We are aging—not just as individuals or communities butas a worldRefine last point
? Source of Malaysian data State latest % elderly Mlaysian pop. & projected % of elderly in 2POPULATION 2010-28M2020-33.3m
Many physiologic fns deteriorate..
Respiratory rate 12 to 24 bpm.A. Assess respiration rate, rhythm, regularity, volume, depth, exercise capacity. Ascultate breath sounds throughout lung fields. B. Inspect thorax, symmetry of chest expansion. Obtain smoking history. C. Monitor secretions, breathing rate during sedation, positioning, , arterial blood gases, pulse oximetry. D. Assess cough, need for suctioning.
CPY3A ( component in cytochrome P450) activity reduced up to 50 %
Sarcopenia (from the Greek meaning "poverty of flesh") is the degenerative loss of skeletal muscle mass and strength associated with aging (0.5-1% loss per year after the age of 25). Sarcopenia is a component of the frailty syndrome.The frailty syndrome is a collection of symptoms or markers, primarily due to the aging-related loss and dysfunction of skeletal muscle and bone, that place (mostly) older adults at increased risk of adverse events such as death, disability, and institutionalization.Degenerative loss of msk muscle mass and strength a/w aging.1% loss per year after 25 y/oSarcopeniaOsteoporosisMuscle weakness
POSTprandial glucose tolerence is impaired w age (inc 10 mg/dL per decade)
CSS-creatinine clearance decline rate 10ml per decade.
Care for elderly
By:Farah Adibah Kasmin 2008402312
CONTENTS Definition of elderly… Epidemiology of aging Changes during process of aging and how does it occur What is geriatrics? Giant of Geriatric?
Definition WHO: People who are 65 years old or more. MALAYSIA : Elderly those with the age of 60 and above “elderly” a chronological age of 65 years old or older, 65 ->74 years old “early elderly” and those over 75 years old “late elderly. Geriatrics & Gerontology International, Volume 6, Issue 3,pages 149–158, September 2006
Epidemiology In 2006, almost 500 million people worldwide were 65 and older. By 2030 1 billion (1 in every 8 of the earth’s inhabitants.)
MALAYSIA Population of Malaysian >60 years in 1995 5.9%, 2000 6.6% 2009 7.1% (2.03M) Projected percentage of elderly in 2020 9.8% Department of Statistics Malaysia. 2010
THE AGING PROCESS A process of gradual and spontaneous change, resulting in maturation throughchildhood, puberty, and young adulthoodand then decline through middle and late age
CHANGES OCCURING DURINGAGINGOverview Alter the older person’s response to illness show great variability among individuals often impacted by genetic and long-term lifestyle factors commonly involve a decline in functional reserve with reduced response to stressors.
General Increase body fat Prone to get obesity Prone to get weight bearing disease(arthritis) Higher chances to get chronic diseases eg: Diabetes and Hypertension Reduce total body water Risk of dehydration
Age-Associated Respiratory changes CHANGES IMPLICATIONS Decreased respiratory muscle Decreased efficiency of strength; stiffer chest wall ventilatory exchange. with reduced compliance. Decreased cough & airway ciliary action -> Diminished ciliary & mucus/foreign matter macrophage activity, drier clearance reduced-> mucus membranes. Increased risk of infection and bronchospasm with airway obstruction. Decreased cough reflex. Increased risk of aspiration
Age-Associated Cardiovascular Changes CHANGES IMPLICATIONS Decreased exercise tolerance- Arterial wall thickening and > fatigue, SOB stiffening, decreased compliance. Risk of arrhythmias Left ventricular and atrial hypertrophy. Sclerosis of atrial and mitral Diminished peripheral valves. pulses, cold extremities. Reduced arterial compliance Reduced β-adrenergic response Increased blood pressure Reduced baroreceptor sensitivity Reduced SA node automaticity postural hypotension
Age-Associated Gastrointestinal changes CHANGES IMPLICATIONS Decreases in strength of muscles of Risk of malabsorption, fluid/electrolyte imbalances, poor mastication, taste, and thirst nutrition. perception. Gastric changes: Increased risk Decreased gastric motility with (GERD), maldigestion, NSAID- delayed emptying. Atrophy of induced ulcers. protective mucosa. Constipation. Risk of fecal incontinence. Colonic contraction less effective & impaired sensation to defecate. Decreased metabolism of drugs. Risk of adverse drug reactions. Liver size and blood flow are reduced -> hepatic reserve decrease.
Age Associated Changes in Musculoskeletal System CHANGES IMPLICATIONS Decreased muscle mass Sarcopenia: increased risk of disability, falls, unstable gait. Decreased myosin adenosine Risk of osteopenia and triphosphatase activity osteoporosis. Deterioration and drying of Limited range of motion, joint joint cartilage. instability, risk of osteoarthritis. Muscle weakness/ muscle Decreased bone mass and fatigue osteoblastic activity
Age associated changes in CNS CHANGES IMPLICATIONS Impairments general muscle strength; reflexes; nerve Decrease in neurons, conduction velocity, slowed motor neurotransmitters, dendrites skills and deficits in balance and and synapses brain atrophy coordination. Changes in autonomic Decreased temperature sensitivity. hypo/hyperthermia regulation -> Compromised thermoregulation. Slowed speed of cognitive processing. Reduced : Brain catecholamine synthesis Increased risk of sleep disorders, delirium, neurodegenerative Brain dopamine synthesis diseases.
Age associated changes in endocrine function CHANGES IMPLICATIONS Impaired glucose DM homeostasis Thyroid dysfunction Reduced thyroxine clearance Metabolic abnormalities Increase ADH, reduce renin (Low Na+, high K+) and aldosterone impotence Reduce testosterone fracture production Reduce vitamin D absorption and activation osteopenia
Age associated changes in urinary system CHANGES IMPLICATIONS Decreases in kidney mass, blood Reduced renal functional flow, GFR reserve; risk of renal complications in illness. Reduced bladder elasticity, muscle tone, capacity. Risk of nephrotoxic injury and adverse reactions from Increased post-void residual, drugs. nocturnal urine production. Increased risk of urinary In males, prostate enlargement urgency, incontinence, UTI, with risk of (BPH). nocturnal polyuria.
References: Geriatrics & Gerontology International, Volume 6 Primary Care Geriatrics 5th Edition. Ham, Sloane, Warshaw, Bernard, Flaherty. 2007. Mosby Encyclopedia of Aging And Public Health By Sana Loue, Martha Sajatovic Thank you