Dr. Anil Kumar discusses issues faced by the elderly population in rural India and how communities can help address them. He outlines common medical issues like diabetes, hypertension, and injuries. Psychological problems like depression are also discussed. The document then provides strategies for primary prevention, including lifestyle modifications, injury prevention, exercise, and social support. It emphasizes training community health workers to monitor vital signs and provide basic emergency care for issues like hypoglycemia, hypertension, and pneumothorax. The summary concludes by stressing the importance of a community-based approach and national policies to support healthcare for the aging population.

1. Dr Anil Kumar
Associate Professor.
Department of General Surgery
HoD Trauma & Emergency.
AIIMS-Patna.

2. Objective:
 Issues in old age with its burden on society.
 How this issues can be sorted out at community level?
 Psychomotor skills like How to check Pulse, BP, Blood
sugar .
 How to deal emergency situation as well as CPR for
cardiac arrest patient.

3. Script:
 Village.
 Ramu kaka: Mr Arjun ji
 Son of Ramu kaka: Mr sanjeev
 Wife of Mr Sanjeev : komal
 Friend of Mr Sanjeev: Mr Krishna
 Sarvan Kumar: Mr Amit Kumar Singh
 Other villagers : Mr vikash, Mr kundan, Mr Shakya,
Mr sakir, Mr Sufiyan.
 Concept : Dr Anil Kumar.

5. Geriatric: ( Elderly)
 A geriatric patient is an older person with
impairment of function.
 Census 2006- 2009 : Life expectancy at birth was
65-67 years .
 In year 2011-2016 : 67-68 years

6. Statistics:
 75% of elderly persons - Rural areas.
 48.2% - women and 55% are widows.
 73% - illiterate
 66% ( BPL) - Without adequate food, clothing, or
shelter.
 27% of older Indians ( >80 years) confined to bed –
Need care!!!!!

7. Future trends in terms of
population for geriatric group.
 As per the 1951 census= 20 million
 As per the 1991 census= 57 million
 Presently = 120 million
 By the year 2050 = 324 million.
(20% of total population)
 The population over the 60 years has tripled in last 50
years in India and is in increasing trends.
 So the major component of our population would be
old age person in future.

8. Main issues:
 Medical:
 Social/ Family
 Economical.

9. Medical Issues:
 Head to toes?????????
 All systems - involved and compromised.

12. Retention of urine, increased frequency

14. Issues in Old Age:
 Diabetes
 Hypertension & CAD
 Joint Pain. Medical Problem
 Depression, neuro-degenerative
disorders like Alzheimer's disease
 Infections( Low immunity) : TB- more common.

15. Issues:
 Impairment of sensory function- Hearing( MC morbidity
in elderly) followed by visual impairment like Cataract
& refractory errors.
 Urinary problem-BPH(>50 years): 65%
 Respiratory problems ( Asthma, Bronchitis,COPD) – 40%
 Cancer: Common.
 Chewing and dental problem.

16. Issues:
 Diarrhea: ORS
 Skin disease.
 Anemia.
 Gastritis.
 Worm manifestation.: NO WORM (ALBENDAZOLE)

17.  3.7 million people suffer from dementia
 40 million people suffer from poor vision.
 6 million : Stroke / year
 1 in 3 suffer from Hypertension, Arthritis &
Depression.
 1 in 5 has Bowel disorder, Auditory problems & DM.
 1 in 10 falls and sustains a fracture/Injury and Cancer is
10 times more common
Burden :

20. Approach:
 Regular follow up to detect change in refraction.
Frequent need of power change is indicative for
advanced stage of cataract.
 Glaucoma is associated with cataract.
 Good nutrition may prevent the onset.
 Family history – Glaucoma -must keep such patient in
follow up.

26. Psychological problem:
 Loss of sleep & Anxiety.
 Feeling of Guilt ( I am burden for my family)
 Impulse of suicide.
 Loss of enthusiasm in life.

27. Major Depression:
 3% in Community
 14% after 2 years of spouse death.
 15% in Medically ill.
 25% in people who requires long-term-
care.

29. Elder Abuse:
 Physical Abuse: Pain or Injury
 Financial abuse: The illegal exploitation or use of
funds of older person
 Sexual abuse: Non- consensual sexual contact of any
kind with older person
 Neglect: Not giving care or other emotional support .

34. How to prevent and manage:
 Primary Prevention: (LIFE)
1. Life style modifications
2. Injury prevention
3. Fully active
4. Emotional support.
 Secondary prevention: Early Diagnosis & Treatment
 Tertiary Prevention: Rehabilitation( Hospice care)

35. Primary Prevention:
Life style
modification

36. Drinking Water

37. Brushing the teeth

39. Yoga.

40. Bathing & washing

41. Pray for God

42. P Pray

43. Pray

44. Blood Sugar Check Up

45. How to check Blood sugar at Home

46. Hypoglycemia:
 Hunger, Tremor, Sweating
 Anxiety , Irritability, accelerated heart rate
 Weakness , confusion
Complications
 seizures
 loss of consciousness and Coma
H/o
Insulin
intake &
skip of
meal

48. Hypoglycemia is more dangerous.
Advise more
glucose, chocolate,
meal to treat
hypoglycemia.

49. Drinking Tea

50. Tea
 Amount : Half Cup
 Lemon or Black Tea: Preferred.
 In case of Gastritis: Better to avoid: Prefer Lemon
Juice.

51. Breakfast

52. Reading Newspaper

53. BP Check-up

54. Morning Medicine:

55. Exercise:

56. Playing with Kids:

57. Playing GAMES

58. TALK TO FAMILY MEMBERS

59. WATCHING TV

60. LUNCH

61. REST & SLEEPING

62. DRINKING WATTER

63. TAKE LONG BREATH

64. GARDENING:

65. Plantation:

66. Evening Tea

67. Laugh a lot: Joke

68. COOCKING

69. NO NO SMOKING

70. NO NO ALCOHOL

71. WESTERN TOILET

72. Don’t upset / angry

73. Dinner ( Together)

74. Don’t forget to take
medicine

75. VAJRA AASAN

76. NIGHT WALK( 10-20 )

77. Brushing before sleep.

78. GOOD NIGHT –SLEEP

79. Life style modification:
 Avoid many disease to occur like DM,
HYPERTENSION, OBESITY, JOINT PAIN
 Keep them engaged all the day
 Avoid Depression.

80. Primary Prevention:
Injury
prevention and
management

81. How to deal Injury

82. IF Injury occurred
How will you
approach?

83. Primary Survey
 Airway with cervical spine protection
 Breathing and ventilation
 Circulation with Hemorrhage control
 Disability: GCS
 Exposure with Hypothermia control

84. For AIRWAY: GCS:
 EYE OPENING
 MOTOR RESPONSE
 VERBAL RESPONSE.

85. GCS: Eye Opening
Response Score
Eye Opening Spontaneously 4
Eye opening on Verbal Response 3
Eye opening on Painful Stimuli 2
Eye opening - None 1

86. Verbal Response
Response Score
Fully Conscious 5
Confused 4
Inappropriate words 3
Incomprehensive words 2
None 1

87. Motor Response: Best Predictor
Response Score
Obeys Commands 6
Localize the Pain 5
Withdrawal( Normal Flexion) 4
Abnormal Flexion( Decorticate) 3
Extension( Decerebrate) 2
None 1

88. In Patient with low GCS-Jaw
Thrust/Chin Lift
 Tongue can fall backward
 Can obstruct the hypopharynx
 Can be managed by- Jaw Thrust
-Chin Lift
 Don't do Head tilt in Trauma patient .

89. Jaw Thrust

90. Chin Lift

91. Breathing: In Respiratory problem

92. Tension Pneumothorax:
 Dx – Absolutely clinical
-Restricted Chest Movement
-Absent Breath Sound
-Hyper-resonant note on Percussion
 Don't wait for radiological confirmation
 Immediately do the needle thoracostomy/ICD
( Definitive t/t)
11-09-2018

93. T/t of Tension Pneumothorax:
11-09-2018
Needle
Thoracostomy in
2nd I.C.S in M.C.L.
Chest tube insertion in 5th
I.C.S in M.A.L.

94. CXR - Pneumothorax.
11-09-2018
JPNATC, AIIMS

95. Bleeding : Pressure Bandage

96. Circulation:
 PULSE: 72 --- 100 Per minute
 Blood Pressure: 120/80 mmHg

98. Practice
 BP Measurement

99. Primary Prevention:
Fully Active:

100. Emotional support:
Excellent impact of good emotional
support: Promote it

104. Stroke: Known case of
Hypertension:

105. Stroke:
 Raised BP.
 Loss of motor power.
 Deviation of face.
 Difficulty or unable to speech.
 Eye opening – compromised.

106. Stroke:
 Head tilt
 Jaw Thrust.
 If GCS less than 8 shift to hospital immediately.

107. After discharge from hospital
 Nursing care & Physiotherapy.
 Ryl’e tube feeding.
 Change of posture.
 Care of Bladder and Bowel.
 Follow up.

108. Diabetes:
 Exercise/walk- minimum 1 hours.
 Sugar free diet.
 Frequent and light diet.
 Oral Hypoglycemic agent /Insulin.
 Care of Foot, Heart, eyes, kidney, Blood vessels and
MI.

109. Heart Attack:
 Cold sweating
 Nausea or Vomiting.
 Light headache and CHEST PAIN RADIATING TO
LEFT ARM OR NECK OR BACK
 Anxiety , Palpitation
 Unexplained fatigue.

110. Heart attack
 Aspirin 300 mg immediately.
 Thrombolysis ( within 2 hours)
 Angioplasty

111. CPR:
If Respiratory system and circulatory system
No carotid pulse and No evidence of respiration
Start CPR

112.  Practice:

113. Nasal Bleeding:
 Check BP- Usually raised - Control it slowly
 Pressure over nose or Pack ( Nasal pack)

114. Raise the head end of the bed

115. Classification of Elderly
 Group 1: Physically and Mentally Fit
 Group 2: Mild Functional Limitations or Mild
Cognitive Impairment
 Group 3: Severe functional limitations or
cognitive Impairment.

116. Group 1: Physically & Mentally Fit:
 Age Range : 60–70 years.
 Goal of care: Need more of health promotional
activities to keep them physically & mentally active.
 Nutrition support
 Physical activity
 Social Interaction LIFE STYLE MOD.
 Psychological support

117. Group 2: Mild impairment
 Age Range : 70–80 years.
 Goal of care : Require assistance to live independently.
 Physiotherapy
 Psychological support need special transport, help
of social worker or children.
 They may need hospitalization
for acute illness.

118. Group 3: severe impairment
 Age: Usually >80 years.
 Many co-morbidity like DM, HTN, STROKE, Dementia.
 This group needs home care or hospice care by hired
home care providers and need for palliative care setup
for such elderly.
 Goal of care: To keep them comfortable in their own
surroundings or keep them comfortable in hospice.

119. Policy:
 Promotion of YOJNA like S.K.Y or others model.
 Establishment of PHC specialized in geriatric care
near to rural area ( within 1 km )
 Improve the transport facility dedicated for geriatric
patient( Geriatric Ambulance).
 Peripheral health workers and community health
volunteer : Need proper training

120. Promotion :
 Health camp , Mobile clinic : Useful (Help Age
India, AIIMS-Patna)
 NGOs, charitable organizations, and faith-based
organizations could play an important role in this
aspect.

121. Awareness :
 Knowledge and awareness regarding geriatric
problems- “Community Geriatric Health Workers”
 Good nutrition, balanced diet and physical
exercise- Very important to improve the Qol.
 To create a feeling of well being- Meditation, Prayer,
and strategies for motivation should also be
included.

122. AIIMS Patna Model:
 Health promotion & preventive services ( Health
Camp)
 Diagnosis and management of geriatric medical
problems (Telemedicine)
 Day care services IPD
 Rehabilitative services, palliative care and home based
care as needed ( Sarvan Kumar Yojna)

123. Conclusion:
 Need to address total health like physical, social,
economic, psychological and spiritual aspects
 All the Medical Colleges, all the private health-care
institution, Police department and NGOs have to join
hands with the government to create geriatric
health-care facilities.
 Implementation of national policy strongly

124. Conclusion:
 Establishment of geriatric ward or at least some
reserved beds in every hospital.
 Aging for everyone begins at birth and ends with
death.

125. Thank You