The "New Young" Generation: Geriatric Medicine Developments

1. GeriatricMedicineDevelopments in Diagnosis, Preventionand Care Jakarta, 18.-19. Sep 2019

2. TOPICS • The “New Young” Generation: 65 – 75 Years • Biochemical, Physical and Mental Aspects of Our Aging • Aging of Our Microbiome and Immune System • Geriatric Assessment and Comprehensive Diagnostics • Palliative Care Examples • Prevention before Treatment: Anti-Aging for Everyone • Future Trends in Geriatric Medicine

3. The “New Young”, aka Silver Tsunami

4. Demographic Statistics In 2050, more than 25% of the population will be older than 65 years 2 Billion People will profoundly affect many aspects of our societies:- Health Care - Economics- Social Networks - Infrastructures - Business Strategies - Legal Systems US Elderly Demography 1950-2050

5. Biochemical & Genetic Aspects of Aging

6. Chemical modificationsimpair the molecular functioning of DNA, membranes, the extracellular matrix (ECM) and enzymes, causing progressive deterioration. • Repair and recycling mechanisms slow down. • Neuro-endocrine & immune systems decline, sending chemical death signals • Junk molecules and aggregates accumulate inside and outside of cells, altering gene expression, enzyme activity, and signaling pathways • Some deteriorating cells release chemicals which harm healthy cells • Cells are lost by apoptosis & necrosis, eg heart, skeletal muscle, and brain • Stem cells stop dividing and no longer replace cells or regenerate tissues Aging of Our Biochemical Systems

7. Aging of Our DefenseSystems • Physical Barriers: Hair, Skin and Mucosa • Biological Barriers: Our Microbiota • Cellular & Biochemical Barriers: Our Immune System with innate and adaptive mechanisms

8. Aging of Our Microbiota Bacteria, archea, fungi, protozoa, viruses… 100 Trillion with 10.000 species, ratio 3:1 to our cells Their Microbiome has 3.3 Million genes (humans: 23.000) Populate our gut, skin, mammary glands, lungs, cavities… Communicate with our body via several mechanisms:endocrine hormones, nerves and immune signaling Crucial part of our immune system: First Line of Defense

9. An Essential, Major BiochemicalFactory: • 60,000 Carbohydrate de-grading Enzymes • 9,000 GlycosideHydrolases • 2,000 Polysaccharide Lysases • Their Shikimate-pathway produces essential AA‘s • Synthesize Vitamins B, K Our Microbiota Our Microbiotahave a close mutual relationship with us. They pre-digest ourfoods, synthesize essential nutrients, areaffectedbymedicationandchangewithourdiet.

10. Aging of our Immune System

11. Decreasing: • Bone Marrow • Thymus • B & T-Cells • Phagocytes • Antibodies Aging of Our Immune Systems • Increasing: • Cytokines • Myeloid Cells • DysfunctionalMemory Cells • Vaccineresponse

12. Patients have multiple disease and variety of symptoms • Chronic pain is frequent • Comorbidities are common • Psychological and mental problems often contribute Geriatric Diagnostics Difficult to make fast assessments without knowing causes

13. Comprehensive Geriatric Assessment

14. It’s NOT :What’s the matter with them?It’s : What MATTERS to them!

15. REACT TO DISEASE INSTITUTIONS PROFESSIONALS FRAGMENTED CARE FUTILE TECHNOLOGY Geriatric Health Care Standards:Past Future PROMOTE WELLNESS COMMUNITIES EMPOWER CLIENTS COORDINATED CATE PALLIATIVE CARE

16. Chronic Geriatric Conditions: Care vs Cure

18. Current Trends & Future Needs • Establish a Preventive, Integrated and Holistic Elderly Care • Improve Education and Cooperation of Caregivers & Elders • Promote Healthy Nutrition and Active Lifestyles • Enable An Active Social Life: Involve Families, Businesses & Communities with a Supportive Social and Medical Security

19. Anti-Aging There is NO single solution, but solutions are at YOUR hands SUKSES DITANGGAN MU SENDIRI

21. nnnnnnnnnnnnnnnnnnnnnnn Biochemical Anti-Aging Measures

22. nnnnnnnnnnnnnnnnnnnnnnn Educational Anti-Aging Measures

23. Mediterranean, Keto, Paleo, FODMAP1, DASH Diets • MIND: Mediterranean & Dash Diets Combined • Pro & Prebiotics: Yogurt, Sauerkraut, Tempeh, Kimchi,Miso, Kombucha, Pickles, Bananas,… Metabolic & Immunological Anti-Aging Measures 1Fermentable oligo-, di-, mono-saccharides and polyols

24. Metabolic & Immuno Anti-Aging Measures

25. Cardio-Training • Strength & Balance Physical Anti-Aging Measures

26. Chooseyourownretirementage • Work after retirement • Singapore, Japan,… • Meaningfullife, additional incomereducesburden, dontwasteknowledge Mental & Spiritual Anti-Aging Measures

27. Preventive Holistic Care Needs ENGAGE PATIENTS DEVELOP ACTIVITIES EDUCATE: SOSMED ! INTEGRATE SYSTEMS SUPPORT HOME CARE PROMOTE WELLNESS COMMUNITIES EMPOWER CLIENTS COORDINATED CATE PALLIATIVE CARE

28. Future Needs and Trends: Activities !

29. Future Needs and Trends: Blue Zones?

30. The “New Young”: Generation 65+ • Need HolisticSolutionsforPatients& Caretakers • IntroducesProfoundChangestoOurSocieties • OfferTremendousOpportunitiesfor Business, Communities, Familys and Society

31. TERIMA KASIH ! Presentation References