geriatric health care

1. Health care of the elderly
Preventive medicine view

2. Geriatrics: The care of aged
clinical gerontology: The study of the physical
& psychological changes which are incidental to
old age is clinical gerontology.

3. AGEING
•It is a progressive and generalized impairment of
body functions.
•People more than 60 years are considered
elderly.
•Old age is not a disease but a normal and
inevitable biological phenomenon.

4. 0
200
400
600
800
1000
1200
1400
1600
1800
2000
2002 2025 2050
millions Number of people aged 60 and over
world developing countries developed countries

5. Branches of geriatrics
•Gerontology.
•Clinical gerontology.
•Social gerontology.
•Geriatric gynecology.
•Experimental gerontology.
•Preventive gerontology.

6. Demography of geriatric population in
Egypt in 2006
•persons aged 60 and over represent 6.9% of the
total population.
•Illiteracy is 81% in females and 64% in males.
•Working males are 28% and females are 3%.
•Life expectancy in males & females was 60.5 &
63.5 y in 1986 and increased up to 69.2 & 73.6 y in
2006 respectively.
•Elderly abuse according to WHO is 4-6%.

7. Minimum geriatric competencies
The domains are:
•Cognitive and behavioral disorders.
•Medication management.
•Self-care capacity.
•Falls, balance and gait disorders.
•Atypical presentation of disease.
•Palliative care.
•Hospital care for elders, and health care planning
and promotion.

8. Health problem
•Medical
•Nutritional
•Accidents
•Elderly abuse
•Social problem of aging

9. Morbidity among elderly
•The prevalence of most chronic diseases and
definite disability increases with age.
•The prevalence of functional impairment
increases with age from 13% among persons
aged 65 to 69 years to 35% among those aged
85 years and older.

10. Mortality among elderly
Heart disease, cancer and cerebrovascular
disease account for 75% of all deaths in elderly
aged 65 years and older.
Most cancer deaths are due to:
•lung cancer in men aged 65 to 84 years.
•prostate cancer in men aged 85 years and older.
•breast cancer in women aged 65 to 74 years.
•colon cancer women aged 75 years and older.

11. Mortality among elderly
•Infections, especially influenza and pneumonia
are still a major cause of mortality for frail older
persons.
•Accidents; with falls being the leading cause of
accidental deaths

12. Disease characteristics
•Multiple.
•Tendency to bed rest and confusion.
•Impaired sensibility to pain and temperature
regulation.
•Altered reaction to drugs.
•Symptoms are insidious non specific and atypical.
•Difficult diagnosis.
Limiting factors : muscle strength decrease –
osteoporosis – arthrosis of weight bearing joints –
atherosclerosis – defective sensory organs.

14. Great geriatric syndromes
(Geriatric giants)
•Conditions, not diseases
•Common in the elderly
Typically:
 Multifactorial
 Share risk factors
 Linked with functional decline, increasing frailty
and poor health outcomes.

15. Psychiatric complaints
These form 8.5% of the old age complaints.
These include:
• Alzheimer’s disease.
• Depression.
• Anxiety.
• Delirium.
• Schizophrenia.
• Personality disorder.
• Suicide and deliberate self harm.

16. PSYCHOLOGICAL SYMPTOMS
• Sleep.
• Interest.
• Guilt (“Are you a burden to others?”).
• Energy.
• Concentration.
• Appetite.
• Psychomotor changes.
• Suicidality (“Do you wish you could die?”).

17. Social problems
•Abuse
•Dependency: physical, financial and functional.
•Insecurity: Insecurity of being abandoned by
their children.
•Rehabilitation: This is one of the main problem
of old age.

18. Elderly Abuse
It refers to ill-treatment of an elderly person.
It can be:
-physical abuse.
-Psychological abuse.
-Financial abuse.
-Sexual abuse.

19. Preventive geriatrics
Life expectancy and future planning.
GHC starts from pediatric age.
Lifestyle and healthy aging.
Why?

20. 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.”

21. Needs of the elderly
1.Social need.
2. Economic needs.
3. Psychological needs.
4. Health needs.

22. Health services provided to
the elderly in Egypt
Governmental sector:
A. Ministry of health and population(MOHP):
•Primary, secondary and tertiary services.
•80% of services provided by MOHP are free and
20% paid.
•267 urban health care centers and 3595 rural
health care centers.

23. Health services provided to
the elderly in Egypt
•In 2007 the Egyptian Ministry of health &
population (MOHP)announced its plan to
establish the geriatric medicine specialty by
recruiting 89 doctors in 2008 to work as
geriatricians in the various elderly health care
units.
• Geriatric Medicine specialty was put in the
urgently needed specialties.

24. Health programs for older
people
The MOHP started from 2001 to develop health
programs for older people that include the
following:
•Short term training program for family physicians
by experts.
•Short term training program for community
nurses with collaborations of experts from Ain
Shams University.
•Memory clinic in the hospitals.
•Geriatric center for rehabilitation.

25. Health services provided to
the elderly in Egypt
B. Teaching hospitals and institutes
organizations (THIO)
9 general teaching hospitals and 10 research
institutes located mostly in Cairo.
C. Health insurance organization (HIO).
Provides insurance to workers in the formal sector.

26. Health services provided to
the elderly in Egypt
D. University hospitals
•Provides high quality care mostly in Cairo area
and generates significant resources.
•Primary, secondary and tertiary treatment.
E. Other Ministries
•Ministry of interior provides free health and
medical care for police and prisoners.
•Ministry of transport provides services for railway
employees.

27. By
Maged Hemaid Mohamed Salem