CommunityGeriatrics. Old age is an incurable disease
• Geriatrics or geriatric medicine is a sub- specialty of internal medicine and family medicine that focuses on health care of elderly people.• It aims to promote health by preventing and treating diseases and disabilities in older adults
Community Geriatrics.• Caring for older patients means not only understanding their diseases and knowing who the support people are in their lives, but also creating a plan of care that includes their social, financial and personal goals.
• There is no set age at which patients may be under the care of a geriatric physician, a physician who specializes in the care of elderly people.• This decision is determined by the individual patients needs, and the availability of a specialist.
WORLD’S DEMOGRAPHICS• Today worldwide there are 600 million persons aged 60 and above.• The elderly population will get double by 2025, and will reach virtually 2 billion by 2025.• The percent age of population >65 years will be higher in developed countries but absolute number will be higher in developing countries.
Cont….• By 2025 countries with highest % of people with >65 are expected to be:- -Japan(28%) -Italy(27.1%) -Germany(24.6%)• However as India and China have largest population so in 2002, greater no. of people>80 years lived in China followed by US and Indiia.
INDIAN DEMOGRAPHICS• In India elderly population is over 82 million.• Indian elderly population is expected to reach the mark of 177 million, almost double by the year 2025.• A nation gets labeled as ‘aging’ when the 60+ age group in its population crosses 7%. India has earned such distinction of graying nation with about 7.7% of older population.
Average old age population of India, 1961-2050 population 350 300 250population in million 200 population 150 100 50 0 1961 1991 2001 2050
General problems in old age Economic problems Sociological changes Spiritual changes
System wise changes1.Cardiovascular changes:Elevated blood pressureVenous stasisExertion and fatigueReduced cardiac efficiencyThickening of blood vesselsArrhythmias and murmurDilated abdominal aortaDecreased physical activity
2. Respiratory systemDecreased physical abilityIncreased potential for infectionsDecreased gas exchangeAspirationDecreased elasticity of alveolar sacsSkeletal changes of chestDecreased cough strengthDysphagiaCommon diseases are Asthma, bronchitis andemphysema
3. Gastrointestinal systemDifficulty in chewingDry mouthDifficulty in digesting starches and fatty foodsDecreased appetiteFeeling of fullnessMalnutritionHeart burn after mealsconstipation
NEUROLOGICAL SYSTEM• Reduced speed in nerve conduction• Increase confusion• Loss of environment clues• Reduced cerebral circulation• Slow to respond and react• Slow learning
Accidents• Bones become fragile• Accidents are more common in home than outside• Fracture neck of femur is very common . CancerThe leading cause of death of death after 40 years of age .
Percentage of elderly reporting various ailments Ailment Reported percentageVisual impairment 88.0Joints, muscles disorder 40.0Neurological complaints 18.7Cardiovascular disease 17.4Respiratory disorder 16.1Skin conditions 13.3Psychiatric problems 9.0Hearing loss 8.2 Report of commission on health in India 1997
Various Levels of healthcare Primordial prevention• Pre geriatric care Primary prevention• Health education• Exercise• Immunization- influenza, and tetanus
Secondary prevention• Screening for hypertension, diabetes periodontal disease dental caries• sensory impairment medication side effects• colon-rectal cancer breast cancer, cervical cancer and prostatic cancer nutritionally-induced anaemias depression, stress urinary incontinence podiatric problems fall risk• Annual medical check-up• Early detection ( Universal approach, Selective approach)• Treatment
Tertiary prevention• Rehabilitation - physical deficits cognitive deficits functional deficits• Caretaker support -Introduction of support necessary to prevent loss of autonomy .• Counselling and Welfare activities ( Sanjay Niradhar Yojana, Vridhashrama )• Improving quality of life• Cultural programme• Old age club• Home help• Old age home
How government help old age people• Government announced a National Policy on older persons in January 1999.• This policy identifies principal areas of intervention as security, healthcare, nutrition, welfare and protection of life and property.• A national council for older persons (NCOP) was constituted to operationalise this policy .• 234oldage home,398 daycare centers and 40 mobile medical units are operational under this policy.
• Under National Social Assistance Programme, old age pension is being provided to more than 4 million aged people.• Old Age Social and Income Security (OASIS) was launched to examine policy questions, connected with Old age income security.• Health care is provided to the older people under Bhavishya Arogya Mediclaim and Rural Group Life insurance Schemes .
• Help Age India is the largest voluntary organization working for the cause and care of the older people.• Help Age India supports various programmes to make life easier for older people like 1. Free cataract operations 2.Mobile medical units 3.Old age homes and care centers. 4.Adopt a gran (grand parent). 5. Income generation and micro –credit.
NATIONAL PROGRAMME FOR THE HEALTH CARE OF THE ELDERLY (NPHCE) NPHCE is an articulation of the International and national commitments of the Government as envisaged under the UN Convention on the Rights of Persons with Disabilities (UNCRPD), National Policy on Older Persons (NPOP) adopted by the Government of India in 1999. NPHCE would operate through NCD cells under the programme constituted at State and District levels
National NCD cell State NCD teri.level Regional Geriatric Centres Geriatric Ward (30 beds)District NCD District Hospital Daily Geriatric Clinic Geriatric Ward (10 beds) CHC/PHC Geriatric Clinic on fixed days Sub Centre Home-based Care
You do not heal old age.you protect it; youpromote it; you extent it. -Sir James Sterling Ross