Healthy Ageing

1. Healthy Ageing By Prof. Dr Asmaa Abdel Aziz Dr. Alaa Hassan

2. Geriatrics is the branch of medicine dealing with health care of the aged population. Ageing (growing old) refers to the natural progressive decline in body systems, that starts in adulthood, but it becomes obvious several decades later Several internal and external influences can accelerate the process of ageing, and increase vulnerability to the diseases of old age. These include: • genetic factors, • lifestyle and • adverse environmental factors.

3. Population Ageing It is increase in the proportion of older people in both developed and developing countries. • It is one of the main features of the world population in the 20th century

4. Figure 1. Population aged 60 & over: World and development regions, 1950-2050

6. Factors behind Population Ageing • The main reasons for the population ageing of society are socio-economic development, and better healthcare which has improved survival rate. From the demographic point of view: population ageing is a result of both mortality and fertility: fewer children are born and more people reach old age. Over the last fifty years mortality rates in developing countries have declined dramatically raising the average life expectancy at birth from around • 41 years in the 1950s • to 62 years in 1990. • By 2025, it is projected to reach 70 years.

8. Health trends and social impact • Many developing countries are facing a double burden: • the health problems of an ageing population, and • Still a high rates of communicable diseases. • In the majority of these countries, poverty , continuing urbanization and the growing participation of women in the work - all contribute to the erosion of care for older people. • The elderly are growing in number, and life expectancy is increasing, but we are still far from fulfilling their needs , a clear policy on elderly care is lacking,

9. Health Problems of the Aged (1) IMPAIRMENTS AND LOSSES • decreased immune response, (Infections) • reduced visual, auditory, and olfactory acuity, osteoporosis and fractures, • slowing of mental response,

10. (2)LONG-TERM ILLNESS (a)Cardiovascular diseases e.g. hypertensive diseases, atherosclerosis, ischemic heart diseases, cerebrovascular disease, and peripheral vascular disease. Diet, heredity, overweight, smoking, diabetes, Hyperlipidemia & stress all are cumulative risk factors. (b) Injuries:Falls occur frequently among elderly . The three most common fracture sites among the elderly are: • neck of femur, • vertebrae, and • distal forearm The contributing factor is osteoporosis.

11. (b) Cancer: The danger of cancer increases after the age of 40 e.g. Lung, breast, prostate, skin, uterine , and colorectal cancer. (d) Diabetes: It is the leading cause of death as the population grows older. (e) Diseases of locomotor system: Myositis, neuritis, gout, rheumatoid arthritis, osteoarthritis,… etc. These conditions cause more discomfort and disability than any other chronic disease in the elderly. (f) Respiratory diseases and infections: Chronic bronchitis, emphysema, asthma, pneumonia, tuberculosis are of major importance.

12. (g) Genitourinary system: Enlargement of the prostate, dysuria, nocturia, frequent and urgency of micturition are the common complaints. • (h) Malnutrition: The elderly often have special nutritional requirements due to: • reduced intake (poor dentition, loneliness, poverty, ignorance), • physical or mental diseases, (depression) • medication use, or • functional status (dependence and immobility).

13. (3) PSYCHOLOGICAL PROBLEMS: • Mental changes as • impaired memory, • dislike of change. • Irritability, • jealousy and • hopelessness are very frequent. • withdrawal, depression and even suicide can occur from failure to adapt.

14. (4) IATROGENIC COMPLICATIONS • Risk factors for iatrogenic complications include : • Multiple chronic diseases: The greater the number • of chronic diseases, the greater the risk that treatment • of one disease will exacerbate others. For example, • treatment of arthritis with a nonsteroidal anti- • inflammatory drug may exacerbate chronic gastritis. • (b)Multiple physicians: Having several physicians can result in frequent change in patient's therapy that increases the risk of uncoordinated care. • (c)Multiple or inappropriate drugsincreases the risk of drug-drug or drug-disease interactions. • (d) Hospitalization: Risks of nosocomial infection, and transfusion reactions.

15. Causes of death among elderly (65+ years) • In 2000, according to WHO the main causes of death among elderly aged 65 years and above were: • Cardiovascular diseases ( hypertension, atherosclerosis, ischaemic ). • Diseases of pulmonary circulation • Senility and other ill-defined conditions. • Cerebrovascular accidents. • Chronic liver diseases and cirrhosis. • Peripheral vascular diseases (embolism, thrombosis ) • Neoplasm • Respiratory diseases ( chronic bronchitis, emphysema & asthma). • Renal diseases ( nephritis, nephrotic syndrome& nephrosis). • Diseases of digestive system. • Infectious and parasitic diseases. • Diabetes mellitus.

16. KSA

17. Preventive health care for the elderly • The goal of preventive medicine in the elderly is the reduction of morbidity and premature mortality, and the preservation of quality of life. • Primary Prevention • Secondary Prevention • Tertiary Prevention

18. Primary Prevention • Promoting healthy lifestyles to reduce the risk of chronic diseases • Use of medications to reduce the onset of illness • Immunization ( Influenza Vaccine) • Safety measures to prevent Injuries • Prevention of Iatrogenic Complications.

19. A) Promoting healthy lifestyles to reduce the risk of chronic diseases Exercise, Smoking, Diet • Regular physical activity reduces the risk of coronary heart disease and decreases the risk of colon cancer, diabetes, and high blood pressure • Avoiding tobacco use • Intake a healthy diet

20. B) Use of medications to reduce the onset of illness • 1- Postmenopausal Hormone Replacement Therapy (HRT) HRT has many: Positive effects, It reduces osteoporosis and fracture Negative effects, It increases the risk of breast cancer &causes irregular bleeding. • 2- Aspirin to Prevent Cardiovascular Disease

21. C) Immunization • An annual influenza vaccination and a Pneumococcal vaccine are recommended for all elderly over age of sixty-five with normal immune systems. • A primary series of tetanus vaccine followed by booster every 10 years are also recommended

22. D) Reducing Injuries • Reduce Falls and fractures: Safety measures inside & outside homes • Prevention of osteoporosis by : • Post-menopausal estrogen therapy • Regular exercise • Calcium intake.

23. E) Prevention of Iatrogenic Complications Elderly care requires a coordinated teamwork to prevent duplication of services and complications caused by multiple or inappropriate drug use.

24. Secondary Prevention Secondary prevention is the early detection & treatment of any health problems at the earliest possible stage aiming at recovery, prevention of complications and premature death. Screening tests for the elderly can be applied at Primary Health Care Centers, geriatric outpatient clinics, or geriatric wards in hospitals. Examples of screening tests: • Tests for visual acuity • Tests for hearing acuity • Tests to detect sensation • Tests to detect blood glucose , lipaedemia • ECG

25. Tertiary Prevention The goal of tertiary prevention is early medical or surgical intervention and rehabilitation to limit disability and allow them to live socially acceptable life

26. Thank You