FYI-frailty-primary-care-unit-role

1. Geriatrics for
the public health centre:
introduction
Sukanya Jongsiriyanyong
Department of Health, Bangkok Metropolitan Administration
22.Aug.2014

2. Aging Society
www.thelancet.com. Published online February 8, 2013
Population ageing
accelerating rapidly
worldwide
Geriatrics for the public health centre: Introduction
9% 14% 20%
พ.ศ.2553 พ.ศ.2564 พ.ศ.2574
Epidemiology

3. Geriatrics for the public health centre: Introduction

4. Geriatrics for the public health centre: Introduction

5. RAMPS
• Reduced body reserve
• Atypical presentation
• Multiple pathology
• Polypharmacy
• Social adversity
5
Geriatrics for the public health centre: Introduction

6. Reduced body reserve
RAMPS
Geriatrics for the public health centre: Introduction

7. Age-related change in
lingual pressure
More pooling/pocketing
in the pharyngeal recesses
Increasing the risk of adverse
consequences due to ineffective
deglutition
!
Dysphagia

8. Atypical presentation
• Hyperthyroidism
• Hypoglycemia
• Infection
• Acute coronary syndrome
• Depression
RAMPS
Geriatrics for the public health centre: Introduction

9. Multiple pathology
RAMPS
Iatrogenesis
Instability
Immobility
Inanition
Incontinence
Dementia
Depression
Delirium
Geriatrics for the public health centre: Introduction

10. Comprehensive geriatric assessment
(CGA)
• Physical assessment
• Mental assessment
• Social assessment
• Functional assessment
10
Geriatrics for the public health centre: Introduction

11. Multiple pathology
Impression: 81-year-old-female; 14-year-education;
engineer; married
1. Abrasion wound both knees due to fall
2. Hypertension with drug-induced postural hypotension
3. Paroxysmal atrial fiﾞbrillation (on anticoagulant therapy)
4. Diabetes mellitus with diabetic retinopathy
5. Osteoarthritis of both knee joints with instability
6. Established osteoporosis with spinal stenosis
7. Moderate dementia, probable Alzheimer’s disease with CVD
8. Vascular parkinsonism
9. Major depressive disorder in remission
10. Malnutrition with oropharyngeal dysphagia
11. Urge urinary incontinence
RAMPS
Geriatrics for the public health centre: Introduction

12. Polypharmacy
Drug-drug interaction
RAMPS
Medical reconciliation
Warfarin
AllopurinolMetformin
DigoxinOmeprazole
Chlorpheniramine Diazepam Insulin
“Start low, go slow”
Geriatrics for the public health centre: Introduction

13. Social adversity
RAMPS
depression in the elderly
adherence in the elderly
Geriatrics for the public health centre: Introduction

14. HAZZARD’S GERIATRIC MEDICINE AND GERONTOLOGY 6th Ed.
Lancet 2013; 381: 752-62.
Health and Quality of Life Outcomes 2009, 7:70.
Open Heart 2014;1:e000033.
Frailty

15. Frailty prevention
Healthy diet
Resistance exercise
Aerobic exercise
Tai-chi
Optimized management of medical conditions
Frailty assessment
Promising intervention
Geriatrics for the public health centre: Introduction

16. Open Heart 2014;1:e000033.
กลุ่มติดสังคม
กลุ่มติดบ้าน
กลุ่มติดเตียง
Primary prevention!
Secondary prevention!
Tertiary prevention

17. Primary prevention for the public health centre
RAMPS
Frailty assessment
Promising intervention
Geriatrics for the public health centre: Introduction

18. Influenza vaccine annually
dT vaccine q 10 years
Primary prevention for the public health centre

19. Secondary prevention for the public health centre
“ใน1ปีที่ผ่านมา เคยหกล้มไหมคะ” “รับประทานได้ไหมคะ”
RAMPS
Frailty assessment
Promising intervention
Geriatrics for the public health centre: Introduction

20. Am Fam Physician 2008;78(12):1369-1374, 1376.
Secondary prevention for the public health centre

21. Advanced Mechanical-altered Pureed
Nectar-like Spoon-thickhoney-like
Tertiary prevention for the public health centre

22. Swallowing technique for stroke patient with dysphagia
• Eat slowly, not rushed
• Small amounts of food/liquid
• Concentrate on swallowing
• Avoid mixing food & liquid in the same mouthful
• Use stronger side of the mouth (unilateral weakness)
HAZZARD’S GERIATRIC MEDICINE AND GERONTOLOGY 6th Ed

23. Modernized medicine
PALLIATION OF SYMPTOMS
Malignancy
Dementia
CHF
COPD
ESRD
Cirrhosis
Geriatrics for the public health centre: Introduction

24. Doing nothing
Humanized medicine
การดูแลรักษาอย่างมีมนุษยธรรม
PALLIATION OF SYMPTOMS
Palliative care
Geriatrics for the public health centre: Introduction

25. Humanized medicine
การดูแลรักษาอย่างมีมนุษยธรรม
PreventionFrailtyRAMPSAging society
Geriatrics for !
the public health centre: introduction
Geriatrics for the public health centre: Introduction

26. Thank you
sukanya.jongsiri@gmail.com
Geriatrics for the public health centre: Introduction