HEALTH ISSUES of the ELDERLY

1. HEALTH ISSUES of the ELDERLY DR KHURSHEED AHMED QURESHI M.D. (Med.) M.D. (PSM) GOVT MEDICAL COLLEGE SRINAGAR KAQ

2. Old age is a normal inevitable biological phenomenon • “ You do not heal old age.. .. .. You can protect it, promote it or extend it ” Sir James Sterling • “ Old age is an incurable disease ” .. .. Seneca KAQ

3. KAQ AGE PYRAMID India Switzerland 80 yrs 50 yrs 01 yrs >60 years = 7.7% (Census of India 2001) >65 years = 3% (India), 12% (UK)

4. Implications of the Ageing population(Socio-Economic and Medical point of view) • Greater proportion of disease burden • Greater demand on health services (2/3rd beds occupied in UK hospitals by old people) • Greater Burden on economy KAQ

5. Biology of Ageing • No evidence for a single mechanism • Multiple and interacting causes • Free radical theory .. .. ..Knowledge incomplete KAQ

6. Physiological changes due to Ageing • Body fat  (Obesity) • Blood glucose  (Diabetes) • Body water  (Anorexia) • Vision  (Presbyopia, Lens opacity, Blindness) • Lungs  elasticity (Dyspnea) • Bone marrow  reserve (Anemia) • Liver Function  (delayed metabolism of drugs) • Bones  density (Fractures) • CVS Hypotensive response to  Pulse (Syncope) • Brain Atrophy (Dementia) KAQ

7. Health Problems of the Aged 1. Problems due to ageing process 2. Problems associated with long term illnesses 3. Psychological problems KAQ

8. 1. Problems due to ageing process • Senile Cataract • Glaucoma • Nerve deafness • Bony changes affecting mobility • Emphysema KAQ

9. 2. Problems associated with long term illnesses • Degenerative diseases of the heart/ blood vessels • Cancer • Diseases of the locomotor system • Diabetes • Accidents • Chronic respiratory diseases • Genito-urinary diseases KAQ

10. 3. Psychological Problems • Social mal-adjustment • Mental changes • Emotional disorder KAQ

11. Common illnesses during old age KAQ

12. Common illnesses during old age • Hypertension • Coronary heart diseases (IHD) • Diabetes • Stroke • Psycho-social problems & Dementia • Osteoporosis • Falls & accidents • Post Menopausal Syndrome • Prostate enlargement (BHP) • Cancers • Miscellaneous (COPD, Parkinson’s Disease, Refractive Error, Deafness, Arthritis, Gout) KAQ

13. Hypertension KAQ

14. Hypertension • B.P ≥ 140/90 (Hypertension) • B.P 120/80 – 140/90 (Pre-hypertension) Risk factors a) Non modifiable : Age, Sex, Hereditary b) Modifiable : Obesity,  Salt,  Sat. fat, OCP Sedentary habits, Stress, Alcohol Prevention Life style modifications Regular (Life long) drug intake, if on treatment KAQ

15. Hypertension…Is it worth treating?

16. Obesity

17. Obesity OBESITY: Absolute growth of the adipose tissue • Enlargement of fat cell size (Hypertrophic obesity) • Increase in fat cell number (Hyperplastic obesity) OVERWEIGHT: Weight in excess of average • Not always due to obesity • Abnormal muscle development or fluid retention

18. OBESITY IN DEVELOPED COUNTRIES • Most prevalent form of malnutrition. • 20 to 40% of adults. • 10 to 20% of children.

19. Metabolic Syndrome

20. Metabolic Syndrome Raised blood pressure (SBP more than 130) Raised fasting blood glucose Dyslipidemia (Low HDL, increased TG) Abdominal obesity (Waist Circumference more than 102 cm for men and more than 88 cm for women)

21. Life Style Modifications in the Prevention & Management of Hypertension & obesity Lose weight, if overweight Increase aerobic physical activity (30 – 45 mts/day) Reduce sodium intake (<6 gms/day [NaCl]) Limit alcohol (< 10z / day) Maintain adequate intake of dietary K+ & Ca+) Stop smoking Reduce intake of dietary saturated fats ↑ vegetables (↑K+), ↑ Fish Yoga and meditation Caffeine (causes acute rise, latter tolerance develops)

22. Coronary Heart Diseases (IHD) KAQ

23. Coronary Heart Diseases (IHD) (Impairment of Heart function due to inadequate flow of blood to the heart compared to its needs) Types a) Angina b) M.I (myocardial infarction) c) Arrhythmia d) CCF (Heart failure) Risk factors Smoking, Obesity, Hypertension, Hyperlipidemia, Diabetes, OCP Prevention Life style modification & alleviation of risk factors Brisk walking 45 min daily Adequate control of Hypertension and Diabetes KAQ

24. ODD’S RATIO FOR ASSOCIATION OF C.H.D. PREVALENCE WITH LIFESTYLE RISK FACTORS Age ≥ 50 years 8.55 ↑ TC/HDL Ratio ≥ 3.5 8.13 Hypertension 6.63 Higher S.E. status 5.70 Obesity 5.44 Smoking 3.61 Absent prayers 2.12 Sedentary habits 1.86 High fat intake 1.62 Male sex 1.57 Income ≥ 2000(Rs.) 1.55 Literacy 1.40 Ref.≈ CHD in Srinagar – 1997 (JAPI)

25. Diabetes KAQ

26. Diabetes (Increased blood sugar levels due to insulin deficiency or Insulin resistance) Blood sugar fasting Blood sugar PP < 100 mg < 140 mg Normal 101 – 125 mg 140 – 199 mg Pre-diabetes ≥ 126 mg ≥ 200 mg Diabetes Risk factors Family history, Obesity, Sedentary habits, GDM, Drugs Prevention Life style modification, Exercises, food habits, Regular medication under close supervision for Diabetics KAQ

27. Magnitude of the Problem GLOBAL PREVALENCE 2013 2035 Diabetes 382 million 592 million (8.3%) (10.1%) Prediabetes 316 million 471 million (6.9%) (8.0%)

28. How much workout you need to compensate for this caloric intake…..

29. How much workout you need to compensate for this caloric intake…..

30. 300 calories

31. 300 calories

32. 300 calories Ride a bike for one hour. or Walking leisurely for one hour. or Jogging / Brisk walk for 45 minutes

33. Diet In Diabetes Total energy requirement: Varies with body wt./activity Males: 36 Kcal/kg/day Females: 34 Kcal/kg/day Proteins: 0.9-1 gm/kg/day Carbohydrate:40-60% of total energy intake Fats: 30-50% of total calories (see BMI) mainly polyunsaturated fats (anti- atherogenic properties) NOTE: Use ↑ fibre , type-A vegetables , ↑ fat replacers Use omega-3 fatty acids (fish oil) Use non- nutritive sweeteners (Saccharin Aspartame) Use ↑ micro-nutrients (anti-oxidants)

34. Dietary Changes? Identify food preferences Give high quality/low calorie diet Increase dietary fiber Proportion of energy dense foods like simple carbohydrates and fats to be reduced

35. Issues # Physical Inactivity *TV/Internet # Poor diet *Too much carbohydrates *Too little Proteins *Too little fiber *Poor omega 3/6 ratio *High invisible fat/salt

36. Stroke (CVA) KAQ

37. Stroke (CVA) Rapid development of cerebral dysfunction due to: a) Obstruction to blood vessels ( ≠fat deposition) b) Rupture of blood vessel (Hemorrhage due to  BP) c) Transient Occlusion (TIA) Risk factors Hypertension, Diabetes, etc Prevention Adequate control of hypertension and Diabetes KAQ

38. Psycho-Social Problems & Dementia KAQ

39. Psycho-Social Problems & Dementia Dementia = Loss of memory Senile Dementia usually starts after 60 yrs Alzheimer's type dementia may start earlier with lot of associated handicaps .. .. ..Family and social support more important than medical treatment KAQ

40. Osteoporosis KAQ

41. Osteoporosis Reduction in the bone mass due to a) Calcium & Vitamin D deficiency b) Immobilization c) Mal-nutrition d) Drugs and Hormones e) Alcoholism f) etc .. .. ..etc * Commonly seen among post-menopausal women * May lead to fractures Prevention Balanced diet Regular exercises / Jogging HRT (Hormone replacement therapy) KAQ

42. Falls & Accidents KAQ

43. Falls & Accidents • Risk factors Visual acuity Hearing Dementia Irrational use of drugs • Interventions (Medical / Environmental) Proper lighting, Flooring & Furnishing Proper stairs with hand support Kitchen with firm non-movable table & handy shelves Bathroom with non-skid flooring with door locks removed Toilet with raised seats Bedrooms with bed at proper height Shoes with firm non-skid soles and low heels KAQ

44. Prostate enlargement (BHP) KAQ

45. Prostate enlargement (BHP) Prostate is a gland which surrounds urethra in males. Enlargement of the prostate leads to a) Difficulty in passing urine b) Straining with resistance in urinary flow c) Post void dribbling d) Nocturia Management a) Medical b) Surgical KAQ

46. Cancers KAQ

47. Cancers (Abnormal growth of cells with tissue invasion) Common cancers among elderly of Kashmir a) Stomach / Esophagus b) Lungs c) Breast d) Colon e) Cervix f) Prostate Warning Signs a) Unexplained loss of weight b) Abrupt loss of appetite c) Change in Bowel habits d) Lump in the breast or Neck e) Abnormal bleeding f) Persistent cough and /or Hoarseness KAQ

48. TIME TRENDS IN CANCERCancer death rates by site in United States

49. Other diseases among elderly • Refractive Error / Cataract • Hearing Impairment • Gout & other types of Arthritis • C.O.P.D./Chronic Bronchitis • Parkinson’s Disease • Post Menopausal Syndrome (females) KAQ

50. Reasons for special care of Elderly KAQ