RELATIONSHIP BETWEEN AGING AND DISEASE, PRINCIPLES OF AGING FACTORS INFLUENCING HEALTHY AGEINGCHALLENGES IN RESPONDING TO POPULATION AGEINGCOMMON HEALTH CONDITIONS ASSOCIATED WITH AGEINGSOCIAL AND ETHICAL ISSUES 

1. SEMINAR ON RELATIONSHIP
BETWEEN AGING AND DISEASE
Presented by
Selvaraj.P
Ph.D Scholar11
Oct-2019 Batch Guide
Dr.Sasi.Vaithilingan
Professor Cum Vice-Principal
VMCON Pondicherry.

2. OBJECTIVES
Understand the principles of aging
List out the factors influencing healthy aging
Understand the common health condition associated
with aging
Describe the various rehabilitative services available
Know the social and ethical issues related to care of
elderly individual

3. INTRODUCTION
• Demographic transition has lead to the population
ageing of India.
• Majority (80%) of are in the rural areas and a large
percentage (30%) of the elderly are below poverty line.
• Feminization of our elderly population (51% of the
elderly population would be women by the year 2016).
• Shape of the population pyramid is gradually changing
from a wide base/ narrow top, to a barrel-shaped form.
1/13/2021 VMRF(DU) NSG 19 OCT 07

4. Con’t
• Industrialization, urbanization, education and exposure
to western lifestyles are bringing changes in social
values and lifestyle thereby weakening the family ties.
• The way a person ages depends upon gender,
socioeconomic determinants, physical environment,
personal and behavioral factors and availability of
health and social services.
• Successful ageing means remaining free of major, life-
threatening chronic diseases
1/13/2021 VMRF(DU) NSG 19 OCT 07

5. Con’t
• Active ageing is the process of optimizing opportunities
for health, participation and security in order to
enhance quality of life as people age.
• Recognizing the need for the care of elderly, the
Government of India adopted the national policy for
older people in 1999.
• Care of the elderly has till date focused on managing
chronic disorders rather than on the promotion of
healthy lifestyle and prevention of chronic diseases.
1/13/2021 VMRF(DU) NSG 19 OCT 07

6. PRINCIPLES OF AGING
• Aging is considered as an emergent phenomenon
• The natural lifespan of a species has also been termed
“essential lifespan” (ELS) or the “warranty period” of a
species. ELS is defined as the time required to fulfil the
Darwinian purpose of life, that is successful
reproduction for the continuation of generations.
• Species undergoing fast maturation and early onset of
reproduction with large reproductive potential
generally have a short ELS.
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7. Con’t
• For example, the ELS of Drosophila is less than a
week as compared with that of about 50 years of
Homo sapiens, even though in protected
environments (laboratories and modern societies),
a large proportion of populations of both species
can and do live for much longer than that.
Therefore, the period of extended survival beyond
ELS is also the period of aging.
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8. Con’t
• Second, aging is characterized by a progressive
accumulation of molecular damage in nucleic acids,
proteins and lipids.
• The inefficiency and failure of maintenance, repair and
turnover pathways is the main cause of age-related
accumulation of damage.
• Homeostasis or homeodynamic ability of a living
system is primarily due to its maintenance and repair
processes
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9. FACTORS INFLUENCING HEALTHY AGEING
• Environments that people live in as
• Environments -development and maintenance of
healthy behaviours.
• Behaviours -Strength training to maintain muscle mass
and good nutrition can both help to preserve cognitive
function.
• Supportive environments enable people to do what is
important to them, despite losses in capacity.
• The availability of safe and accessible public buildings
and transport. 1/13/2021 VMRF(DU) NSG 19 OCT 07

10. CHALLENGES IN RESPONDING TO
POPULATION AGEING
1. Diversity in older age
• There is no ‘typical’ older person. Some 80 year-olds
have physical and mental capacities similar to many 20
year-olds.
2. Health inequities
• A large part arises from people’s physical and social
environments and the impact of these environments on
their opportunities and health behaviour.
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11. Con’t
3. Outdated and ageist stereotypes
• Older people are often assumed to be frail or
dependent, and a burden to society. Public health, and
society as a whole, need to address these and other
ageist attitudes,
4. A rapidly changing world
• Globalization, technological developments (e.g. in
transport and communication), urbanization, migration
and changing gender norms are influencing the lives of
older people in direct and indirect ways.
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12. WHO’S RESPONSE
• Global Strategy and Action Plan on Ageing and
Health is being developed by WHO in consultation with
Member States and other partners.
• Commitment to Healthy Ageing.
• Aligning health systems with the needs of older
populations.
• Developing systems for providing long-term care.
• Creating age-friendly environments.
• Improving measurement, monitoring and
VMRF(DU) NSG 19 OCT 07

13. COMMON HEALTH CONDITIONS
ASSOCIATED WITH AGEING
• Older age is also characterized by the emergence of
several complex health states that tend to occur only
later in life and that do not fall into discrete disease
categories. These are commonly called geriatric
syndromes.
• They are often the consequence of multiple underlying
factors and include frailty, urinary incontinence, falls,
delirium and pressure ulcers.
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14. 1. Chronic health conditions
• According to the National Council on Aging, about 92
percent of seniors have at least one chronic disease and
77 percent have at least two.
• Heart disease, stroke, cancer, and diabetes are among
the most common and costly chronic health conditions.
• The National Center for Chronic Disease Prevention and
Health Promotion- Checkup, maintaining a healthy diet
and keeping an exercise routine to help manage or
prevent chronic diseases.
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15. 2. Cardiovascular Diseases
• Cardiovascular diseases are the primary cause of death
in older adults,
• Vascular disease is so strongly age related that it has
been proposed as a biomarker of aging.
• Community studies have revealed high incidence of
undetected hypertension in elderly.
• Current treatments for cardiovascular risk factors,
including smoking cessation, lipid lowering, blood
pressure control, and avoidance of obesity through diet
and exercise, are underutilized in elderly

16. 3 Disorders of the Musculoskeletal System
• Articular and non-articular conditions are a major
cause of disability and discomfort in the elderly.
• These disorders determine the quality of life for
older adults as the ability to live independently is
hampered.
• Both inflammatory and degenerative arthritis,
osteoporosis and diffuse pain syndromes are
common in the elderly.1/13/2021 VMRF(DU) NSG 19 OCT 07

17. 4.physical injury
• Every 15 seconds, an older adult is admitted to the
emergency room for a fall.
• Because aging causes bones to shrink and muscle to
lose strength and flexibility,
• Two diseases that contribute to frailty are osteoporosis
and osteoarthritis. - falls are not inevitable. In many
cases, they can be prevented through education,
increased physical activity and practical modifications
within the home.
1/13/2021 VMRF(DU) NSG 19 OCT 07

18. 5 Respiratory Disorders
• Prevalence of chronic obstructive pulmonary
disease increases with age causing considerable
morbidity and mortality.
• Treatment should aim to maximize the patient’s
function and quality of life while minimizing drug-
induced side effects. Older patients also benefit
from pulmonary rehabilitation.
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19. 6. Mental Health
• Age related physiological changes, socio-economic and
psychological factors and the co morbidities alter the
presentation of the psychiatric disorders and its
response to treatment in elderly.
• The prevalence of delirium in hospitalized elderly
patients is about 15% on admission, commonly caused
by the physiologic consequences of a medical
condition.
• Symptoms and signs of depression are common in
geriatric population. VMRF(DU) NSG 19 OCT 07

20. Con’t
• Suicide is also common in elderly population.
• Dementia is another gradually progressive psychiatric
disorder with a sustained loss of intellectual functions
and memory and preserved consciousness causing
dysfunction in daily living
• Besides these disorders, substance abuse is also
common. Use of tobacco, alcohol, opium and other
addictions are significant health risk factors in this age
group .
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21. 6. Instability and Falls
• Unstable gait and falls are common among older
people and falls are among the major causes of
morbidity in this population.
• Falling is often a marker for frailty.
• Falls may be predictors as well as indirect cause of
death. Close to one third of those aged 65 and older
living at home, suffer a fall each year, and about one in
40 of those will be hospitalized.
• The factors that could cause or contribute to fall are
multiple. VMRF(DU) NSG 19 OCT 07

22. Con’t
• Intrinsic factors like medical and neuropsychiatric
conditions, impaired vision and hearing, age-related
changes in neuromuscular function, gait and postural
reflexes and extrinsic factors like medications,
• Environmental hazards are the common causes for falls.
Fractures of the hip, femur, humerus, wrist and ribs and
painful soft tissue injuries are the most frequent
physical complications.
• The efforts for fall prevention need to be strengthened
at community level VMRF(DU) NSG 19 OCT 07

23. 7 .Immobility
• Immobility is a common pathway by which a host of
diseases and problems in older individuals produce
further disability.
• Improvements in mobility are possible, even in the
most immobile older patients.
• Relatively small improvements in mobility can
decrease the incidence and severity of complications,
improve the patient’s well being, and make life easier
for caregivers.
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24. 8. Sensory Impairment
• Common causes of blindness are cataracts, glaucoma,
macular degeneration, and diabetic retinopathy.
Screening for these disorders should include testing
visual acuity, performing ophthalmoscopic evaluation,
and checking intraocular pressure.
• Hearing problems are common in the elderly,
especially in a highly industrialized society where noise
and age interact to cause hearing loss. Kacker et al
found that nearly 60% of older people had hearing
impairment in both urban and rural areas
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25. 9. Infectious Diseases
• Infectious diseases in elderly have high prevalence,
morbidity and mortality.
• Clinicians should be acquainted and familiar with
unique features of infections in the elderly population
to improve clinical outcomes,
• Age related physiological changes in body organs,
alteration of host defenses, immune senescence,
change in glucose homeostasis, malnutrition and
impaired circulation and tissue perfusion predispose
them for infections.1/13/2021 VMRF(DU) NSG 19 OCT 07

26. Con’t
• Unexplained change in functional capacity, worsening
of mental status, weight loss or failure to thrive,
weakness and fatigue, falls, loss of appetite, urinary
incontinence and generalized pain may indicate
presence of infection.
• Fever may be absent in 20-30% of elderly patients
harboring a serious infection; on the contrary
hypothermia may be present in them.
• Prevalence of tuberculosis in aged is higher than
younger VMRF(DU) NSG 19 OCT 07

27. REHABILITATION
• Rehabilitation therapy (i.e. physical, occupational,
and speech) plays a key role in care of elderly.
• It includes functional assessment, development
and implementation of rehabilitative plans to take
care of functional impairments
• An environmental prescription may include
alteration in the physical environment (e.g. ramps,
grabbers and elevated toilet seats).
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28. DRUG PRESCRIPTION
• The absorption, distribution, and clearance of
medications is altered due to altered gastrointestinal
(GI) motility and blood flow, decreased lean body mass,
increased proportion of adipose tissue, decreased
creatinine clearance and decreased hepatic blood flow.
• A good rule of thumb is “Start low and go slow”.
• Studies also show that certain medications are less safe
for older people
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29. Con’t
• The correct medication is prescribed for the correct
condition
• The medication is right for you, your age, and your
conditions
• You take the proper dose for the length of time your
healthcare provider prescribes
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30. 1 Polypharmacy
• Many older adults cope with more than one medical
condition at the same time. Often, managing multiple
conditions can mean that the older adult may need
many different medications.
• When older adults take five or more medicines, it is
called “polypharmacy.” With polypharmacy, the
medicines may interact with each other and with your
body in harmful ways..
• Many older adults take multiple medications from
different prescribers..VMRF(DU) NSG 19 OCT 07

31. 3.Prescribing Cascade
• Polypharmacy increases the possibility of a “prescribing
cascade.”
• A prescribing cascade is when a side effect of one
medication is mistaken for a new medical condition and
is then treated with another medication.
• This can lead to being prescribed more medications
than you need and also further increases your risk of
having more side effects and continuing the cascade
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32. 3 What Older Adults Can Do To Manage
Medications
• Make a list
• Review your medication regulary
• Look out for site effect
• Ask about Over-the-Counter Medications
• Take your medication properly
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33. 1/13/2021 VMRF(DU) NSG 19 OCT 07

34. LONG-TERM CARE
• A proportion of older patients will require substantial
long-term care, a range of services that addresses the
health, personal care, and social needs of individuals
who lack some capacity for self-care
• Actively Recuperating Or Being Rehabilitated,
• With Physical Dependencies,
• With Primarily Severe Cognitive Losses,
• Receiving Terminal Care, And
• In A Permanent Vegetative State.
1/13/2021 VMRF(DU) NSG 19 OCT 07

35. Types Of Community Long Term Care
Programs
• Home Care (Home Nursing And Home Making),
• Adult Day Care, Adult Foster Care,
• Assisted Living, Geriatric Assessment,
• Hospice/Terminal Care,
• Telephone Reassurance,
• Caregiver Support,
• Congregate Housing,
• Home Repairs,
• Respite Care And Emergency Alarms.
1/13/2021 VMRF(DU) NSG 19 OCT 07

36. SOCIAL AND ETHICAL ISSUES
• Aging at the site is a desired goal.
• Ethics is a fundamental part of geriatrics.
• Ethics, or the provision of ethical care, refers to a framework
or guideline for determining what is morally good (ie, right) or
bad (ie, wrong).
• Ethical problems arise when there is conflict about what is
the “right” thing to do.
• This dilemma generally occurs when decisions need to be
made whether or not a medical intervention should be
implemented and whether or not the intervention is futile.

37. Con’t
• The answers to ethical questions are not
straightforward; they involve a complex integration
of thoughts, feelings, beliefs, and evidence-based
data.
• Ageism can play a strong role in these decisions.
• Acknowledging and acting on the wishes of the
older individual are a critical component of ethical
care.
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38. Con’t
• Ethics: declarations of right or wrong and what out to
be
• Bioethics: application of ethics to matters of life and
death
• Ethical dilemma: a difficult problem seemingly
incapable of a satisfactory solution; situation involving
two equally unsatisfactory alternatives
• Nursing ethics: application of ethical principles in
nursing practice
1/13/2021 VMRF(DU) NSG 19 OCT 07

39. Con’t
• Decision making capacity.
• Informed consent.
• Refusal of treatment.
• Advance directive.
• Major ethical principles.
• Psycho-social aspects of aging.
• Elder abuse, any form of mistreatment that results in
harm or loss to an older person, Elder abuse is typically
underreported in most cultures.

40. Con’t
• It focuses on the roles of autonomy and rationing.
• Elderly are being encouraged to indicate their
preferences in advance for how they would wish to
be treated in the event that they are too
incapacitated to express their wishes as advance
directives.
1/13/2021 VMRF(DU) NSG 19 OCT 07

41. SUMMARY
• Between 2015 and 2050, the proportion of the world's
population over 60 years will nearly double from 12% to 22%.
• By 2020, the number of people aged 60 years and older will
outnumber children younger than 5 years.
• In 2050, 80% of older people will be living in low- and middle-
income countries.
• The pace of population ageing is much faster than in the past.
• All countries face major challenges to ensure that their health
and social systems are ready to make the most of this
demographic shift.1/13/2021 VMRF(DU) NSG 19 OCT 07

42. REFERENCE
• Prakash R, Choudhary SK, Singh U. Study of morbidity pattern
among geriatric population in an urban area of Udaipur,
Rajasthan. Indian Journal of Community Medicine
2004;14:35- 40.
• https://www.healthinaging.org/medications-older-adults
• https://www.who.int/news-room/fact-sheets/detail/ageing-
and-health
• https://www.healthinaging.org/a-z-topic/delirium/care-
treatment
• https://vitalrecord.tamhsc.edu/10-common-elderly-health-
issues/1/13/2021 VMRF(DU) NSG 19 OCT 07