Gerontology and Geriatrics Dr Gary Sinoff Department of

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Gerontology and Geriatrics Dr Gary Sinoff Department of Gerontology University of Haifa

Gerontology and Geriatrics Dr Gary Sinoff Department of Gerontology University of Haifa

Study of the Elderly • Focuses on aging and old age • Individual aspects

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. ”

“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 •

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

Goals of Geriatric Medicine • Maximize the positive aspects of aging. • The compression of morbidity. • Delaying the onset of chronic disease and maximizing function.

Definitions

Definitions

DEFINITION OF AGING A PROCESS OF IRREVERSIBLE ACCUMULATION OF DELETIRIOUS CHANGES IN THE CELLS

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

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

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

Defining Old Age • Chronological Age • Biological Age • Psychological Age • Sociological Age

Chronological Age • Commonly used indicator – 65 and over • Limitations - People’s

Chronological Age • Commonly used indicator – 65 and over • Limitations - People’s functional capabilities vary - May not capture the diversity of people

Demographics

Demographics

Changing Global Age Structure 1996

Changing Global Age Structure 1996

Changing Global Age Structure 2025

Changing Global Age Structure 2025

World and Regional Life Expectancy 20 yrs increase in past 50 Source: United Nations,

World and Regional Life Expectancy 20 yrs increase in past 50 Source: United Nations, 2001

World Population Dynamics

World Population Dynamics

TOP TEN

TOP TEN

Regional Distribution of Population aged > 60 in millions Start Learning Chinese or Hindi

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

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

The Population Explosion

Growth of World Population 1830 1960 1975 1987 1999 1 billion 2 billion 3

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

The Grey Tsunami ? The Grey Tsunami R. O. M. P. ? Collingwood April 24, 2008 Dr. Carolyn Bennett M. P.

Squaring of the survival curve

Squaring of the survival curve

The Demographic Transition

The Demographic Transition

Demographic Transition Stage 1: Death rates and birth rates both high. Stage 2: Fall

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

Population Pyramids for the four demographic transition phases

Approach to Illness in the Older Patient In older adults, the presenting problem is

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.

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

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

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”

“O” Complex of Geriatric Medicine DON’T FORGET “FAILURE TO THRIVE”

THE “CASCADE” OF OLD AGE

THE “CASCADE” OF OLD AGE

The Epidemiological Transition: Changing Pattern of Causes of Death 25 T h 20 o

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

Disabilities

History and Examination

History and Examination

History

History

HISTORY • • More time consuming Depends on senses Cognitive state Ignoring symptoms Atypical

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

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

The Curse of the Modern Society • Mobile phones

All Systems BUT ALSO!!! – Social – Living Conditions – Past experiences – Economic

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

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

PHYSICAL EXAMINATION • Ask permission to initiate procedures • Need for assistive devices •

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

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

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

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

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

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.

 שיעור הבא Physiology

שיעור הבא Physiology