2. Definition
AGING : It is a progressive and generalized impairment of body
functions resulting in, loss of adaptive responses to stress and
increasing the risk of age-related diseases.
Greek: gerus = old age
iatrea = treatment
Geriatrics: A branch of medicine that deals with the problems and
diseases of old age and aging people.
Gerontology: Comprehensive study of aging and the problems of
the aged.
People more than 60 yrs are considered elderly.
Old age is not a disease but a normal and
inevitable biological phenomenon.
3. Definition of elderly
According to WHO, most developed countries have accepted the
chronological age of 65 years and above as a definition of 'elderly' or
older persons.
According to UN : 60+ years will be referred as the older population or
elderly.
Young old – upto 75 years.
Old old – upto 85 years.
Very old – over 85 years.
5. World Population trend of 60+ Years
1980-2020 (in millions)
1980 1990 2000 2010 2020
World 381.2 484.7 608.7 754.2 1011.6
Developed 173.3 203.6 234.6 232.4 308.2
Developing 207.9 281.8 374.1 491.8 703.4
Asia (excl. Japan) 160 218.2 290 377.7 539.9
China 78.6 101.2 131.7 167.9 238.9
India 44.6 60.2 81.4 107 149.7
United Nations, World Demographic Estimate and Projections
6. Elderly Population in India
With a comparatively young population, India is still poised
to become home to the second largest number of older
persons in the world.
Projection studies indicate that the number of 60+ in India
will increase from 100 million in 2013 to 198 million in 2030.
In 2001, the proportion of older people was 7.7% which
increased to 8.94% in 2016.
7. Elderly Population in India
The life expectancy at birth in India is as follows:
Japan is the most elderly country in the whole world with average
life span of 82 years.
Year In males (in
years)
In females (in
years)
1996-2001 62.3 63.39
2011-2016 67.04 68.8
9. The special features of the elderly
population in India are :
• Majority (80%) of them are in the rural areas,
thus making service delivery a challenge,
• Feminization of the elderly population ( 51% of
the elderly population would be women by the
year 2016)
• Increase in the number of the older-old (
persons above 80 years) and
• Large percentage (30%) of the elderly are below
poverty line.
Source: Operational guidelines (National programme for Health care of the elderly
(NPHCE), pg: 9
10. The Problems of the Old
1. Physiological problems
2. Pathological problems
3. Psychological problems
4. Mental problems
5. Social problems
6. Economical problems
11. Physiological problems
Loss of elasticity of the skin, thinning and loss of hair,
Brittleness of bones and weakness of muscles, slowness of
movements, unsteadiness of gait, and
Sluggishness of reflexes
Impairment of the special senses, especially hearing and sight
Accidents, often at home, are an important cause of physical
illness in the elderly.
Falls are the leading cause of death among people aged 75+ and
responsible for appreciable morbidity including fracture, impaired
mobility.
Immune system become weak.
Metabolism starts slowing down.
12. Pathological Problems
Diseases of the heart & blood vessels, e.g.:
hypertension,
atherosclerosis,
CVDs,
MI, IHDs, Stroke etc
Cancer, Diabetes, Obesity
Diseases of the eye
Cataract
Loss of vision
Reduced visual acuity
Age-related macular degeneration (AMD)
Retinopathy
13. Pathological Problems
Diseases of respiratory systems
Chronic bronchitis
Bronchial asthma
Emphysema etc
Diseases of genitourinary system
Enlargement of prostate
Incontinence of urine
Dysuria
Nocturia
Urinary tract infection
Fecal incontinence
14. Locomotor system disorders
It forms 40% of the old age complaints
They are:
Fibrositis
Osteoarthritis
Rheumatoid arthritis
Myositis
Neuritis
Gout
Spondilitis of spine
15. Musculo-skeletal system
Irreversible
loss of motor
units and fibres
Reduced
muscle
strength
Locomotor
disability
Deposition of
fat
Loss of
mineralisation
Osteoporosis Pathological
fractures
Wear-n-tear of
articular
cartilage
OA and RA Mobility
problems
16. Psychological problems
1. Mental changes: Loss of memory, senile dementia
2. Isolation: Death of closed ones, lack of care, social
maladjustments isolation
3. Depression: factors like isolation, poverty, diseases, emotional
disturbances, lack of happiness etc, leads to depression.
4. Psychological problems form 8.5% of the old age complaints
4. Neurological problems form 18.7% of the old age complaints
5. These are:
Dementia
Parkinson's disease
Alzheimer’s disease
17. Skin conditions
Skin conditions form a major part of old age
complaints
Skin conditions include:
Senile wrinkles
Scaly lesions
Scaly dermatosis
Blistering diseases
Neoplastic disorders
18. Skin and its appendages
Loss of elasticity of skin Wrinkling
Loss of hair Alopecia and baldness
Brittleness of fingernails
19. Gastrointestinal complaints
GI disorders for about 9% of the old age complaints
These are:
Peptic ulcer
Constipation
Ulcerative colitis
Carcinoma of GIT
Atrophy of mucous membrane
of mouth
Reduced food
intake and change
of taste and smell
Nutritional
deficiency states
Loss of teeth
Decreased no. of taste buds
Decreased salivation
Decreased sensation of smell
20. Hearing loss
Hearing complaints form about 8.2% of the old age
complaints
These include
Nerve deafness
Conductive hearing loss
21. Geriatric Gynecology
Atrophy of
vaginal and
urethral mucosa
UTI’s and
atrophic
vaginitis
Carcinoma
cervix
Weakening of
pelvic muscles
Prolapse of
uterus
Ulceration and
carcinomatous
change
23. Social problems
Abuse : The abuse may be of a physical nature, it may be
psychological (involving emotional or verbal aggression), or it
may involve financial or other material maltreatment.
Dependancy :PHYSICAL, FINANCIAL, FUNCTIONAL and other
dependancy has a major affect on the self esteem of the old.
Insecurity :Insecurity of being abandoned by their children.
Rehabilitation
24. Elder Abuse
It refers to ill-treatment of an elderly person.
It can be-physical abuse
-psychological abuse
-financial abuse
-Neglect.
It is a very sensitive issue and requires a high
index of suspicion.
25. Need for geriatrics
Elderly population will keep on rising due to
advancing medical technology.
Diseases present atypically and at an earlier
stage.
Often a multi-organ system involvement.
Worsening of pre-existing diseases are
frequent.
Burden over the health care system.
Burden over the nations economy.
27. Prevention and Management of
Health Problems in Geriatrics
One of the most important measure of how
civilized we are is how we treat our elderly.
According to Sir James Sterling Ross ”you do
not heal old age, you protect it, you promote
it and you extend it.”
29. Assessment of the
elderly
AIMS –
Cost effective use of services.
Maintaining the elderly active.
Providing quality care up to the max. satisfaction of
the user.
30. Multi-disciplinary Geriatric
Assessment (Geriatric Clinic)
The concept of geriatric clinic suits best for
assessment and management of diseases and
disabilities in the elderly.
Components-
Gerontologist/Physician
Physiotherapist
Occupational therapist
Ophthalmologist
Audiologist
Psychiatrist
Dietitian
Nurse and
Social worker.
31. Scope-
This facility is available only at tertiary and
few secondary health care centers.
In a primary health care set-up, a trained
physician, a trained nurse and a
physiotherapist should be able to assess the
elderly fairly well.
32. Preventive Health Care in Elderly
It includes-
Primary prevention.
Secondary prevention.
Tertiary prevention.
33. Primary prevention
Control of BP, Weight, diabetes if any
Avoid smoking, limit alchohol
Regular moderate physical exercise, yoga, meditation
Avoidance of drug abuse and self medication
Well balanced diet, low saturated fatty acids, refined sugars and fast
food
More calcium rich diet, fruits and vegetables
Reading, writing, listening to music, doing puzzles, suduku, etc
Avoid loneliness
Drink enough water
Periodical health check ups
Financial Security
Health Promotion:
34. Primary prevention
Immunization-
Influenza
Pneumococcal
Tetanus.
Hepatitis B
Osteoporosis prevention-
Calcium and vit-d supplementation.
Hip protector devices.
Specific protection:
35. Injury prevention
Burns accidents and falls should be prevented
by;-
Removal of obstacles
Keep the floor dry
Bright lighting
Flat shoes
Railing/holding bars in bathrooms
Low level switches
Easy and safe access to water.
36. Secondary prevention
Screening helps in early detection of
modifiable risk factors and their
adequate management.
Hyper/hypotension, diabetes mellitus
Dental problems
Drug adverse effects
Cancers
Infections
Nutritional deficiency states
Eyes /ears
Screening
37. Tertiary prevention
Consists of giving intensive treatment in the hospital for
those who come in advanced stage of disease.
Disability Limitation:
38. Tertiary prevention
It deals with rehabilitation and caregiver support.
Rehabilitation is a problem solving process focused on
the patients functional abilities.
Rehabilitation team includes; a physician, a
physiotherapist, an occupational therapist, a speech and
language therapist, a psychiatrist, a dietitian, a nurse and
a social worker.
Rehabilitation:
39. Interventions in rehabilitation
Hard interventions:
drugs.
physiotherapy.
occupational therapy.
aids and adaptation-Hearing aids, artificial limbs
speech and language therapist.
Soft interventions-
advice.
education.
counseling.
encouragement.
listening.
40. Supporting the
caregiver
Social attitude
Physicians support
Organization of “day care centers”
Hospitalization in c/o chronic illness
Counseling the caregiver
41. Prevention and management of
elder abuse
Assessment of physical and mental capacity of
the elderly.
Assessment of general quality of care
Assessment of relation with the abuser
Assessment of abusers for their problems
Counseling the abusers
Institutionalization in old age homes