Allied Health sciences - 2011 Basic Community Health

Care of elders
Dr. N Sivarajah Faculty of Medicine, University of Jaffna
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First Miss India 1949 Pramila Abraham

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Types of Ageing
Physiological Ageing Normal ageing : Changes with time in anatomical structure and physiological function Pathological Aging Increasing occurrence of Disease interactions with the process of Normal ageing

GERONTOLOGY
The Scientific study of the phenomenon of old age
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GERIATRICS The subdivision of Medicine which is concerned with old age and its diseases
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Causes of ageing of Populations

Age structure of Populations depends on Past trends in Fertility Mortality and Migration
DECREASED MORTALITY DECREASED MMR DECREASED IMR

INCREASE IN PROPORTION OF OLD PEOPLE

DECREASED FERTILITY Main factor responsible for increase in proportion of old people
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At what age does ageing start?

Ageing starts at Birth
Cell aging Organ aging

Age of retirement also varies

Sweden 70 years USA 65 years Developing countries 55 years

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Percentage Distribution of population 65 years and above by census years (Sri Lanka)
Census Year Percent 65 + Census Year Percent 65 +

1881
1891 1901

2.2
2.1 1.4

1953 1963 1971 1981 1993

(DHS Survey)

3.5 3.6 4.2 4.2 6.1

1911
1921 1946
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2.3
2.4 3.5

2000
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Aged
Majority accept 65 years to be the dividing line between middle age and old age

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Reasons for increase in proportion of elders

Improvement of Health Care
Hospital care Preventive care

Introduction of Antibiotics and Antenatal care leading to fall in IMR & MMR Lowered Birth rate Increase in expectation of life
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population
Burden on society due to Higher dependency Higher expenditure on health Increase of handicapped
Physically Vision, hearing, arthritis, CVD Diabetes etc. Mentally Socially
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EXPECTATION OF LIFE AT BIRTH BY SEX

80

75.4 70.7

70

EXPECTATION OF LIFE IN YEARS

60

50

40

36.4
Male Female

30

34.2

20

10

0 '1900- '1910- 1920- 19461902 1912 1922 1947 1948 1949 1950 1952 1953 19621964 1965 1967 1971 1981 1991- 19961996 2001

PERIOD

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Present Proportion of elders (60+years) in the world (2003)

Country Japan Germany Sweden % 25.0 24.4 23.8 Country China Sri Lanka India % 10.5 10.3 7.8

U.K.
U.S.A.
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20.8
16.3

Pakistan
Maldives
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5.7
5.2
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Expected Regional Distribution of elders (over 65) in 2050

Latin America & Carribean 10% N America 7% Europe 1% Oceana 1%

Africa 12%
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Asia 69%

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Problems of the elders

1.Medical Problems 2.Economic Problems 3.Social Problems

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1. Medical Problems
Vascular system
Atheromatous Arterial Diseases of Brain, Heart and peripheral vessels

Locomotor system
Rheumatoid Arthritis Osteoarthritis Spondylitis of spine
Continued
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Medical Problems (contd.)

Respiratory System
Bronchitis

Genito-Urinary system
Incontinence

Cerebro-vascular disease Prostatism Gynae diseases

Psychological disturbances

Bereavement Resentment Anger

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Medical Problems (contd.)

Special senses
Hearing Vision

Psychological
Often associated with physical disorder or fear of physical disorder During treatment, the mental illness also has to be treated with the physical illness
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Medical Problems (contd.)

Nutritional Disorders Accidents
Home accidents Fracture of hip

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2. Economic Problems
Dependency
Increases with increase in aged population. In UK dependency same as 1901. Rise in pensions offset by fall in child dependency.

Increased cost of health care In UK

of those over 65 years are on drugs 1/3 of National drug bill spent on those over 65 years
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3. Social Problems
Multigenerational families Extended family system is breaking down More elders are living alone Higher proportion of widows Migration of old people Gerontic conclaves

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What do the elderly want?

To be able to carry on with their normal activities by themselves, such as
House keeping Preparation and consumption of food Transportation Personal care Social interactions Until the terminal stages With a short period of terminal dependency

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Objectives of caring for the old should be

Not to add years to life and life to years Not to be kept alive to an advanced age by over enthusiastic medical intervention, BUT To stay
Fitter and Longer With a short period of terminal dependency

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Objectives of the care of the elderly achieved through

Prevention of ill health Promotion of Health Care of the
ill Disabled Handicapped

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Prevention of ill health in the elderly

Primary Prevention Secondary Prevention Tertiary Prevention

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Primary Prevention
Start in adolescence Introduce behavior change to reduce CVD, Diabetes, Malignancies etc Health education

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Secondary Prevention
Screening in adulthood & middle age
Regular Medical examination (vision, hearing, CVD, Diabetes etc)at
Recruitment At frequent intervals in the workplace

Pap smears Well womens clinics

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Tertiary Prevention
Geriatric Units in Hospitals Cadre for geriatrician Geriatric Care at primary care level Domiciliary Geriatric Care
Care & monitoring at homes by PHC workers especially the diabetics, hypertensives etc

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