1) Diseases often present atypically in the elderly due to changes from the aging process and increased likelihood of multiple conditions. Symptoms may be non-specific like fatigue rather than typical features.
2) Assessment of any changes from baseline in functioning, behavior, or symptoms is important as subtle changes could indicate an underlying medical problem.
3) Atypical presentations can lead to misdiagnosis, delayed treatment, and worse outcomes in the elderly if the clinician is not experienced in geriatric care. A high index of suspicion is needed.
Common Geriatric Syndromes - July 2022 Dr. A.E.A. Jaiyesimi.pdfAdamu Mohammad
This document discusses geriatric syndromes and the increasing burden of diseases affecting the elderly population in Nigeria. It notes that life expectancy has improved worldwide, leading to an aging population. In Nigeria, reliable data is lacking but estimates suggest around 3.1% of the population is aged 65 and over, a proportion that is increasing. Common geriatric conditions discussed include stroke, Parkinson's disease, dementia, cancers, cardiovascular diseases, diabetes, arthritis, and renal diseases. The document emphasizes that geriatric syndromes can impact quality of life and notes some key problems to assess in elderly patients like falls, memory issues, incontinence, pain, mobility and more. Early detection of these conditions is important for treatment and rehabilitation.
Common Geriatric Syndromes - July 2022 Dr. A.E.A. Jaiyesimi.pdfAdamu Mohammad
The document discusses geriatric syndromes and care of the elderly. It notes that worldwide populations are aging as life expectancy increases. Geriatric syndromes are common health problems among seniors that affect function, quality of life, and risk of hospitalization. They include falls, immobility, incontinence, and cognitive impairment. A multidisciplinary approach is needed to assess and manage elderly patients with geriatric syndromes through comprehensive geriatric assessment, care planning, and addressing both medical and functional needs.
Geriatric medicine is practiced across various clinical settings to treat older patients. It is an important field because most doctors will treat many older patients, yet illness in older adults often presents atypically. A comprehensive geriatric assessment by a multidisciplinary team that includes a geriatrics doctor can improve outcomes for older patients by optimizing medical care, functional ability, and quality of life. Communication with older patients and their caregivers is key.
This document discusses the epidemiology and socioeconomic impact of aging. It covers topics such as gerontology, geriatrics, aging processes, worldwide demographics of the elderly population, Indian demographics, mortality rates, common diseases in older adults, disability, and the socioeconomic impacts of aging. Socioeconomic status is a key factor influencing the quality of life of older adults, including factors like income support, employment, healthcare costs, and poverty rates.
DEVOLOPMENTAL DISABILTIES IN OLDER PEOPLE NEW.pptxhashimedavath
Developmental disabilities can persist into older age and present unique challenges. Common conditions that contribute to disability in older populations include arthritis, cognitive impairment, cardiovascular and respiratory diseases, and falls. Effective management involves a combination of medications, physical therapy, lifestyle changes, and social support tailored to individual needs and conditions such as Alzheimer's disease, autism, Down syndrome, or cerebral palsy. Regular medical care and communication between individuals and healthcare providers are important to address evolving health issues.
this presentation will contains problem of old age, how can they affect the life of geriatric peoples, prevention and control of geriatric problems, national program for better health of old peoples, initiations done by private trusts to improve their health
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This document discusses health problems among different age groups. It begins by outlining the course, including sections on adolescents, adults and the elderly, and the handicapped. For adults and the elderly, it defines terms, classifies adults by age, and discusses common health problems associated with young, middle-aged and elderly adults. Key health issues for the elderly include effects of aging, long-term illnesses, and psychological problems. It concludes by providing recommendations for supporting elderly health, such as community involvement and ensuring access to healthcare.
Common Geriatric Syndromes - July 2022 Dr. A.E.A. Jaiyesimi.pdfAdamu Mohammad
This document discusses geriatric syndromes and the increasing burden of diseases affecting the elderly population in Nigeria. It notes that life expectancy has improved worldwide, leading to an aging population. In Nigeria, reliable data is lacking but estimates suggest around 3.1% of the population is aged 65 and over, a proportion that is increasing. Common geriatric conditions discussed include stroke, Parkinson's disease, dementia, cancers, cardiovascular diseases, diabetes, arthritis, and renal diseases. The document emphasizes that geriatric syndromes can impact quality of life and notes some key problems to assess in elderly patients like falls, memory issues, incontinence, pain, mobility and more. Early detection of these conditions is important for treatment and rehabilitation.
Common Geriatric Syndromes - July 2022 Dr. A.E.A. Jaiyesimi.pdfAdamu Mohammad
The document discusses geriatric syndromes and care of the elderly. It notes that worldwide populations are aging as life expectancy increases. Geriatric syndromes are common health problems among seniors that affect function, quality of life, and risk of hospitalization. They include falls, immobility, incontinence, and cognitive impairment. A multidisciplinary approach is needed to assess and manage elderly patients with geriatric syndromes through comprehensive geriatric assessment, care planning, and addressing both medical and functional needs.
Geriatric medicine is practiced across various clinical settings to treat older patients. It is an important field because most doctors will treat many older patients, yet illness in older adults often presents atypically. A comprehensive geriatric assessment by a multidisciplinary team that includes a geriatrics doctor can improve outcomes for older patients by optimizing medical care, functional ability, and quality of life. Communication with older patients and their caregivers is key.
This document discusses the epidemiology and socioeconomic impact of aging. It covers topics such as gerontology, geriatrics, aging processes, worldwide demographics of the elderly population, Indian demographics, mortality rates, common diseases in older adults, disability, and the socioeconomic impacts of aging. Socioeconomic status is a key factor influencing the quality of life of older adults, including factors like income support, employment, healthcare costs, and poverty rates.
DEVOLOPMENTAL DISABILTIES IN OLDER PEOPLE NEW.pptxhashimedavath
Developmental disabilities can persist into older age and present unique challenges. Common conditions that contribute to disability in older populations include arthritis, cognitive impairment, cardiovascular and respiratory diseases, and falls. Effective management involves a combination of medications, physical therapy, lifestyle changes, and social support tailored to individual needs and conditions such as Alzheimer's disease, autism, Down syndrome, or cerebral palsy. Regular medical care and communication between individuals and healthcare providers are important to address evolving health issues.
this presentation will contains problem of old age, how can they affect the life of geriatric peoples, prevention and control of geriatric problems, national program for better health of old peoples, initiations done by private trusts to improve their health
5. PBH 3215 HEALTH PROBLEMS OF ADOLESCENTS, ADULTS AND HANDICAPPED.pptxRajimusharaf
This document discusses health problems among different age groups. It begins by outlining the course, including sections on adolescents, adults and the elderly, and the handicapped. For adults and the elderly, it defines terms, classifies adults by age, and discusses common health problems associated with young, middle-aged and elderly adults. Key health issues for the elderly include effects of aging, long-term illnesses, and psychological problems. It concludes by providing recommendations for supporting elderly health, such as community involvement and ensuring access to healthcare.
This document discusses the assessment and management of geriatric patients in emergency settings. It covers the demographics of the elderly population, the aging process, common medical problems in the elderly, trauma considerations, and approaches to assessing and managing elderly patients. Special attention is needed due to physiological changes, multiple illnesses, sensory impairments, and other age-related factors that can impact care.
Geriatric health deals with the health of the aged. It focuses on promoting health and preventing/treating diseases in older adults. Key points covered include:
- Defining geriatrics, aging, and related terms
- Statistics on the aging population worldwide and in Bangladesh
- Common health problems faced by the elderly like chronic diseases, disabilities, and psychological issues
- The importance of lifestyle, family/community/national support, and integrated care approaches for healthy aging
- Challenges providing care for the elderly from health, economic, social, and ethical perspectives.
This document provides an overview of geriatrics and aging. It defines geriatrics as the care of aged people and notes it is a subspecialty of internal medicine focused on prevention and treatment of age-related disabilities. Key points include:
- Geriatrics aims to address common problems in old age like immobility, instability, intellectual impairment, incontinence, and multiple medical issues.
- Comprehensive Geriatric Assessment is a multidisciplinary approach to evaluate older patients' medical, psychological and functional status to maximize health and quality of life.
- Research seeks to understand aging processes to develop interventions that may slow or stop aging through approaches like modifying gene expression, repairing telomeres, or
This document provides an overview of geriatrics and common issues in caring for elderly patients. It discusses how biological age is more important than chronological age in clinical decision making. Frailty and disability are also addressed. Common geriatric problems like falls, delirium, incontinence and adverse drug reactions are examined in terms of presentation, evaluation, and management strategies. The importance of a comprehensive assessment, considering multiple comorbidities and functional status, is emphasized in developing treatment plans for elderly patients.
A chronic condition is a disease or illness that lasts for a long time or recurs frequently. Common chronic diseases include arthritis, asthma, cancer, diabetes, and some viral diseases. Chronic conditions are distinguished from acute conditions by affecting multiple body systems long-term and not being fully responsive to treatment. They may involve periods of remission or relapse. Chronic conditions can hinder independence and create additional limitations. Lifestyle factors like diet, exercise, not smoking, and limiting alcohol can help prevent or manage chronic diseases.
alzhemier's disease in neurological.pptxDrYeshaVashi
- Holoprosencephaly (HPE) is a malformation where the two cerebral hemispheres appear fused, caused by failure of cleavage of the embryonic cerebral vesicle. It has a spectrum of severity from alobar to lobar.
- HPE is diagnosed based on midline facial dysplasias present in 93% of patients. It is associated with developmental delay and seizures.
- Treatment focuses on managing complications like hydrocephalus, seizures, and endocrine issues. The prognosis depends on the severity of anatomical and neurological involvement.
Geriatric medicine focuses on frail older patients whose health is easily impacted by minor illness. These patients often have multiple medical issues and atypical presentations of conditions. Decisions about their care require considering biological age, tolerance for interventions, impact on management, and patient/family preferences. Falls are a major problem and can result from acute illness, syncope, or mechanical issues like weakness, poor vision or balance. Thorough evaluation and targeting modifiable risk factors can help prevent falls and fractures in older adults.
Do any of the following phrases sound familiar It’s nothing to wor.docxblossomblackbourne
Do any of the following phrases sound familiar: “It’s nothing to worry yourself sick over,” “I was sick with worry,” or “Don’t stress yourself out”?
These are not just warnings or expressions about too much negative mental activity. What does it mean to worry to the point of sickness? What does it look like to stress yourself out? For you, it could be a bout with insomnia. For someone else, too much worry could result in an upset stomach. Yet for another, excessive stress for a long period of time could contribute to high blood pressure and heart disease.
The type of illness that results from too much stress depends on a variety of factors. Your age, gender, ethnic heritage, culture, and even geographical location all influence your response to developing stress-related illnesses. Some populations are more vulnerable to the effects of stress, just as some populations are more susceptible to certain diseases. Population-based health care focuses on assessing health needs, planning culturally sensitive prevention and intervention programs, and improving public health.
In this context, populations are groups of people defined by a common condition that perhaps need focused health education, prevention programs, or treatment. The following are some examples of populations:
Pregnant women
Military personnel returning from war
Those with low socioeconomic status
Those experiencing discrimination
Refugees
Those with asthma
The elderly
Those experiencing significant loss
Illegal immigrants
Those with cardiovascular disease
Adult survivors of childhood sexual abuse
Victims of crime
Those with serious mental illness
Whether it is poverty, grief, or discrimination, the variety of stressors that members of these populations might encounter does not vanish overnight. As a result, the persistence of stress can contribute to long-lasting illness or chronic disease, such as heart disease, stroke, cancer, diabetes, obesity, and arthritis. Seventy percent of all deaths in the United States are due to chronic disease. Fifty percent of Americans have at least one chronic disease. Chronic diseases are the most common and expensive diseases facing the world and since most chronic diseases have modifiable risk factors, most are preventable. The most common modifiable risks are poor diet, lack of exercise, and tobacco, alcohol, or drug use.
.
Children with disabilities: concept of disability, definitions, categories, causes, rights, health and community care, prevention, community-based rehabilitation.
Geriatrics is the medical specialty dedicated to providing care for older adults. Geriatricians are trained to address health issues that may affect older patients differently than younger adults, such as multiple illnesses occurring at the same time or medications affecting older people differently. Common conditions seen in older adults include heart disease, arthritis, diabetes, falls, depression, Alzheimer's disease, and Parkinson's disease. As people age, assistive devices and home modifications may help extend independence by assisting with activities of daily living.
New Microsoft PowerPoint Presentation.pdfAliMufleh1
Geriatric rehabilitation aims to promote health and treat diseases and disabilities in older adults. It involves a team-based approach including physical therapists, occupational therapists, and other specialists. The goals are to prevent impairments, maintain function, and help individuals live as independently as possible through their lifespan. Physical therapy for older adults requires special skills to address aging-related changes and optimize mobility and quality of life.
This document discusses the management of diabetes in elderly patients. It notes that diabetes prevalence is increasing globally and is especially prevalent in aging populations due to increased complexity, comorbidities, and risk of functional decline. Proper management of elderly diabetes requires individualized, holistic care plans focused on safety, risk minimization, and maintaining quality of life. Key aspects of care include education, nutrition, exercise, medication management, screening and prevention of complications, and management of comorbidities like cardiovascular disease.
This document provides an outline of a chapter on health, illness, disease, nutrition, eating behaviors, exercise, and substance use across the lifespan. Some key points include:
- Children's health is impacted by immunizations, safety practices, and poverty which can lead to malnutrition. Adolescent health is influenced by social contexts like family, peers, and schools.
- Nutrition and eating behaviors change across development from infancy through adulthood. Issues like malnutrition, obesity, and eating disorders can impact health.
- Exercise provides physical and mental benefits across the lifespan but activity levels tend to decline with age. Regular exercise is linked to better health outcomes.
- Substance use often begins in adolescence
This document defines frailty and discusses its biological underpinnings. It begins by defining frailty as a clinical state of increased vulnerability to stressors due to age-related declines in physiological systems. Two main approaches to conceptualizing frailty are described: the phenotypic approach which sees it as a biological syndrome, and the deficit accumulation approach which views it as a multidimensional risk state. The document then discusses the potential biological mechanisms that can drive physical frailty, including declines in metabolism, nutrition utilization and skeletal muscle that trigger a cycle of physiological decline. It also briefly discusses the epidemiology and risk factors of frailty.
Cardiovascular diseases (CVDs) accounted for 17.9 million deaths worldwide in 2019, or 32% of all deaths. Heart attack and stroke caused 85% of CVD deaths. In low- and middle-income countries, over three quarters of deaths are due to CVDs. Addressing behavioral risk factors like smoking, diet, obesity, and alcohol can prevent the majority of CVDs. Early detection through screening and treatment management are also important for reducing CVD burdens.
This document provides an overview of epilepsy presented by Dr. KD Dele Ijagbulu. It discusses the introduction and epidemiology of epilepsy, defining it as a neurological disorder characterized by recurrent seizures. It then covers the impact of epilepsy on quality of life, including risks of death from seizures, difficulties with accurate diagnosis, and challenges with medication and treatment options. The document also addresses the aetiology, pathophysiology, classification, diagnosis and differential diagnosis of epilepsy.
This document discusses frailty, which is defined as an age-related clinical state of increased vulnerability and decreased ability to maintain homeostasis across multiple physiological systems. Frailty is characterized by declines in functional reserves and is related to, but distinct from, disability and disease. Frailty results from underlying physiological alterations associated with aging and can be compounded by disease. It increases vulnerability to stressors and risk of adverse health outcomes. Diagnosis focuses on clinical presentation and functional impairment. Treatment aims to identify frailty early, address underlying causes, prevent adverse outcomes through comprehensive geriatric care, and maintain strength, nutrition, and activity levels.
This document summarizes acute leukaemias, including their epidemiology, etiology, clinical features, investigations, classification, treatment, and special considerations. Acute leukaemias result from malignant transformation of haematopoietic stem cells and can be myeloid, lymphoid, or biphenotypic. Risk factors include genetic syndromes, radiation, chemicals, and viruses. Treatment involves supportive care, chemotherapy consisting of induction and consolidation phases, and sometimes stem cell transplant. Prognosis has improved with advances in diagnosis and therapy but acute leukaemias still require rapid assessment and treatment initiation.
This document provides an overview of renal tubular acidosis (RTA). It defines RTA as a condition where the kidneys are unable to appropriately acidify the urine, resulting in acid accumulation in the body. There are four main types of RTA - type 1 involves a defect in the distal tubule, type 2 involves a defect in the proximal tubule, type 3 is a combined defect, and type 4 involves hyperkalemia. The document outlines the pathophysiology, clinical features, diagnostic testing and management considerations for each type of RTA.
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This document discusses the assessment and management of geriatric patients in emergency settings. It covers the demographics of the elderly population, the aging process, common medical problems in the elderly, trauma considerations, and approaches to assessing and managing elderly patients. Special attention is needed due to physiological changes, multiple illnesses, sensory impairments, and other age-related factors that can impact care.
Geriatric health deals with the health of the aged. It focuses on promoting health and preventing/treating diseases in older adults. Key points covered include:
- Defining geriatrics, aging, and related terms
- Statistics on the aging population worldwide and in Bangladesh
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- The importance of lifestyle, family/community/national support, and integrated care approaches for healthy aging
- Challenges providing care for the elderly from health, economic, social, and ethical perspectives.
This document provides an overview of geriatrics and aging. It defines geriatrics as the care of aged people and notes it is a subspecialty of internal medicine focused on prevention and treatment of age-related disabilities. Key points include:
- Geriatrics aims to address common problems in old age like immobility, instability, intellectual impairment, incontinence, and multiple medical issues.
- Comprehensive Geriatric Assessment is a multidisciplinary approach to evaluate older patients' medical, psychological and functional status to maximize health and quality of life.
- Research seeks to understand aging processes to develop interventions that may slow or stop aging through approaches like modifying gene expression, repairing telomeres, or
This document provides an overview of geriatrics and common issues in caring for elderly patients. It discusses how biological age is more important than chronological age in clinical decision making. Frailty and disability are also addressed. Common geriatric problems like falls, delirium, incontinence and adverse drug reactions are examined in terms of presentation, evaluation, and management strategies. The importance of a comprehensive assessment, considering multiple comorbidities and functional status, is emphasized in developing treatment plans for elderly patients.
A chronic condition is a disease or illness that lasts for a long time or recurs frequently. Common chronic diseases include arthritis, asthma, cancer, diabetes, and some viral diseases. Chronic conditions are distinguished from acute conditions by affecting multiple body systems long-term and not being fully responsive to treatment. They may involve periods of remission or relapse. Chronic conditions can hinder independence and create additional limitations. Lifestyle factors like diet, exercise, not smoking, and limiting alcohol can help prevent or manage chronic diseases.
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- Holoprosencephaly (HPE) is a malformation where the two cerebral hemispheres appear fused, caused by failure of cleavage of the embryonic cerebral vesicle. It has a spectrum of severity from alobar to lobar.
- HPE is diagnosed based on midline facial dysplasias present in 93% of patients. It is associated with developmental delay and seizures.
- Treatment focuses on managing complications like hydrocephalus, seizures, and endocrine issues. The prognosis depends on the severity of anatomical and neurological involvement.
Geriatric medicine focuses on frail older patients whose health is easily impacted by minor illness. These patients often have multiple medical issues and atypical presentations of conditions. Decisions about their care require considering biological age, tolerance for interventions, impact on management, and patient/family preferences. Falls are a major problem and can result from acute illness, syncope, or mechanical issues like weakness, poor vision or balance. Thorough evaluation and targeting modifiable risk factors can help prevent falls and fractures in older adults.
Do any of the following phrases sound familiar It’s nothing to wor.docxblossomblackbourne
Do any of the following phrases sound familiar: “It’s nothing to worry yourself sick over,” “I was sick with worry,” or “Don’t stress yourself out”?
These are not just warnings or expressions about too much negative mental activity. What does it mean to worry to the point of sickness? What does it look like to stress yourself out? For you, it could be a bout with insomnia. For someone else, too much worry could result in an upset stomach. Yet for another, excessive stress for a long period of time could contribute to high blood pressure and heart disease.
The type of illness that results from too much stress depends on a variety of factors. Your age, gender, ethnic heritage, culture, and even geographical location all influence your response to developing stress-related illnesses. Some populations are more vulnerable to the effects of stress, just as some populations are more susceptible to certain diseases. Population-based health care focuses on assessing health needs, planning culturally sensitive prevention and intervention programs, and improving public health.
In this context, populations are groups of people defined by a common condition that perhaps need focused health education, prevention programs, or treatment. The following are some examples of populations:
Pregnant women
Military personnel returning from war
Those with low socioeconomic status
Those experiencing discrimination
Refugees
Those with asthma
The elderly
Those experiencing significant loss
Illegal immigrants
Those with cardiovascular disease
Adult survivors of childhood sexual abuse
Victims of crime
Those with serious mental illness
Whether it is poverty, grief, or discrimination, the variety of stressors that members of these populations might encounter does not vanish overnight. As a result, the persistence of stress can contribute to long-lasting illness or chronic disease, such as heart disease, stroke, cancer, diabetes, obesity, and arthritis. Seventy percent of all deaths in the United States are due to chronic disease. Fifty percent of Americans have at least one chronic disease. Chronic diseases are the most common and expensive diseases facing the world and since most chronic diseases have modifiable risk factors, most are preventable. The most common modifiable risks are poor diet, lack of exercise, and tobacco, alcohol, or drug use.
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Geriatrics is the medical specialty dedicated to providing care for older adults. Geriatricians are trained to address health issues that may affect older patients differently than younger adults, such as multiple illnesses occurring at the same time or medications affecting older people differently. Common conditions seen in older adults include heart disease, arthritis, diabetes, falls, depression, Alzheimer's disease, and Parkinson's disease. As people age, assistive devices and home modifications may help extend independence by assisting with activities of daily living.
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This document discusses the management of diabetes in elderly patients. It notes that diabetes prevalence is increasing globally and is especially prevalent in aging populations due to increased complexity, comorbidities, and risk of functional decline. Proper management of elderly diabetes requires individualized, holistic care plans focused on safety, risk minimization, and maintaining quality of life. Key aspects of care include education, nutrition, exercise, medication management, screening and prevention of complications, and management of comorbidities like cardiovascular disease.
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2. ATYPICAL PRESENTATIONS OF DISEASES IN THE
ELDERLY
.GENERAL(INTERNAL) MEDICINE UPDATE COURSE
• FACULTY OF INTERNAL MEDICINE
• NATIONAL POSTGRADUATE MEDICAL COLLEGE OF NIGERIA
• LECTURER: DR ALFRED E.A. JAIYESIMI : 26th July 2022
3. OUTLINE
➢ Definition and Demographic Implications of the
term Elderly
➢Ageing Process and Impact on Health
➢Ageing Vs Pathological Processes
➢Presentation of Diseases in the Elderly
➢Implications of Atypical Presentations of
Diseases in the Elderly
4. Definition and Demographic Implications of
the term Elderly
• The term ELDERLY is often used in a loose manner to imply persons advanced in chronologic years
in a community and is more of a socio-demographic classification
• As a chronologic phrase it refers to individuals who have attained the sixth decade of life and
beyond.
• As Western nations and highly developed countries –U.S.A; U.K; Israel; Japan e.t.c experience a
remarkable increase of Life Expectancy(average age at death) in a linear manner over the past
century and associated decrease in birth rate/fertility with improved childhood mortality rate the
population distribution pattern has shifted from a pyramidal pattern to squared or inverted
pyramid shape!
• A steady rise of life expectancy from 49 years for females and 45 years for males to about 84
years for females and 79 years for males presently occurs.
• Nigeria lacks accurate statistics of current population distribution but a cursory impression of
individuals attain the Sixth, Seventh and Eighth decades of life is not unusual.
• In Bangladesh life expectancy was 67.7 years in 2010 and 71.5 years in 2017. (Bangladesh Bureau
of Statistics)
5. WORLD-WIDE POPULATION ESTIMATES FOR THE ELDERLY AND
CLASSIFICATION
• ESTIMATES:
• YEAR Number(above 60 years old) World-population
• 2015 901 million 12.2%
• 2030 1402 million 16.5%
• 2050 2092 million 21.5%
• DEFINITION OF ELDERLY:
• Young Old : 60 to 69 years
• Middle Old: 70 to 79 years
• Old Old: 80 years and beyond
• (Forman D.E;Berman A.D;McCabe C.H;Baim D.S.;Wei J.Y; 1992 Journal of
the American Geriatrics Society. 40(1):19-22
6. Ageing Process and Impact on Health
• Whilst Elderly refers to chronologic years of life, it does not relate to
presence or absence of diseases, functional state and biological
changes that may be present in various organs such as the brain, skin,
cardiovascular system, kidneys, musculoskeletal system etc.
• Ageing is a biological process that occurs in all living organisms.
• Ageing process is not fully understood and appears to be
multifactorial and variable in rate of progression in various individuals
and in the different organs affected.
• The complex nature of ageing reflects the interplay of intrinsic
processes – genetic, metabolic, environmental factors; life style –
such as diet, sedentary, physically and intellectually active.
7. Ageing Process and Impact on Health (Contd)
In essence, it is not unusual to notice marked effects of ageing in some
sixty year olds and yet minimal ageing effects in Octogenerians.
• Furthermore, the ageing process may affect some organs more than
others and which organ is more affected varies from person to
person.
• The demographic changes resulting in an ever increasing prevalence
of an ageing population may be attributed to decreasing birth/fertility
rate; lowering of childhood mortality and improvements in medical
care and diagnostic facilities.
• It is vital to appreciate that individuals may neither age at the same
rate or in the same manner.
8. Ageing Process and Impact on Health (Contd)
• Likewise the Clinician is faced with the challenge of deciding the
effects of normal aging; pathologic changes and the cumulative effect
of pathologic conditions on a background of pre-existing aging effects.
• Whilst the effect of aging is a gradual decrement in function in various
organ systems, it is therefore possible for an elderly person to have a
resting level of performance to adequately cope with minimal daily
stress such as mobility, functions of daily living, intellectual activities
etc.
• The residual capacity of various organ systems may under stress
become grossly inadequate to compensate and cope physiologically
with a consequent marked disproportionate adverse effect.
9. Ageing Process and Impact on Health (Contd)
• In the elderly, normal homeostatic mechanisms may be blunted and
limited . An example is the poor Cardiovascular response of
tachycardia and increased cardiac output; decreased glomerular
filtration rate and renal blood flow; brain atrophy and degeneration of
neural cells leading to memory impairment, peripheral neuropathy
and autonomic disfunction.
• Diminished Lymphocyte proliferative response and Interleukin – 2 (IL-
2) production that occurs with aging is associated with decreased
immunity and increased susceptibility to infections and sepsis as well
as malignancies.
10. Ageing Vs Pathological Processes
• The multiorgan decrement in organ function and limited homeostatic
response to stress as well as concomitant co-existence of multiple diseases
results in atypical response and presentation to disease
• Metabolic dysfunction in the elderly may be sub-clinical i.e. a background
insensitivity of hormone receptors or decreased hormone production may
put them at risk of Diabetes Mellitus, Osteoporosis, Hypothyroidism which
may become pronounced due to environmental stress, infections or
medications.
• The elderly persons are also often exposed to social, financial limitations
and physical inabilities which may result in depression, social isolation,
poor nutrition, lack of confidence, limited mental stimulations as well as
loss of interest and limited mobility resulting in poor physical conditioning
i.e. muscle strength, coordination, poor gait and balance with increased
risk of falls.
11. Ageing Vs Pathological Processes
• The ‘empty nest’ i.e. all children far away from home or loss of a
spouse; retirement; physical limitation due to osteoarthritis; inability
to drive or read due to visual impairment and hearing loss may
aggravate cognitive decline and trigger fear, insomnia and depression.
• Poor visibility, muscular deconditioning, osteoarthritis with pain as
well as adverse effect of medication could lead to falls and fractures;
whilst fear of falls, loss of confidence walking with concomitant gait
and balance problems, pain relating to osteoarthritis could limit
mobility and result in urinary and fecal incontinence.
12. Ageing Vs Pathological Processes
• Cognitive decline as well as mood problems may also result in the
elderly failing to give accurate or detailed communication on how
they feel or the problems they are experiencing. It is therefore not
unusual that elderly persons may just complain of not feeling right or
being tired all the time.
13. Presentation of Diseases in the Elderly
• It is critical therefore that the Clinician appreciates the following:
❖Presentation of disease in the elderly may not conform to typical
textbook description of disease e.g. infection (chest, urinary, biliary)
may not present with fever, leucocytosis, productive cough,abdominal
pain or typical chest pain but rather may have hypothermia, loss of
appetite, acute confusion (delirium) or falls.
❖Likewise, infection may result in acute worsening of pre-existing
disease for example in breathlessness and heart failure; atrial
fibrillation, ventricular tachyrrhythmias or even myocardial infarction
without typical chest pain or sweaty episodes.
14. Presentation of Diseases in the Elderly (Contd)
Due to the haemodynamic effect of infection and sepsis – acute
cardiovascular events may be the initial presenting feature of sepsis.
Likewise the stress of sepsis in an elderly person may manifest with
overt Diabetes mellitus, acute confusional state, hallucinations, or
drowsiness
❖Assesment of the elderly must mandatorily consider and identify any
changes in baseline functioning, behaviour, cognitive state, mobility,
bowel or urinary habits as well as appetite and fluid intake. Any
sudden change or deterioration in any of these should be considered
an acute medical problem and may indicate some underlying disease
– acute or chronic
15. Presentation of Diseases in the Elderly (Contd)
❖The elderly have multiple disease conditions and may be on multiple
medications. Due to altered pharmacokinetics and increased adverse
effects in the elderly they may present with iatrogenic conditions
rather than underlying disease.
❖Misdiagnosis and missed diagnosis are commonly encountered in the
elderly and they are therefore either subjected to wrong treatment or
denied treatment. An example would be an agitated, delirious person
– due to sepsis, hyoxia, sedatives, stroke, heart failure or even
constipation being classified as dementia. Thus whilst delirium may
present with cognitive changes and altered level of consciousness it is
a reversible condition whilst Dementia is progressive and irreversible.
16. Presentation of Diseases in the Elderly (Contd)
❖Also, elderly person with Diabetes mellitus may not complain of
angina (chest pain) when they have an acute coronary syndrome (ACS)
or myocardial infarction i.e. silent MI but rather present with dyspoea,
confusion, nausea, fatigue or syncope. Elderly persons with Diabetes
mellitus or dementia or parasympathetic cardiac or peripheral
autonomic neuropathy are likely to have atypical presentation of
acute myocardial infarction and this could be as high as 40% of acute
MI in the elderly presenting in emergency service and result in denial
of appropriate therapy.
17. Presentation of Diseases in the Elderly (Contd)
❖Aging neurons in the elderly resulting in peripheral neuropathy and
autonomic neuropathy could result in decreased appreciation of sensations
– such as touch i.e. pain, joint position, temperature or, postural
hypotension; as well as bladder and anal sphincteric control. Neuropathic
ulcers, Charcot arthropathy – foot deformity, twisted ankle and
unsteady gait and balance could further impair mobility with muscle bulk
loss, loss of confidence walking, impaired gait and balance could result in a
chair-bound or bedbound lifestyle and associated massive leg swelling
(oedema) or decubitus i.e. pressure ulcers complicating the atrophic frail
skin. Associated urinary or fecal incontinence could except when full
cognitive assessment is done be deemed as features of dementia and lead
to placement in a nursing home rather than rehabilitative care
18. Presentation of Diseases in the Elderly (Contd)
❖Some clinical findings in the elderly may not indicate an underlying
disease. Examples of clinical findings in the elderly that may not be
significant are reduced skin turgor, fine crackles at the base of the lungs;
slightly reduced PaO2, neck stiffness, and a positive urine dipstick in
women (Bacteriua).
❖However, presence of red cells and protein in the urine dipstick should not
be dismissed. Likewise the presence of iron deficiency anaemia which may
present as fatigue or lethargy may be a red flag sign for underlying
malignancies in the gastro-intestinal or urinary tract.
❖Malignancies are common in elderly and may present in an atypical
manner such as anorexia, confusion, tiredness, leg swelling, deep vein
thrombosis, nephrotic syndrome or non specific anaemia. Aside of breast,
prostate and lung cancer, the elderly may develop multiple myeloma,
amyloidosis and gastrointestinal malignancies.
19. Implications of Atypical Presentations of Diseases
in the Elderly
❖Atypical presentation in the elderly person, of diseases may create
uncertainty if the initial attending physician lacks training and
experience.
❖Inappropriate investigations may be conducted, whilst simple
interventions such as rehydration, assessment of the skin for
abrasions, haematomas,and ulcers as well as cellulitis may be
overlooked.
❖Review of medications and possible drug-drug related interactions
are neglected
❖Malnourished state as well as electrolyte abnormalities such as
hypokalaemia, hypocalcaemeia or hypomagnesimia which may
coexist and easily treated may not receive attention.
20. Implications of Atypical presentations of
Diseases in the Elderly(Continued)
❖Delay in initiating appropriate management may lead to high
mortality and prolonged hospital stay.
❖Due to frailty, a tendency to withold or late treatment initiation may
occur in elderly with acute abdomen due to appendicitis, cholecystitis
or intestinal obstruction, or prostate cancer.