This document provides an overview of geriatric care and the problems faced by the elderly population. It defines key terms like aging, geriatrics, and gerontology. It discusses the physiological, pathological, psychological, and social problems commonly seen in older adults, such as loss of mobility, cardiovascular disease, dementia, depression, and abuse. It also outlines the rising trends in life expectancy globally and the projected growth of elderly populations in countries like India. The document emphasizes the importance of geriatric assessment and preventive healthcare for older populations, which includes screening, rehabilitation, injury prevention, and supporting caregivers.

1. Geriatric Care

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.

4. Branches of geriatrics
 Gerontology
 Clinical gerontology
 Social gerontology
 Geriatric gynecology
 Experimental gerontology
 Preventive gerontology

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

8. 0
2
4
6
8
10
12
14 KERALA
GOA
TAMIL
NADU
PUNJAB
HIMACHAL
PRADESH
MAHARASHTRA
ANDHRA
PRADESH
PUDUCHERRY
ODISHA
KARNATAKA
UTTARAKHAND
HARYANA
INDIA
WEST
BENGAL
LAKSHADWEEP
TRIPURA
MADHYA
PRADESH
GUJARAT
CHHATTISGARH
UTTAR
PRADESH
RAJASTHAN
JAMMU
&
KASHMIR
BIHAR
MANIPUR
JHARKHAND
NCT
OF
DELHI
ASSAM
SIKKIM
ANDAMAN
&
NICOBAR…
CHANDIGARH
MIZORAM
NAGALAND
DAMAN
&
DIU
MEGHALAYA
ARUNACHAL
PRADESH
DADRA
&
NAGAR
HAVELI
Percentage of elderly (60 years or more) to total population,
India, States and UTs, Persons, Census 2011 and 2001
%-Old Age 60+ years P 2011 %-Old Age 60+ years P 2001
 In Census 2011, 8.6 % of persons are in age group 60+ years compared to 7.4
% in Census 2001
 Aged persons have increased in all the States and UTs, except in Daman & Diu

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

22. Haematology
Reduced bone
marrow reserve
Anaemias
Reduced T-cell
function
Non-resolving
infections
Prone to
infections
Increased
synthesis of
auto-antibodies
Auto-immune
disorders

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.

26. PREVENTION AND
MANAGEMENT

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.”

28. Components of
assessment
 Physical
 Functional
 Psychological-
 cognitive
 affective
 Socio-economical
 Environmental

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

42. Thank you