Gerontology and Geriatrics Dr Gary Sinoff Department of
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Gerontology and Geriatrics Dr Gary Sinoff Department of Gerontology University of Haifa
Study of the Elderly • Focuses on aging and old age • Individual aspects • Social aspects • Young discipline
“Anyone can get old. All you have to do is live long enough. ” Groucho Marx
Goals of Gerontology • To increase our knowledge about aging and old age • To improve the quality of life in old age
Goals of Geriatric Medicine • Maximize the positive aspects of aging. • The compression of morbidity. • Delaying the onset of chronic disease and maximizing function.
Definitions
DEFINITION OF AGING A PROCESS OF IRREVERSIBLE ACCUMULATION OF DELETIRIOUS CHANGES IN THE CELLS AND TISSUES WITH ADVANCING AGE [TIME] THAT INCREASE THE RISK OF DISEASE AND/ OR DEATH.
Aging Process • Variable and complex • The life span for humans is based on several factors but is seems to be limited to 120 years • Difficult to distinguish between aging and disease • Normal aging is an inborn or innate process
How do we define “old” today? Young Old: 65 -74 1942 Middle Old: 75 -84 1936 Old: 85+ 1923
Defining Old Age • Chronological Age • Biological Age • Psychological Age • Sociological Age
Chronological Age • Commonly used indicator – 65 and over • Limitations - People’s functional capabilities vary - May not capture the diversity of people
Demographics
Changing Global Age Structure 1996
Changing Global Age Structure 2025
World and Regional Life Expectancy 20 yrs increase in past 50 Source: United Nations, 2001
World Population Dynamics
TOP TEN
Regional Distribution of Population aged > 60 in millions Start Learning Chinese or Hindi
Life expectancy • Average number of years you can expect to live. • Increased largely because of reduction in early mortality Øimmunization, safety, engineering, food preservation/nutrition), Øsomewhat through medical innovation (antibiotics and diagnostics)
The Population Explosion
Growth of World Population 1830 1960 1975 1987 1999 1 billion 2 billion 3 billion 4 billion 5 billion 6 billion thousands of years 100 years 30 years 15 years 12 years
The Grey Tsunami ? The Grey Tsunami R. O. M. P. ? Collingwood April 24, 2008 Dr. Carolyn Bennett M. P.
Squaring of the survival curve
The Demographic Transition
Demographic Transition Stage 1: Death rates and birth rates both high. Stage 2: Fall in death rates, Population increases. Stage 3. Decline in birth rate stabilizes population. Stage 4. Birth and death rates both low, population stable. Stage 5 (new). Higher death rates than birth rates, populations contract.
Population Pyramids for the four demographic transition phases
Approach to Illness in the Older Patient In older adults, the presenting problem is just the “tip of the iceberg” of a pathological process, which takes careful diagnostic assessment to uncover
To be old is to be sick • Most seniors are healthy and active. • Three quarters of the seniors report their health to be good, very good or excellent.
Most seniors live in nursing homes. • Just 5% of males and 9% of females in NH. • Most are over 85 years of age. • Decline of percentage since 1970’s.
Principles of Geriatrics 1. Onset of a new disease affects a previous vulnerable organ system. 2. Due to impaired physiological reserves, older patients present at an earlier stage. 3. Multiple abnormalities which can be treated and small improvements yield dramatic improvements 4. Many findings which are abnormal in young, are common in the elderly. 5. Symptoms in elderly often from multiple causes, therefore the “law of parsimony” does not apply. 6. Treatment and prevention is equally or more effective than in younger.
“O” Complex of Geriatric Medicine DON’T FORGET “FAILURE TO THRIVE”
THE “CASCADE” OF OLD AGE
The Epidemiological Transition: Changing Pattern of Causes of Death 25 T h 20 o u 15 s a 10 n d 5 s 1950 1960 1970 Infectious Diseases Diabetes Cancer 1985 1993 Tuberculosis Diseases of circulatory system Source: World Health Statistics, 1989, 1995
Disabilities
History and Examination
History
HISTORY • • More time consuming Depends on senses Cognitive state Ignoring symptoms Atypical symptoms Social problems Non-verbal communication - smells - body language
Body Language • Very important when a language barrier exists • Usually at a subconscious level • Components of body language eye contact facial expressions proximity posture gestures
The Curse of the Modern Society • Mobile phones
All Systems BUT ALSO!!! – Social – Living Conditions – Past experiences – Economic – Family support systems – Activities – War experiences
Sympathy or Empathy Sympathy The act or capacity of entering into or sharing the feelings or interests of another wherein whatever affects one similarly affects the other. versus Empathy The action of understanding, being aware of, being sensitive to, and experiencing the feelings, thoughts, and experience of another.
PHYSICAL EXAMINATION
PHYSICAL EXAMINATION • Ask permission to initiate procedures • Need for assistive devices • Respect the patient’s beliefs • Allow ample time and area of privacy
GERIATRIC EXAMINATION • What components are often missed in routine exams? – Visual Impairment – Hearing Deficit – Malnutrition – Cognitive Impairment – Depression – Mobility – Urinary Incontinence – Physical Disabilities
Remember . . . ‘the elderly patient is admitted to hospital not because of social problems but because of medical problems with social consequences or social problems with medical consequences’ (Isaacs, 1992)
Time and Money • TIME: Average length of time spent on care giving was about eight years, with about onethird of the respondents providing care for 10 or more years. • MONEY: Almost all respondents reported helping the care recipient with some expenses, most frequently with food, transportation, or medications.
The vast majority of long-term care is provided informally and privately, at no public cost. American Society on Aging, 2000
Caregiver for Elderly g Getting to and from doctor and other appointments. g Helping someone clean their home. g Communicating with health care professionals. g Assisting someone or arranging for home repairs. g Contacting or helping someone communicate with community service organizations. g Arranging for or helping someone to arrange for Meals on Wheels. g Helping arrange for home g Assisting someone to pay their health care or hospice bills. services.
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