this file is a part of my work in promotion in faculty of mediicne ain shams University. the promotion to associated professor.

1. Challenges to Geriatric Care in
Egypt 2010
Dr.Khaled Mahmoud Abd Elaziz
Lecturer of public health and preventive
medicine, Faculty of Medicine, Ain
Shams University up to 2009

2.  A mention of the mercy of your Lord
towards His servant Zechariah. When he
called on his Lord, a call in seclusion.
 He said, “My Lord, my bones have become
feeble, and my hair is aflame with gray, and
never, Lord, have I been disappointed in my
prayer to you. (19: 2-4)
Quran (Surat Maryam)

3. Such an elderly person is blessed with insight,
experience, and wisdom and he is looked up
to with reverence for guidance and counseling.
For more insight how Islam handles aging in
Quran please follow the link in this slide
DOI: https://doi.org/10.1007/978-3-319-69892-
2_148-1

4. Prevalence of the elderly in Egypt 2010
The Egyptian national census has shown increased
Prevalence of old age where the prevalence
increased from 5.1% in 1950 to 6.3% in 2006,
and it is expected to reach 11.5% in 2025 and to
increase to 20.8% in 2050. By that time 20 million
Egyptians will be categorized as elderly.

5. Prevalence of the elderly in Egypt
Elderly people 60 years and above expected
to reach 8.9% in 2016 and 10.9% in 2026.
-The life expectancy has risen in Egypt from
62.9 years to around 69.2 years in males
and 73.6 in females (71.4)
-Demographic transition (graying nations)
low rates of fertility and mortality

6. 7 millions Egyptian are above 60 years of age
(united nations report 2005)

7. Why it is a challenge (Geriatric care)
-Increase in the population of elder persons expected to be
14 millions in the all Arabic countries by year 2010
-Significant gains of life expectancy in Arab world now
average around 73 years.
-Old age dependency ratio is expected to reach 8% by
2025 and 13% by year 2050
-Shift of the workforce from support of children to
support of elderly population
-As regards policy level most Arab countries in the united
nations report determined the level of concern about
population aging policies to be “minor” except for Iraq.

8. Challenges to geriatric care include
Handling chronic conditions
Ethical issues (abuse and neglect)
Mental health challenges
Cognitive function
Health care services:
Curative, health promotion, supportive care, Long
term care
Challenges in Emergency medicine
Community services

9. Chronic conditions in elderly population
Most prevalent Comorbities
Strategies to
handle to
chronic
conditions
Sucessful
management
Self
management
program

10. Six most prevalent, most debilitating and most
common causes of death in population 65 years or
more
Six most
prevalent
Most debilitating Most common
cause of death
Hypertension
Arthritis
Heart disease
Cancer
Diabetes
Vision limitation
Mental distress
Stroke
Vision limit.
Hearing limit.
Diabetes
Lung conditions
Heart disease
Cancer
Stroke
Lung conditions
Alzheimer
Diabetes

11. List of the common geriatric problems
Dysfunction
Falls
Gait/balance assessment
Geriatric pharmacology
Urinary tract infections
Constipation
Malnutrition
Visual problems (cataract glucoma)
Incontinence (stress, urge, overflow)
Impotence
hypothermia

12. Comorbidities of chronic conidtions:
35% of elderly between 65 and 79 have more
than one chronic disease. And 70% of
elderly above 80 years have more than one
chronic disease.

13. Recent researches on successful management
of chronic conditions in elderly:
1- Recognizing and acting on symptoms
2-using medication correctly
3-managing emergencies
4-maintaing nutrition and diet
5-maintaing adequate exercise
6-Giving up smoking

14. Recent researches on successful management of
chronic conditions in elderly:
7-using stress reduction techniques
8-interacting effectively with health providers
9-using community resources
10-adapting to work
11-managing relations with significant others
12-managing psychological responses to chronic
illness.

15. These 12 elements have been integrated into
the chronic disease self management
program (CDSMP)
CDSMP has been used to patients with many
chronic conditions to manage symptoms
well, to communicate effectively with
health professionals, and to develop
realistic appraisals of the risks they face.
Evidence based model of self management
that should be tested.

16. Challenges to chronic disease management
Avoiding inappropriate medication and poly
pharamcy
14% of elderly of people aged 75 or more are
using at least one inappropriate drug
(community based study in USA)
A second study has reported the prevalence rate of
inappropriate medication 23%.
Polypharmacy is the use of many medications all
appropriate. (fear of drug to drug interactions,
less patient compliance)

17. Ethical challenges to geriatric care
Elder abuse Informed
consent
Durable power
of an attorney
Advance
directive
Do not resuscitate
end of life issues

18. Elder abuse
Although not restricted to the family, violence against
older adults most often occurs in a family setting and
is often unreported.
In USA 1 in 4 cases of elder abuse is reported
4% to 7% of older adults living with family members
are abused; 10,000,000/year
The most prevalent type of abuse is physical abuse
,followed by habitual verbal aggression and then
neglect.

19. Physical abuse
Any violent behavior that results in bodily harm; i.e.
hitting, kicking, biting, choking, burning, striking with
objects, pullinghair, unreasonable restraint, and
forcing an older adult to ingest a substance, such as
medications.
Psychological abuse or chronic verbal
aggression
Material abuse or financial exploitation
Violation of rights
Neglect - both intentional and unintentional

20. Advance directive
are instructions given by individuals specifying what
actions should be taken for their health in the event that
they are no longer able to make decisions due to illness
or incapacity, and appoints a named person to make
such decisions on their behalf.
Durable power of an attorney
an advance directive which empowers the attorney-in-
fact (proxy) to make health-care decisions for the
grantor.
Health care decisions include the power to consent,
refuse consent or withdraw consent to any type of
medical care, treatment, service or procedure.

21. Informed consent
The informed consent doctrine is generally
implemented through good healthcare practice:
pre-operation discussions with patients and the
use of medical consent forms in hospitals.
However, reliance on a signed form should not
undermine the basis of the doctrine in giving the
patient an opportunity to weigh and respond to
the risk

22. Mental health problems among elderly
Disorder Prevalence
Depression
Anxiety disorder
Substance misuse
Dementia
70 years
80 years
90 years
Vascular dementia
20
5-7
5
5
20
50
15-50% of all
dementia

23. Mental health problems among elderly
-Ranked second in disease burden among illness
categories in United states for all ages.
-One poor result of mental health is social isolation
-Social isolation is associated with many poor outcomes:
Greater risk of suicides, poor medication management,
inferior nutrition, overuse of the over counter drugs,
Poor living environment (spiral of deterioration)
-Social isolation and loneliness increase in the risk of
nursing home admissions

24. Cognitive function
Dementia
A person who has memory impairment
(inability to learn new information and recall
previous information) +
One of the following conditions
Aphasia (language comprehension)
Apraxia (performing movement to verbal
order)
Agnosia (difficulty in recognizing familiar faces
or objects)
Tested by MMSE minimental state examination

25. Prevalence of AD in USA is around 1.9 million
people aged 65 or more.
Prevalence in Egypt 300 thousands cases
expected to rise. (conference on Alzheimer)
Outcomes
AD increase the risk of mortality among
elderly.
Major risk factor for nursing home placement
More risk of falls and hospitalization
More burden on family caregiving (ADL)
assistance

26. Lowering alzheimer risk
1-Nutrition and dietary supplementation
(omega3), less evidence vitamin B, C, folate, B
carotene
2-medical conditions as Hypertension and DM
3-Depression
4-social connection and social engagement: puzzle
word… etc
5-Exercise and leisure activities: participating in
hobbies and attending social clubs
6-Quitting smoking: smoking is related with loss
of brain functions with aging
7-Gene: ApoE gene linkage

27. Challenges to health care system for geriatrics:
1-Shifiting face of health care from acute to
chronic diseases.
2-Increased emphasis on primary care and
ambulatory care
3-from institutions to network of care: from a
single site (hospital, nursing home) to many
sites: assisted living, supportive housing,
community clinics, community hospitals,
rehabilitation facilities,
4- From single physician to multiple specialities,
geriatrics, psychiatrics, etc….
5-Expectation/knowledge/ involvement of
patients, family and community

28. Challenges to health care system for geriatrics:
1-Frail elderly 3% of the population use 30% of
the health care resources.
2-seniors use 1/3 of all hospital admissions and ½
of inpatient days.
3-readmission rates is 42% in patients 75 years or
older
4-higher return rates to emergency departments
5-disconnect between patients needs and hospital
environment (hostile environment)
6-adverse effects are higher for frail elderly even
when adjusted for age/comorbidity

29. Challenges to health promotion for elderly
Challenges for elderly:
Continue self development
Adopt a healthy lifestyle
Adopt to loss
Challenges for families and care givers
Provide informal support
Respect elder autonomy
Avoid over protection
Challenges for health care providers
Validate preventive strategies
Re evaluate current strategies
Reduce iatrogenic insults
Recognize the needs of family carers

30. Challenges to health promotion for elderly
Challenges for public health
Promote health education for elderly
Assisting local communities for the development of health
straigies.
Educate to dispel agiesm
Challenges for government
Planning and implementation of promotional health
policies.
Providing legislation and restricts unhealthy behaviors
Enable and empower elderly people to lead a full and
healthy life in society.
Providing a framework for public and private
organization to meet the health needs of aging
population

31. Goals for supportive care
1-Sense of security and order
2-Enjoyment
3-Meaningful activity
4-Social relationship
5-Dignity
6-Privacy
7-Individuality (identity with past)
8-Autonomy (express preference)
9-Spiritual well being
10-Functional competence
11-Physical comfort

32. Long term care
 Long-term care” includes the complete
spectrum of services and supports required
to meet health and personal care needs
over an extended period of time.
 Needed mostly for persons with limited ADL
activity
 20% of the US household provides family
care giving support.
 Enhancing long term care for elderly with
dementia: certified assistant nurse care and
upgrading the home attendent

33. Emergency medicine
Geriatric emergency admission represent 18% of
admission to Emergency department in USA.
Challenges include
1-Non standard disease presentation
2-altered lab values
3-Multiple comorbid diseases
4-Extensive medical history
5-Communication problems
6-Altered mental status
7-Lack of training and educational programs for
geriatric emergency medicine

34. Challenges facing geriatric community services
in Egypt:
1-Most of the services provided by NGOs
inEgypt to independent elderly while the vast
majority needy group (dependant) are
exclude from the services.
2-Elderly clubs are deficient
3-Long term care is deficient
4-most of the services (geriatric homes) in
urban areas only

35. Challenges facing geriatric community services
in Egypt:
5-Social care should be developed in the direction of
helping families and development of effective home
care service with input targeting families of older
people
6-Empowering NGOs technically and financially
7-Non professional teams dealing with geriatric
patients (no minimal training requirement for staff)
8-geriatric homes have shared other activities
9-No psychiatric assessment in some geriatric homes

36. Public health measures to promote
healthy aging
1- Prevent epidemics and spread of diseases:
influenza immunization, screening for
chronic diseases
2-Protection against enviromental hazards:
recognition and reduction of health hazards
at homes of older adults, development of
aging friendly community that promote
physical activity

37. 3-Prevent injuries: falls preventions
programs, accident prevention programs
4-Promote and encourage healthy behaviors
and mental health: promotion of later life
engagement, enhancement of self
management of chronic disease
5-Ensure quality and accessibility of health
services: Development of quality indicators
for aging experience (home care, nursing
home care, assisted living)- Training of
medical professions about aging experience

38. Solutions to challenges of aging
 Healthy ageing: prevention of chronic diseases,
postponement of disability and dependency
 Integrated care models, which include health and
social care
 Research: better understanding of ageing
processes and age associated chronic diseases
 Embracing new technologies
 Planning for the sufficient, well educated, diverse
and well distributed health workforce
 Planning for high-quality, cost-effective, well
distributed health care

39. Recommendations Healthy Ageing
Encourage the participation in social life
 Raise awareness of relevant mental issues, such as
depression and dementia
 Improve access to safe and stimulating indoor and outdoor
environments
 Promote healthy food and eating habits
 Increase the level of physical activity
 Initiate safety promotion and injury prevention programmes
(violence, medication, etc.)
 Promote smoking cessation and the reduction of harmful
alcohol consumption
 Make preventive health services accessible to older people

40. References
1-Middle East journal of age and aging.
2-CAPMAS 2002
3-Public health aging (maximizing function and well being)
Steven M Albert 2010. (springer publishing)
4-little black book of geriatrics (karen Gershman) 2006
5-The challenges of chronic disease and aging. Howard
Bergman
6-Challenges of biological aging. Edward Masoro 2000.
7-Productive aging: concepts and challenges Nancy Morrow
Howel 2001
8-Older adults and ethics Bret Hendriks 2010
9-Second middle east conference on age and aging 2009.
10-ESCWA aging in the arab countries. United nations report

41. References
11-Freedman et al 2007.national health interview survey
12- CDC national vital statistics 2004
13-Lorig et al.: effective management of chronic illnesses and
comorbidities. 2000
14-The challenge of chronic disease and aging. Howard
Bergman 2009
15-Elderly care, the wikipedia the free encyclopedia
16-Preventive care for elderly people. Cambridge university
press 2004
17- Preventing Alzheimer risk. US news health
18- John Shumacher 2004: emergency medicine and older
adults, continuing challenges and opportunities.
19-Mahmoud Refay2007: Role of non governmental
organizations in the care of Egyptian elderly Msc Thesis
Faculty of medicine-Ain Shams University