximum life Span) can help.
e.g.;
- 3 to 5 yeas in rodents
- 115 years in human
“Social trends, 1982”

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Facts (3)
Decreases calorie intake helps in delaying
ageism.
“Christianser and Grzgowski, 1993”

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Can we prevent ageing?

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NOBODY CAN PREVENT A PERSON FROM
GETTING OLD.
BUT IT IS POSSIBLE THAT DISABILITIES
COULD BE DETECTED MUCH EARLIER AND
ATTENTION IS GIVEN TO IT MAKING
SURE THAT IT DOES NOT PROGRESS.
Can we prevent ageing?

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Level of activity declines with increase age and
the prevalence of disability increases with age.
“Mastin GM, etal 1996

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Elderly relate most of their problems to ageing
process so do not complain. Therefore there is
an accumulative process of complication
happening leading to worsening of disabilities.
“Williamson, 1996”

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Studies have shown that the risk of
death after the age of 30 years
doubles every 8 years

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Common problems among the
elderly:
1- Mobility.
2- Changes in body physiology (drugs, illness).
3- Decrease in mental abilities.
4- Incontinence.
5- Risk of storks.
6- Psychological problems.
“Barber, JH 1984”

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‫الرحيم‬ ‫الرحمن‬ ‫هللا‬ ‫بسم‬
"‫ضعف‬ ‫من‬ ‫خلقكم‬ ‫الذي‬ ‫وهللا‬‫م‬ َ‫ل‬َ‫ع‬ َ‫ج‬ َّ‫م‬
ُ
‫ث‬‫د‬ْ‫ع‬َ‫ب‬ ْ‫ن‬
ْ‫ع‬َ‫ب‬ ْ‫ن‬‫م‬ َ‫ل‬َ‫ع‬ َ‫ج‬ َّ‫م‬
ُ
‫ث‬
ً
‫ة‬َّ‫و‬
ُ
‫ق‬ ٍ‫ف‬ْ‫ع‬
َ
‫ض‬ْ‫ي‬
َ
‫ش‬َ‫و‬‫ا‬
ً
‫ف‬ْ‫ع‬
َ
‫ض‬ ٍ‫ة‬َّ‫و‬
ُ
‫ق‬ ‫د‬
ً
‫ة‬َ‫ب‬‫يخلق‬
‫القدير‬ ‫العليم‬‫وهو‬ ‫يشاء‬‫ما‬"
‫م‬‫و‬‫الر‬‫ة‬‫ر‬‫سو‬

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Physical Changes
As age increases, changes occur in the
behaviors, appearance, physical and
mental abilities.

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BIOLOGICAL CHANGES IN THE ELDERLY
Fibroblast
Collagen
Elastic Fibers -- Stiffness

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BIOLOGICAL CHANGES IN THE ELDERLY
Fibroblast
Collagen
Elastic Fibers -- Stiffness
Differentiate between mutton and beef!

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1- Eye
2- Ear
3-Taste
4-BMR (Internal metabolism)
5-Cardiovascular system
“Reubin A, etal 1985”
‫ترجمان‬ ‫إلى‬ ‫سمعي‬ ‫أحوجت‬ ‫قد‬ ‫حزمتها‬ ‫وقد‬ ‫الثمانون‬ ‫أن‬

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6- Respiratory system “Kitzman Dw, etal 1988”
7- Renal System (Kidney function less by 50%
at 80 years) “Campbell, lefrak,1987”
8- Nervous system (Brain Smaller by 10% at
80 years)
9- Body temperature (Temp centers, Sweat
glands)

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10- Sleeping: up to 45%.
30% of causes of Insomnia are due
to depression but cold, uncomfortable
bed, pain, diseases, noise, stimulant
drinks (coffee,tea) play a role.

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10- Sleeping: up to 45%.
30% of causes of Insomnia are due
to depression but cold, uncomfortable
bed, pain, diseases, noise, stimulant
drinks (coffee, tea) play a role.

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‫طالب‬ ‫أبي‬ ‫بن‬‫علي‬‫اإلمام‬ ‫قال‬(‫السالم‬ ‫عليه‬):
”‫املضج‬ ‫في‬‫ق‬‫أر‬ ‫الستين‬ ‫أحدكم‬ ‫بلغ‬ ‫إذا‬‫ونام‬ ‫ع‬
‫وجع‬‫بال‬ ‫وأن‬ ‫املجمع‬ ‫في‬“

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11- Sign and symptoms of illnesses
Although pain may be a major complaint
of old people, pain sensation is altered
e.g. in fracture pelvis what patient complains of
is inability to move.
“Pathy, 1967”
12- Cancer
13- Brain function; Acute Or Chronic
(Dementia 5-10% over 65 years of age).
14- Mobility
15- Immunity

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16-Disabilities.
Difficulty in moving around leads to difficulty
in becoming independent.
Each elderly has 3.4 disabilities of which 50%
were not known to their GP (which were
amenable to some sortie of action).
“Isac, 1971”
30% of women are prone to fall at 65-69 years
This increases to 50% after 80 years of age.
All could lead to disabilities.

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17- Osteoporosis.
18- Giddiness.
19- Incontinence.
20- Homeostasis (Temp, BP)
21- Psychological system.

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‫الرحيم‬ ‫الرحمن‬ ‫هللا‬ ‫بسم‬
”‫أ‬،‫الخلق‬ ‫في‬ ‫ننكسه‬ ‫نعمره‬ ‫ومن‬‫فال‬
‫ن‬‫يعقلو‬“
‫العظيم‬ ‫هللا‬ ‫صدق‬
(‫ة‬‫ر‬‫سو‬‫ياسين‬–‫اآلية‬68)

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Active ageing

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Please Help

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The process of optimizing opportunities
for health, participation and security in
order to enhance quality of life as
people age.
WHO in 1990
Active Ageing

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Active Ageing Vs Healthy ageing
Active Ageing

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•Independence
•Participation
•Dignity
•Self-fulfillment
United Nation
Active Ageing

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Need based Vs right Based
Active Ageing

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It is a life long process
Active Ageing

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•Antenatal care
•Growth and development in child hood
•Healthy life style in adult life
•Independencies in older ages
Active Ageing

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•Physical environment
•Economic equity
•Education
•Health and social Services
•Cultural attitudes
•Gender equality
Active Ageing

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•We are late
•Immediate action
Active Ageing

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SERVICES
1- HOME VISIT: CLEANING, WASHING,
PERSONAL TOILET, CARE OF
MEDICATION
2- MEAL ON WHEELS
3- VISITING SERVICES
4- SOCIAL AIDS

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5-LAUNDRY
6-NIGHT WATCH SERVICES
7-DAY CENTRE & CLUB
8-DOMICILIARY VISITS
9-BENEFITS: PERSONAL ALLOWANCES
HOT FOOD,CLOTHING,TICKETS
SERVICES

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10-HOBBIES & CRAFTS CENTERS
11-CHIROPODY SERVICES
12-HOSPICE
13-CLINICS
14-PRE-RETIREMENT TRAINING COURSES
15-RETIRED EMPLOYEE’S ASSOCIATION
16-REMPLOYMENT BUREAUS: VOLUNTARY
SERVICES

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>> At Age 4........... Success is.......not peeing in your pants.
>>
>> At Age 6............Success is.......finding your way home (from school).
>>
>> At Age 12...........Success is........having friends
>>
>> At Age 18...........Success is........having a driver's license
>>
>> At Age 20...........Success is........having sex
>>
>> At Age 35...........Success is........having money
>>
>> At Age 45...........Success is........having money
>>
>> At Age 55...........Success is........having money
>>
>> At Age 60...........Success is........having sex
>>
>> At Age 65...........Success is........keeping a driver's license
>>
>> At Age 70...........Success is........having friends
>>
>> At Age 75...........Success is........finding your way home (from anywhere)
>>
>> At Age 80...........Success is.......not peeing in your pants

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Growing Old Matthew Arnold
What is it to grow old?
Is it to lose the glory of the form,
The luster of the eye?
Is it for beauty to forego her wreath?
Yes, but not for this alone.
Is it to feel our strength
Not our bloom only, but our strength decay?
Is it to feel each limb
Grow stiffer, every function less exact,
Each nerve more weakly strung?
Yes, this, and more! but not,
Ah, 'tis not what in youth we dreamed 'would be!
It is not to have our life
Mellowed and softened as with sunset-glow,
A golden day's decline!

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it is not to see the world
As from a height, with rapt prophetic eyes,
And heart profoundly stirred;
And weep, and feel the fullness of the past,
The years that are no more!
It is to suffer this,
And feel but half, and feebly, what we feel:
Deep in our hidden heart
Festers the dull remembrance of a change,
But no emotion none.
It is last stage of all
When we are frozen up within, and quite
The phantom of ourselves,
To hear the world applaud the hollow ghost
Which blamed the living man.
Growing Old
Matthew Arnold

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‫حزمتها‬ ‫وقد‬ ‫الثمانون‬ ‫أن‬‫ترجمان‬ ‫إلى‬ ‫سمعي‬ ‫أحوجت‬ ‫قد‬

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‫وأنت‬ ‫تكون‬ ‫ان‬ ‫اترجو‬‫شيخ‬‫الشباب‬ ‫ايام‬ ‫كنت‬ ‫قد‬ ‫كما‬
‫ثوب‬ ‫ليس‬ ‫نفسك‬ ‫كذبتك‬ ‫لقد‬‫دريس‬‫الثياب‬ ‫من‬ ‫كالجديد‬
‫الجاحظ‬ ‫بحر‬ ‫بن‬ ‫عمرو‬

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‫ايامه‬ ‫مضت‬ ‫فقد‬ ‫الشباب‬ ‫اما‬‫زما‬ ‫الغداة‬ ‫كفي‬ ‫من‬ ‫واستل‬‫مه‬
‫وتغيرت‬ ‫آياته‬ ‫وتنكرت‬‫آطامه‬ ‫وتقوضت‬ ‫جاراته‬
‫حياته‬ ‫الشباب‬ ‫في‬ ‫من‬ ‫درى‬ ‫ولقد‬‫حمام‬ ‫عاله‬ ‫اذا‬ ‫المشيب‬ ‫ان‬‫ه‬
‫المرتضى‬ ‫الشريف‬‫الحسين‬ ‫بن‬ ‫علي‬

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Thank you