Burden and methods in overcoming giants of geriatrics

1. BURDEN DISEASE AMONG ELDER PERSON
DR HARDEVSINGH a/l HARPALSINGH
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2. Learning objectives
1. To define elderly, ageing population, aged population
2. To describe common causes of mortality and morbidities among elderly
3. To describe the strategies and activities for elderly health care
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3. DEFINITION
 Functional age
 Perception age
 Chronological age
 Cut off point
 60 (WHO – developing
countries)
 65 (WHO - developed
countries)
Age group classification
(WHO: 60 and above)
 Young old :60 - 74
 Middle old :75 - 84
 Old old :85 or more
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4. Ageing
 Based on United Nations (UN)
 Ageing society
 People aged 65+ reached 7% of
total populations
 Aged society
 People aged 65+ reached 14% of
total populations
 Based on WHO
 Ageing society
 People aged 60+ reached 10% of
total population
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https://www.un.org/en/development/desa/population/publications/pdf/ageing/WorldPopulationAgeing2019-Highlights.pdf

5. Facts on ageing by WHO (Misconception)
1. There is no typical older person
2. Diversity in older age is not random
3. Only a small proportion of older people are care dependent
4. Population ageing will increase health-care costs but not by as much as
expected.
5. 70 is not yet the new 60
6. Good health in older age is not just the absence of disease
7. Families are important but alone cannot provide the care many older people need
8. Expenditure on older populations is an investment, not a cost
9. It’s not all about genes
10. Mandatory retirement ages do not help create jobs for youth
5
Misconceptions on ageing and health [WWW Document], n.d. URL https://www.who.int/news-room/photo-story/photo-story-detail/ageing-and-life-course
(accessed 11.9.20).

6. Why focus on Elderly?
 Ageing population
Global phenomenon
A phenomenon occurring both in developed and developing
countries
Be prepared to face the challenge of an ageing population
Challenge of increase longevity but compressed morbidity
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7. 7
Source: Asian Development Bank 2017

8. National Policy for Older Persons
 Approved in October 1995
 Malaysia one of the earliest countries in the Asia Pacific region to have policy
for older person.
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VISION

9. MISSION
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Ensure healthy lives and promote well being for
elderly with sustainable health care system
Strengthening social bonds, not only between
people, but also between generations
Improving experiences for older people through a
network of technology and innovation

10. Ageing Process and Physiological
Changes
 Nervous system
 Cognition
 Memory, learning and intelligence
 Special senses (vision, hearing, taste acuity, smell, and touch)
 Musculoskeletal system
 Body composition changes
 Obesity in elderly
10
Amarya, S., Singh, K., Sabharwal, M., 2018. Ageing Process and Physiological Changes, in: D’Onofrio, G., Greco, A., Sancarlo, D. (Eds.), Gerontology. InTech.
https://doi.org/10.5772/intechopen.76249

11. Problems in elderly (NHMS 2018)
 Functional Status
 Activities of Daily Living
 Disability
 Physical Activities
 Geriatric Syndromes
 Mental health
 Urinary Incontinence
 Falls
 Non-Communicable Disease (NCDs)
 NCDs
 NCD risk factors
 Nutrition
 Nutritional status
 Dietary practices
 Quality of life (QoL)
11
Institute for Public Health (IPH), National Institutes of Health, Ministry of Health Malaysia. 2019. National Health and Morbidity Survey (NHMS) 2018: Elderly Health. Vol. II: Elderly
Health Findings, 2018. 182pages

12. Reviews on Elderly
Malaysian younger generation still shows filial piety towards elderly parents. Many
undergraduates indicated their uncertainty whether their elderly parents should
stay with them or be sent to old folk homes.
Tan et al 2008
More and more people now tended to send their aged parents and relatives to
these homes instead of caring for them in their twilight years.
Women, Family and Community Development Minister, 6 November 2016
Nearly 30% of the seniors in the Malaysia were abandoned or received no
financial support from their spouses
LPPKN’s survey in 2015
Caring for the elderly is something which needs to be taught and inculcated in the
younger generation.
Kuching City South Mayor James Chan in forum on “Empowering the Elderly” in Kuching Festival 2011
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13. Illustrations of older characters were rare in children literature. This shows that
older people were underrepresented and stereotyped.
Ansello et al 1977
Review content of 12 primary school textbooks in Turkey. Elderly people are
underrepresented as the textbooks do not include enough information on elderly
people.
Kaya et al 2014
Aging stereotypes are frequently transmitted through children’s literature lead to a
biased understanding of aging
Hollis-Sawyer & Cuevas 2013
The textbooks in Taiwan do not include enough information on elderly people.
Huang et al 2011
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Reviews on Elderly
Illustrations of older characters were rare in children literature. This shows that
older people were underrepresented and stereotyped.
Ansello et al 1977
Review content of 12 primary school textbooks in Turkey. Elderly people are
underrepresented as the textbooks do not include enough information on elderly
people.
Kaya et al 2014
Aging stereotypes are frequently transmitted through children’s literature lead to a
biased understanding of aging
Hollis-Sawyer & Cuevas 2013
The textbooks in Taiwan do not include enough information on elderly people.
Huang et al 2011

14. GIANTS OF GERIATRIC
• The GIANTS are disabilities that lower the
quality of living.
• In common: multiple causes, chronic
nature, reduced independence, no simple
cure.
• The ‘final pathway’ that affect elderly with
diminished ability to recover, make them
DEPENDANT on others.
(Bernard Isaacs, 1975)
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15. GIANTS OF GERIATRIC (Bernard Isaacs, 1975)
Incontinence
- Urinary & Fecal
Instability/Immobility
- Risk of fall &
Osteoporotic fracture
Impaired cognitive function
- Dementia/depression
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16. 16

17. WHO fact
 20% of adults aged 60 and over suffer from a mental or neurological disorder
 50 million people worldwide are living with dementia
 60% living in low-income and middle-income countries.
 Unipolar depression occurs in 7% of the general older population
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https://www.who.int/news-room/fact-sheets/detail/mental-health-of-older-adults

18. NHMS 2018 Elderly Health
Dementia Depressive Symptom
Percentage 8.5% 11.2% - depressive symptom
5.3% - probable major
depression
Location Rural area (12.9%)
Urban area (6.8%)
Rural area (14.4%)
Urban area (10.1%)
Gender Female 9.7%
Male 7.1%
Female 11.7%
Male 10.7%
Marital status Single Single
Occupational status Unemployed 15.2% Unemployed 12.7%
Education level Low education level 22%
18
Institute for Public Health (IPH), National Institutes of Health, Ministry of Health Malaysia. 2019. National Health and Morbidity Survey (NHMS) 2018: Elderly Health. Vol. II: Elderly
Health Findings, 2018. 182pages

19. Depression
 Depression may be an early sign of Alzheimer’s disease or,
 An increased risk to Alzheimer’s disease cognitive impairment is a significant predictor for depressive
symptoms. (Al-Jawad et al., 2007)
 Up to 70.0% of institutionalized elderly have depression. (Shahar et al., 2011)
 36.5% of institutionalized elderly have cognitive impairment. (Suzana et al., 2009)
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Recommendations
 Preventive strategies cater towards determinants of depressive disorders such as income and employment
 Improving pension and EPF plan.
 Encourage health clinics and welfare department to increase numbers of elderly activities centre and
association in rural areas
 Create awareness among public for preventive measure and early identification of depression

20. Room for improvements
 Develop awareness and increase the knowledge about mental health among the
general public and health care providers.
 Cooperation between government agency and NGO
 Dasar Warga Emas Negara
 Health care plans promoting community care for people with mental health to
reduce the burden of the caregivers.
 Community Mental Health Centre
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21. Burden among caregivers
 Higher burden when taking care dementia patient with behavioural and psychological
symptoms & male elderly.
 Caregivers who have higher education experience higher burden.
 Worse among Chinese and Indian caregivers.
 28.5% of caregiver will develop some depressive symptoms.
21
1. (Rosdinom et al., 2013)(Choo et al., 2003)(Chai et al., 2018)
2. Acton GJ, Kang J. Interventions to reduce the burden of caregiving for an adult with dementia: A meta-analysis. Res Nurs
Health. 2001;24:349–60.
 Recommendation
 Multi-component interventions such as support groups and educations (greatly reduces burden)
 Comprehensive counselling sessions for caregivers for elderly with dementia and stroke survivors

22. Fall
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23. Prevalence of Fall
 28-35% of people aged of 65 and over fall each year
 32-42% for those over 70 years of age
 Older people who are living in nursing homes fall more often than those who are
living in community.
 30-50% of people living in long-term care institutions fall each year, and 40% of
them experienced recurrent falls
 27.3% of 516 participants in Melaka.(1)
 30% of 50 participants in old folks' home in Kuala Lumpur.(2)
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1. Rizawati M, Mas Ayu S. Home environment and fall at home among the elderly in Masjid Tanah Province. J Health Transl Med. 2008;11:7282.
2. Hasanain Faisal Ghazi. The prevalence of falls and its associated factors among elderly living in old folks home in Kuala Lumpur, Malaysia

24. Intrinsic :
Aging, poor balance
Occurrence of falls
Fall Outcomes
No injuries
Contributing
factors Extrinsic :
Home hazards
Loss of
Confidence
Fractures Soft tissues
injures,
trauma
Disability,
reduced
quality of life
Mechanisms of Fall
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25. 25

26. Intrinsic (Personal) factors for Falls
 Aged (over 65 years)
 Female
 Low mobility or fragility – lower extremity weakness, and poor grip
strength
 Functional impairments - limited Activities of Daily living (ADL)
 Poor gait and balance
 Low body weight
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Risk Factors

27.  Cognitive impairment or dementia
 Chronic illness
- Parkinson disease, visual difficulties,
stroke, hypertension, or urinary
incontinence
 Psychoactive medication
- tranquilizers or antidepressants
 Previous falls
 Heavy drinking
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28. Extrinsic or Environmental Factors
 Polypharmacy – four or more prescription
medications combination
 Home hazards
 Clutter, or loose rugs
 Poor lighting on stairs and hallways
 Lack of bathroom safety, e.g. grab bars in bathtub
 Footwear
 Busy street or elevated walkways
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29. Consequences of Falls
 Mortality
 Morbidity
 Fractures
 Soft tissue injuries
 Head trauma
 Joint distortions and dislocations
 Loss of confidence - fear of falling
 Restricted activity
 Economic impact.
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30. Personal Prevention
 Home Safety – Reducing hazards
 Balance Exercise Lessen Fall impact – hip
protectors
 Healthy Lifestyle
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31. Assistant Devices
Hip pads
Mobility aids
Cane
Walkers
Wheelchairs
Bathroom aids
- Raised toilet seats
- Grab bars
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32. Intervention Programs
 Exercise or physical therapy to increase/gain muscle strength,
balance, and gait
 Assessment of home fall hazards
 Evaluation of medical condition, medications, and nutrition
 Support groups
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33. Nursing Home Intervention
 Physical rehabilitation program
 Staff education
 Environmental assessments and modification
 Reduce medications, or physical restraints
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34. Cumulative concern: Needs of Elder people
 Fulfilling physical, psychological and social needs
 Not to forget the implication of ageing population
 Health care
 Social care / social networking
 Economic
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35. ACT POLICY METHOD
Akta Orang-Orang Papa
1977 (Akta 183)
Akta Pusat Jagaan 1993
(Akta 506)
Rang Undang-Undang
Kemudahan dan
Perkhidmatan Jagaan
Kesihatan Warga Emas
Swasta 2017
Dasar Warga Emas
Pelan Tindakan
Dasar Warga Emas
Negara
Dasar Kesihatan
Warga Emas
Kaedah-Kaedah Pengurusan Rumah
Orang-Orang Tua 1983
Kaedah-Kaedah (Rumah Kebajikan)
Orang-Orang Papa 1981
Kaedah-Kaedah Rumah-Rumah
Pesakit Melarat 1978
Panduan untuk Penjaga Warga
Emas
Garis Panduan Perkhidmatan
Kesihatan Warga Emas di Peringkat
Daerah, Klinik Kesihatan dan
Penglibatan Komuniti.
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36. Healthy Ageing and Sustainable Developmental Goals
36
10 facts on ageing and health [WWW Document], n.d. URL https://www.who.int/news-room/fact-
sheets/detail/10-facts-on-ageing-and-health (accessed 11.9.20).

37. WHO Global Strategy and Action Plan on
Ageing and Health (2016-2020)
 5 Strategic Objectives
Commitment
Age-friendly environments
Re-aligning health systems
Developing systems for providing long-term care
Better measurement, monitoring and research
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38. OVERCOMING
STRENGTH WEAKNESS
THREAT OPPORTUNITY
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INTERNAL
EXTERNAL
• Readily available
resources
• Human resources
• Logistic
• Passionate team
• Addressing current issue
• Inventing new Module
• Financial constraints
• Acceptance
• Students
• Family
• Understanding
• Top management support
(National Agenda)
• Participants
• Available slot

39. Educate the
primary school
children on the
importance of
elderly population
Increase awareness
among the primary
school children
about elderly
population
Inculcate the culture
of combating
ageism among
school children to
reduce the
generation gap
1 2 3
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40. Conclusions
 Elderly Health are significant health hazards to the aging society.
 They are associated with significant morbidity and can cause mortality.
 Most syndromes are multi-factorial, involving an interaction between
intrinsic risk factors, activity, and environment.
 Identifying risk factors can help to evaluate the problems, and to plan
personal, and community intervention strategy.
 Medical, rehabilitative, environmental and behavioral interventions
may help to decrease unwanted complication.
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