Geriatric medicine

1. PREVENTION OF GERIATRIC
PROBLEMS IN AGEING

2. • “In the end, it’s not the years in your life that
count. It’s the life in your years”
- Abraham Lincoln
• “You do not heal old age .You protect it; you
promote it; you extend it”
-Sir James Sterling Ross

3. GERAS-Old age IATROS- Physician
GERONTOLOGY
Study of the
physical and
psychological
changes which are
incident to
old age
SOCIAL
GERONTOLOGY
CLINICAL
GERONTOLOGY
(OR)
GERIATRICS
EXPERIMENTAL
GERONTOLOGY

4. PREVENTIVE MEDICINE
AND
GERIATRICS

5. PREVENTIVE GERIATRICS
• It is the art and science of preventing disease in
the geriatric population and promoting their health
and efficiency
• It aims:
1. To potentially increase the length of life by
preventing physical, psychological and iatrogenic
disorders.
2. To prolong the period of independent living.
3. To enhance the quality of remaining life, however
long.

6. • Hippocrates noted conditions common in
later life.
• Aristotle offered theory of ageing based on
loss of heat.
• The word geriatrics was invented by Ignatz
L. Nascher, a Vienna born immigrant to the
united states.
• Nascher was the father of geriatrics and
Majory Warren was its Mother.
• The 1st Geriatric service was started in U.K
in 1947.
• Geriatric department at GH, Chennai was
established in 1978.
• Post Graduate course in Geriatric medicine
has been started in 1996 at Madras medical
college.
• Prof. V.S. Natarajan was the first Geriatric
professor in India.

7. SIZE OF THE PROBLEM
• In the year 2002, there were
an estimated 605 million old
persons in the world, of which
400 million are living in low-
income countries.
• Italy and Japan have the
highest proportion of older
persons (about 16.7 per cent
and 16 per cent respectively
the year 2003).
• By 2025, the number of elderly
people is expected to rise
more than 1.2 billion with
about 840 million of these in
low-income countries
• In India, for the year 2003, the
SRS estimates were 7.2 per
cent of total population were
above the age of 60 years.
• 1980- 5.3%
• 2000- 7.7%
• 2025- 13.3% ( 1.2
billion )
• 71% - Developing
World
• 70 million population in
India-2001
• 177 million population -
2025
• 40% below poverty line
• 73% illiterate

9. PROBLEMS DUE TO AGING PROCESS
• Senile cataract
• Glaucoma
• Nerve deafness
• Osteoporosis affecting mobility
• Emphysema
• Failure of special senses
• Changes in mental outlook

10. PROBLEMS ASSOCIATED WITH
LONG-TERM ILLNESS
1. Degenerative diseases of Heart and
Blood vessels
• Inner walls of arteries breakdown and a lipoid material is
deposited. This in time is replaced by calcium which leads to
atherosclerosis.
2. Cancer
3. Accidents
• Bones become fragile due to certain amount of
decalcification as a result of which they break easily.
• Fracture of neck of femur is very common.

11. 4. Diabetes
5. Diseases of Loco motor system
• Fibrositis, myositis, neuritis, gout, rheumatoid arthritis,
osteoarthritis, spondylitis of spine, etc.
• These conditions cause more discomfort and disability
than any other chronic disease in elderly
6. Respiratory illness
• Chronic bronchitis, asthma, emphysema are of major
importance.
7. Genitourinary system
• Enlargement of the prostate, dysuria, nocturia, frequent
and urgency of micturition are the common complaints.

12. PSYCHOLOGICAL PROBLEMS
(1)MENTAL CHANGES
Impaired memory, rigidity of outlook and dislike of change.
(2)SEXUAL ADJUSTMENT
Between 40 and 50, there is cessation of reproduction by
women and diminution of sexual activity on the part of men.
Irritability, jealousy and despondency are very frequent.
(3)EMOTIONAL DISORDERS
Result from social maladjustment.

15. 1. DIET AND NUTRITION
• A good diet reduces the chances of developing the diseases of
old age.
• One of the problem is excessive fat intake. Saturated fats and
trans-fatty acids, have been linked to raised cholesterol levels in
the blood, leading to increased risk of cardiovascular diseases.
• The diet should be balanced with less saturated fats and oils;
should contain lots of fruits and vegetables; salt and sugar
should be less; include plenty of calcium rich food; eat high
fibre diet.
2. EXERCISE
3. WEIGHT
• Overweight and obesity.

16. 4. SMOKING
• Former smokers live longer than continuing smokers; smoking cessation
at the age of 50 years reduces the risk of dying within the next 15 years
by 50 per cent
5. ALCOHOL
• sensitivity to the effect of alcohol increases with age.
• Older people achieve a higher blood alcohol concentration than younger
people after consuming an equal amount of alcohol.
• Drinking is linked to liver diseases, stomach ulcers, gout, depression,
osteoporosis, heart disease, breast cancer, diabetes and hypertension.
6. SOCIAL ACTIVITIES
• People who become socially isolated - are less healthy.
• Getting out and keeping involved with others creates a sense of
belonging.
• Mixing with other people of similar age, can help people realize that they
are not alone.

18. NONPHARMACOLOGICAL MEASURES TO
PREVENT DISEASES
Non pharmacological measures Potential Effect
a) Diet a)
i) Fat 30% of total calories i) Decreases risk of atherosclerosis,
colorectal, breast and prostrate
cancers, large bowel diseases.
(10% monounsaturated and
10% polyunsaturated)
ii) High fruit and vegetable intake ii) Protective for cardiovascular diseases,
respiratory function, cataract, macular
degeneration, diabetes, colorectal,
breast and prostrate cancers.
iii) High complex carbohydrates, iii) Protective for cardio vascular diseases,
non starch polysaccharides diabetes, cancers
iv) Reduced sodium and iv) Lowers hypertension and cardiovascular
increased potassium intake diseases.

19. b) Physical activity b) Protective for
cardiovascular diseases,
diabetes, osteoporosis
c) Mental activity and social support c) Retards
cognitive decline
d) Environmental pollution control d) Decline of
CV and respiratory
diseases.
e) Stoppage of smoking/Tobacco e) Decreases risk
chewing of lung cancers, oral
cancers, cardiovascular
diseases, respiratory diseases,
peptic ulcers.

20. PHARMACOLOGICAL MEASURES TO
PREVENT DISEASES
Preventive effect Pharmacological measures
a) Atherosclerosis - Hypoglycemic drugs
Control of risk factors: - Antihypertensive
diabetes, hypertension, - Lipid lowering agents
obesity, hyperlipidimia - Aspirin, Macrolide group of
antibiotics
- Antioxidants, Vitamin E , B –
carotene
- Hormone replacement therapy in
post menopausal women
.

21. b) Osteoporosis / Fractures Calcium and Vitamin D
Physical exercises
Hormone replacement
therapy in post
menopausal women
Bisphosphonates
c) Cognitive functions preservation Antioxidants - Vitamin E
NSAIDs
d) Immune functions preservation Vaccination against
(i) Tetanus
(ii) S. Pneumonae
(iii) H.Influenzae, Zinc,
Vitamin B6 and B 12,
Antioxidants
Vitamin E, Vitamin A,
Vitamin C, selenium

23. Areas potentially amenable to
preventive health care in the elderly
• Primary
• Health habits: smoking, alcohol abuse, obesity, nutrition, physical activity, sleep
• Coronary heart disease risk factors
• Immunization: influenza ,pneumovax, tetanus
• Injury prevention, Iatrogenesis prevention, Osteoporosis prevention
• Secondary : Screening for
• Hypertension
• Diabetes
• Periodontal disease, dental caries
• Sensory impairment, medication side effects,
• Colo - rectal cancer, breast cancer, cervical cancer, prostatic cancer
• Nutritionally-induced anemias, depression, stress, urinary incontinence, podiatric problems, fall risk
• Tuberculosis (high risk)
• Syphilis (high risk) stroke prevention, myocardial infarction
• Tertiary
• Rehabilitation : physical deficits, cognitive deficits, functional deficits
• Caretaker support, Introduction of support necessary to prevent loss of autonomy

24. PRIMARY PREVENTION
Condition Prevention strategy Comments
1. Infection Immunization
(a) Influenza Yearly Though beneficial,
it is not possible as
a national
programme, but may
be given in
vulnerable group
(b) Pneumococcal Once at 65 years Repeated 6 yearly
in vulnerable
group like asplenic
patients, patients
on dialysis

25. c) Tetanus/diphtheria Every 10 years Possible in all elderly
(already existing national
programme for children)
2. Cigarette / Tobacco Counseling by Mass media involvement
use / Alcoholism physicians / health to create awareness
workers / education
by mass media
3. Nutrition Counseling / health Mass media involvement
education for balanced to create awareness
diet high in fruits and and change habits
vegetables

26. Counseling / health education Mass media
4. Sedentary lifestyles for exercises especially programs to create
flexibility exercise aimed to awareness about
improve balance benefit of exercise

27. SECONDARY PREVENTION
Condition Screening Frequency Definitive test Corrective step
Visual Visual acuity 1 – 2 years Ophthalmological Cataract removal
Impairment (Snellen’s chart, examination or other measures
Jaeger's chart)
Hearing Hearing tests 1 -2 years Audiometry Hearing aid, other
Impairment measures
Hypertension Blood pressure 1- 2 years *********** Non -
management pharmacological
measures

28. Breast cancer Breast 1 – 3 years Biopsy Definitive
examination treatment
Mammography
Cervical Pap smear in 1 – 3 years Biopsy Definitive
cancer women not treatment
screened
earlier in life
Malnutrition B.M.I ( Height 1 year Nutritional Diet counseling/
and weight ) assessment Nutritional
supplements

29. CANCER SCREENING
• Incidence of breast cancer increases with age (up to 75 years).
• Manual breast examination every year by a clinician is a highly
recommended screening measure to detect breast malignancy.
• Mammography cannot be a mass screening tool as it is not
widely available.
• Cervical cancer is often viewed as a problem of young women.
The truth is, 25% of new cervical cancers and 40% of total
cervical cancer deaths occur in the elderly.
• Pap smear, because of its cost benefit ratio, can be used both
for young and older women once every three years at least, as
a mass screening tool.

30. For prostate cancer neither the most
widely recommended diagnostic tools i.e.
digital rectal examination or prostate
specific antigen (PSA) nor the
effectiveness of early treatment of prostate
cancer are definite enough to justify mass
screening.

31. • Seventy-five percent of colorectal cancers occur in the
65+ population.
• A sigmoidoscopic screening every 3-5 years can result in
a 70% detection in colorectal cancers occurring in an
area within reach of the sigmoidoscope.
• Mass screening with sigmoidoscopy is not
recommended due to the cost involved but selective
screening in high risk groups is however recommended.
• Oral cancers are quite common in tobacco chewing
populations. They may be detected at an early stage by
oral examination and can be effectively treated.

32. MOST VALUABLE PREVENTIVE MEASURE
• To take a careful history, focusing not only on the “chief
complaint” but also on common and often hidden
conditions such as falls, confusion, depression, alcohol
abuse, sexual dysfunction, and incontinence.
• To anticipate the complications for which the specific
patient is at risk and take steps to avert them.

34. THANK YOU