3,overview geriatri-menua sehat

8/12/2019 3,Overview Geriatri-menua Sehat

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Dr. Erlina Marfianti, MSc SpPD


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Increased longevity has resulted in an Aging WorldAffluent nations/societies most affected by babyboomers reaching > age 60

The older population (> 65 years) was 36.8 million in2005 in USARepresented 12.4% of U.S. population- about one inevery eight AmericansExpected to be 20% by year 2030- about 75 million

Will comprise 1 in 5 Americans by 2030


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Expentancy for life >>Age> 60 >>

Thn 1990 (5,8%) 2000(7,4 %) 2010 (8,0%)Problems in elderly >>Transisi epidemiology shifting role disease


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20th century saw a global phenomenon of longevity atriumph and a challengeAverage life expectancy at birth- increased by 20 years since1950 to 66 yearsIs expected to increase another 10 years by 2050By 2050, the population of older people will exceed that ofchildren (0-14 yrs)Is a social phenomenon without historical precedent

In 2002, number of persons > 60 years was 605 million;expectedBy 2050, number is expected to reach almost 2 billion


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From Wood R, Bain M. The Health and Well-being of Older People inScotland.Insights from National data. ISD, Edinburgh 2001.[www.isdscotland.org]


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From Wood R, Bain M. The Health and Well-being of Older People in

Scotland. Insights from National data. ISD, Edinburgh 2001.[www.isdscotland.org]


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Refers to a decline in the proportion ofchildren and young people and an increase in

the proportion of people age 60 and over.As populations age, the triangular populationpyramid of 2002 will be replaced with a morecylinder-like structure in 2025


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The older population (> 65 years) was 36.8 million in2005 in USARepresented 12.4% of U.S. population- about one inevery eight AmericansExpected to be 20% by year 2030- about 75 millionWill comprise 1 in 5 Americans by 2030

FASTEST GROWING GROUP OF OLDERPOPULATION IS OLDEST OLD I.E. > 80YRS


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Can be defined as a progressive, generalizedimpairment of function resulting in a loss of

adaptative response to a stress and in agrowing risk of age-associated disease(Kirkwood, 1996).Healthy adults frailChronological Age decline functionalcapacity


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Aging (bertambahnya umur )Senessence ( bertambahnya tua )

Homeostenosis ( berkurangnya cadanganhomeostasis)


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In biology, senescence is the process of ageing Senescence is the steady deterioration of cell functionfollowing the period of development in youth Cellular senescence- cells lose the ability to divide in responseto DNA damage -cells either senesce, or self-destruct(apoptosis) if the damage is irreparable Organismal senescence is the aging of whole organisms.Aging SenescenceSpecies have different "rates of aging"- a mouse is elderly at3 years; humans at 85 yrsApart from species specific genetics, chance eventsdetermine the probability of death


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ImpairmentDisability

Handicap

Quality of Life in elderly


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ImmobilityInstability

IntelectualimpairmentIsolationIncontinenciaImmunodefisienceInfectionInanition

Impaction(constipation)IatrogenesisImpairment of vision,hearing, taste,smelling,

communication,convalensence


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Is characterized by:Declining ability to respond to stress

Increasing homeostatic imbalanceIncreased risk of diseaseDeath is ultimate consequence of ageing


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Main Diagnoses in those with anyDisability,Health Survey for England

2001

0

10

20

30

40

50

Musculoskeletal

Circulator y

InjuryRespirator y

Ear

NervousSystem

Eye

Percentage


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Prevalence of Ischaemic Heart Disease andStroke, Scottish Health Survey

2003

0

10

20

30

40

50

Men 45-54Men 55-64Men 65-74Men 75+Women 45-54

Women 55-64

Women 65-74

Women75+

percentage

IHD (not H/TorDM)

Stroke

IHD orStroke


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Age and Blood Pressure in Scottish Health Survey2003

(English Health Survey 2003 data are very similar)

40

60

80

100

120

140

160

180

200

men 35-44men 45-54men 55-64men 65-74men 75+women 35-44

women 45-54

women 55-64

women 65-74

women75+

mm Hg

systolic 95th%ilesystolicmeansystolic 5th%ile

diastolic 95th%ilediastolicmeandiastolic 5th%ile


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Prevalence of Hypertension(


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Incidence and Prevalence of Dementia in the RotterdamStudy(Barendregt JJ and Ott A, Eur J Epid

2005;20:827-32)

0

10

20

30

40

50

60

55 -59 60-64 65-69 70-74 75-79 80-84 85-89 90+

Age

PrevalenceinWomen

IncidenceinWomen

PrevalenceinMen

Incidence inMen


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http://www.anti-aging.org/blog/aging_3.jpg


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Discuss the Characteristics of Aging

Review the various Theories of AgingExplore the effects of Aging on the

different organ systems


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Mortality increases exponentiallyBiochemical composition of tissue changes

Physiologic capacity decreasesAbility to maintain homeostasis diminishesSusceptibility and vulnerability to diseaseincreases

Environmental and Genetic factorsinfluence the rate of aging


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Loss of physiologic reserve and decreasedhomeostatic control may result from: Allostatic load (persistent activation of normal

neuroendocrine, immune, and autonomic responsesto stress)

Development of homeostenosis (altered response tophysiologic stresses)

Changes are generally irreversible


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Synopsis: Oxygen converted during metabolismcauses protein, lipid, and DNA damage over time

In support: Mutations in oxidative stress pathway can extend life

span Mutations in other pathways that increase longevity

resist oxidative damageIn opposition : Antioxidants do not delay human

senescence or disease


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Glokosilasi non enzymatik advancedglycation end products (AGEs)

Protein, other macomoleculs >> disfunctionAGEs interaction with DNARestriction calori benefit >>


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Mitokhondrial DNceleratedA repairRelation with ROS (free radical)

Mutasi DNAAccelerated Aging


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Synopsis : Age-acquired chromosomal instabilitiescontribute to gene silencing or expression of disease-related genes (e.g. cancer genes)

In support: Damage by free radicals causes mitochondrial DNA

(mtDNA) mutations in muscle and brain Defective mitochondrial respiration and further oxidant

injury creates a cycle of damage

Mitochondrial mutations and defective respiration havebeen linked to neurodegeneration

In opposition : The practical impact on non-diseasedaging appears to be minimal


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Synopsis: Time-acquired deficits, primarily in T-cellfunction, increase susceptibility to infections and

cancer

In support : Some diseases are associated with

aging

In opposition : Immunologic function is apparently

not directly related to healthy aging


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Synopsis: Hypothalamic and pituitary responsesare altered (TRH, GNRH, GHRH, TSH, LH, FSH,

GH, ACTH)

In support: No direct support as causative ofhealthy aging, supplementation does not alteraging in humans


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Loss of proliferative potential, e.g.: Slower onset of lymphocyte proliferation Diminished cloning efficiency of individual T cells

Fewer population doublings of fibroblasts

Proliferative potential does not invariably diminishwith age

Changes in gene expression, signal transduction,and telomere length contribute to cellular aging


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Age-dependent problems with apoptosis couldresult in leukemias, lymphomas, and abnormaltissue repair

Apoptosis may play a role in age-relatedneurodegeneration, e.g.: Neuronal loss in Alzheimers disease may be due to

cytotoxicity of -amyloid, which can induce apoptosisin cultured cells

Putative toxins such as free radicals have beenimplicated in neuronal loss in Parkinsons disease


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http://www.healthgoods.com/shopping/images/aging_chart.gif


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Overall reduction in blood flow occurs as we ageHeart of a 20-year old can pump 10 times theamount actually needed to preserve life

After age 30, about 1% of reserve is lost/ yearResults in:Normal atrophy of the heart muscleCalcification of the heart valves

Arteriosclerosis ("hardening of the arteries")Atherosclerosis (intra-artery deposits)


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ReducedBrain, Liverand Kidney

Function

Vulnerable toDrug Toxicity

Risk of HBP,Heart Attack,Stroke, HeartFailure

Poor Responseto Stress

SlowerHealing rate

CVD Changes

Poorer CellOxygen


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The reduced blood flow results in lessstrength due to:diminished oxygen exchange

reduced kidney and liver functionless cellular nourishmentOther problems :

Intermittent pain in the legs with walkingVaricose veinsPrelediction for Blood clots


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Age-associated change Possible diseaseoutcomes

vascular intimal thickening Early stages ofatherosclerosis

vascular stiffness Systolic HTNStroke

Atherosclerosis

LV wall thickness early diastolic cardiac filling cardiac filling pressure Lower threshold for dyspnea

Left Atrial size Lone Atrial Fibrillation


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Cardiac output both at rest and with moderate exercisedoes not change with age. A finding of cardiac outputin this patient would suggest an underlying disease.

An S4 gallop may occur without underlying disease inpersons older than 80 years. early ventricular fillingvelocities are caused by aged, less compliant ventricles.


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http://www.ahealthyme.com/Imagebank/adam/8676.jpg


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FEV1 and FVC Residual volume

Ventilation-Perfusion mismatching causes PaO 2 [100 (0.32 * age)]Maximum inspiratory and expiratorypressures Diffusion of CO decreasedDecreased ventilatory response tohypercapnia


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Arterial PO2 with age because of an age-related increase inventilation-perfusion mismatch. The age-expected normal Pa O2is determined by calculating 100 minus (0.325 patient age).

Vital capacity with age. Total lung capacity does not changewith age. Residual volume substantially in older persons.


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Manifest changes that affect QOL significantly

Osteoporosis is a common condition characterized by:progressive loss of bone densityIncreased vulnerability to fracturesThinning of vertebrae loss of height; spontaneousfracturesReduction in height occurs by1 cm (0.4 inches) every 10 yearsafter age 40Height loss is even greater after 70 yearsThe vertebrae calcify increasing rigidity, making bendingdifficult


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muscle fibers muscle mass (sarcopenia) lean body mass

Infiltration of fat into muscle bundles Fatigability Basal metabolic rate (4%/decade after age

50)


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Bone density both trabecular and cortical bone Osteoclast bone formation Bone remodelling adipocyte formation in bone marrow Slower healing of fractures Vitamin D absorption osteoblasts boneformation Bone loss Loss of height (stooping) and DorsalKyphosis Bone density & microarchitectural bone deterioration Osteoporosis


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Non-articular cartilage grows throughout lifeArticular cartilage does change

thickness of cartilage chondrocytes

Collagen becomes stiffer Disorderedcartilage matrixAs a result, less able to handle mechanicalstress


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Progressive loss of muscle mass occurs as we age changein body shapeAccelerated after age 65- causes weight lossChanges in body shape can affect balance, contributing tofallsElderly individuals with weak muscles are at greater risk formortality than age-matched individualsIncrease in amount and rate of loss of muscle increases riskof premature deathPhysical inactivity is 3rd leading cause of death; plays role inchronic illnesses of aging


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A reduction in stomach hydrochloric acid,digestive enzymes, saliva causes:Bloating and flatulenceImpaired swallowingReduced breakdown and absorption of foodsDeficiencies in vitamin B, C, and K ;malnutrition is a real possibility


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Age-associated change Possible diseaseoutcomes

liver size and blood flow Impaired clearance ofdrugs requiring phase Imetabolism

Impaired response to gastricmucosal injury

Increased risk of gastric &duodenal ulcers

pancreatic mass and enzyme

reserves

Increased insulin

resistance in effective coloniccontractions

Constipation

in gut lymphoid tissue Increased risk of gastric &

duodenal ulcers


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Age-associated change Possible diseaseoutcomes stomach acid production Atrophic gastritis

Impaired acid clearance GERD

Slowing of gastric emptying Prolong gastric distention meal -induced satiety

Ca absorption Bone loss

Delay in colonic transit rectal wall sensitivity

Constipation

tensile strength in smoothmuscle of colonic wall

Diverticulosis

Insulin secretion Insulin resistance


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Overall effectiveness decreases, leading to:Increased infection riskDecreased ability to fight diseasesSlowed wound healingAutoimmune disordersCancers


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Cell-Mediated immunityLower affinity antibody production delayed-type hypersensitivity Interferon-gamma, TGF-beta, TNF, IL-6, IL-1 production

causing impaired macrophage function circulating IL-6 IL-2 release and IL-2 responsiveness production of B cells by bone marrow

Resulting in immunity contributing to susceptibility toinfections and malignancy


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Menopause is obvious milestone of aging (cessationof periods > 1year)Loss of Reproductive Capacity occurs

Normal around 50 years; occurs by age 40 in 8%womenSecretion of estrogens, progesterone, and prolactinhormones are reducedSex drive is not necessarily diminishedAging does not impair a womans capacity to haveor enjoy sexual relationships


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Prolapse- descent of uterus may occur due tolax tissuesUrinary stress incontinence commonBreasts lose tissue and subcutaneous fat flatten and sagBreast cancer risk increases with ageThe genital tissue atrophies; more prone toinfections


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Men do not experience a sudden andropause Age is not a good predictor of male fertilityTestosterone levels maintained/decrease slightlyDecreases in the sex drive (libido) may occurNormal for erections to occur less frequentlyAging alone does not impair a mans capacity toenjoy sexual relationships


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Normally no changeUsually affected by diseases like high BP,diabetes and cancerLead to increased risk for acute and chronickidney failureUrinary tract infections are common


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Renovascular bed Renal Blood flow

Selective loss of cortical vasculature

Renal mass 25% - mainly cortical

Renal weight


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Cr clearance & GFR (10mL/decade) excretion of drugs, toxins concentrating and diluting capacity serum renin and aldosterone (30-50%) fluid and electrolyte abnormalities - volume

depletion and dehydration risk of hyerkalemia

Na & K excretion and conservation vitamin D activation


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Thyroid gland moderate atrophyOvarian failure T3 DHEA PTH GH, testosterone, estrogen

Insulin secretion Impaired glucosetolerance


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% of marrow space occupied byhematopoietic tissue declines stem cells in marrowSlowed erythropoiesis incorporation of ironinto RBCAverage values of Hb and hematocrit slightly


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Brain Weight no. of nerve cells in brain cerebral blood flow (20%) neurofibrillary tangles and scattered senileplaquesAltered neurotransmitters


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IntellectMaintained until at least age 80Slowing in central processing Tasks take longerto perform

Verbal skillsMaintained until age 70Gradually in vocabulary, semantic errors andabnormal prosody

MentationDifficulty learning, especially languages andforgetfulness in non-critical areas doesnt impairrecall of important memories or affect function


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spinal motor neuronsNerve conduction slows

vibratory sensation especially feet thermal sensitivity (warm-cool) size of large myelinated fibers


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Aging has profound effects on mental facultiesBrain tissue is irreparable changes are permanent

Speed of communication between nervous tissues isdecreasedTransmission of messages within nerve cellsbecomes slowerThe brain and spinal cord lose nerve cells andweightWaste products collect in brain, causing plaques andtangles


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Changes result in:

Lost or reduced reflexes problems with movement and safetySlight slowing of thought, memory, and thinking- a normal part ofagingA change in thinking/memory/behavior are important indicators ofdiseaseALL ELDERLY PEOPLE DO NOT BECOME SENILE

Disease States Delirium, dementia, and severe memory loss are NOT normal

processes of agingCaused by degenerative brain disorders such as Alzheimer's diseaseIllnesses unrelated to brain can cause changes in thinking/ behaviorSevere infections can lead to confused statesDiabetes- fluctuations in glucose levels can causethinking/behavioral disorders


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http://futurederm.files.wordpress.com/2

007/12/122907-skin-aging.jpg

http://www.scf-online.com/german/39_d/images39_d/skinageing_39_d_large.jpg


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Epidermal changesMelanocytes 15%/decadeDensity doubles on sun-exposed skin lentigines

Langerhans cells density responsiveness

Dermal Changes

collagen 1% annual decline, altered fibers densityProgressive loss of elastic tissue in the papillary dermis


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Physiologic Decrement Clinical Consequence(s)Mechanical protectionaltered Sensory perception

Frequent injuries

Sweating Tendency to hypothermia

effectiveness ofthermoregulation (vascular)

Vulnerability to heat andcold

Vitamin D production Osteomalacia

Impaired Wound healing Persistent wounds, weakscars


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TOUCH-Gradual reductionafter 50- injuries,

hypothermia

SMELL- Decreases after

70 yrs- may affecthygiene

TASTE- Minimalchanges

VISION-Usually needglasses by 55-Only 15-20%

have drivingability

HEARING30% people over

age 65 have

impairment

SENSES

Normal acuity with age


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All senses are controlled totally by the brainAging increases minimum amount of stimulationbefore a sensation is perceivedAny compromise in senses has tremendous impacton lifestyleHearing and vision changes- dramatic effect onQOLMany changes can be improved with glasses,hearing aids, and lifestyle modificationsCommunication problems common- lead to socialisolation and loneliness


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SmellDetection by 50%

Thirst thirst drive

Impaired control of thirst by endorphins


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Ears perform two functions 1. Hearing 2.Maintaining body balance (equilibrium)Equilibrium (controlled by the inner ear)Hearing is ruled by the outer ear disorders respondbetterAging adversely affects both structuresAcuity of hearing declines slightly after age 5030% people > 65 have significant hearingimpairmentImpacted ear wax commoner with increasing age deafness, easy to treatPersistent, abnormal ear noise (tinnitus) - commonin older adults


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Visual acuity may gradually decline- not universalAfter age 55, most people need glasses at least partof the time

Driving ability is impaired in 15% to 20% due to badvision5% become unable to readTrouble adapting to darkness or bright lightSignificant difficulty with night driving may be thefirst sign of a cataract


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Color Perceptions Change As we age, it is harder to distinguish blues and greensthan reds and yellowsElderly should use yellow, orange, and red contrasts athome- improves ability to locate thingsUsing a red nightlight is better than a conventional bulb

"Floaters" in vision- harmless; sudden needs consultation

Reduced peripheral vision occurs- cannot see adjacentpeople- may cause offense to friendsBlindness- usually caused by diseases like diabetes andhigh BP


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Taste and Smell Taste does not seem to decrease until after age 60,if at allSense of smell may diminish, especially after age70- leads to poor hygiene, and unawareness of gas

leaks etcTouch, Vibration, And PainAging can reduce sensations of pain, vibration, cold,heat, pressure, and touchDecreased temperature sensitivity increases the riskof frostbite, hypothermia, and burnsAfter age 50, many people have reduced sensitivityto pain.Reduced feel of vibrations- loss of stability inmotion


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Small changes normal - do not significantly change our sense of who the personisPersonality and social interaction often change due to neurodegenerativediseasesDrastic changes in personality reflect a disease process- difficult for caregivers tocope with/accept

Senility or senile is an out -dated term- now replaced with DementiaSenility or Dementia should NOT BE EQUATED TO AGING- DEMENTIA IS ADISEASE STATEDementia condition where one has a progressive decline in memory and othercognitive functions that results in a change in the ability to conduct one's usualactivities Dementia is characterized by multiple cognitive deficits with memoryimpairments as an early symptomDiagnosis of dementia- not given in absence of impairment in socialfunctioning/independent living


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With a healthy lifestyle, few changes seen that are deleterious to QOLIn fact, some actions may grow more correct as we age (within limits)

Learning

The ability to learn continues throughout lifeOften require more time and effort to absorb new informationNeed more effort to organize and understand new informationTendency to avoid learning new things not perceived as beneficialReasons unknown; may be partly attributed to decline in senses aswe age


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Older adults must often deal with physical, medicalor social stressorsStress can precipitate many diseases like diabetes,

high BP, anxiety attacks etcCommon stresses for older people are:diseases or health conditions, possibly chronic (e.g.,heart disease, arthritis, cancer)perceived loss of social status after retirementdeath of a spouse/child/sibling


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Risk factors that might be relevant :(?Baseline ?Rate of Change ? Young ?Old)

1. Genetic2. Nutrition (especially early)3. Cerebral and non- cerebral disease (inc vascular disease in Alzheimers, diabetes) 4. Oxidative stress / other stresses or events5. Inflammation6. Socioeconomic /high education/ sustained intellectual engagement/ occupational complexity7. Neuroplasticity (its not just the relentless loss of cells).


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Working (intermediate term) loss occurs with normal agingEpisodic- especially impaired in normal aging e.g. ability toprocess recent informationSemantic (e.g. vocabulary) Improves with age; lost indementiasProcedural (long-term memory of skills) - shows No Declinewith age; affected by diseasesVery long-term memory (months to years)- increases uptoage 50; maintained until well after 70Short-term memory- shows little decline; loss associated

with diseasesOlder adults tend to be worse at remembering the source oftheir information


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Forgetting things much more often than you usedtoForgetting how to do things you've done manytimes beforeTrouble learning new thingsRepeating phrases or stories in the sameconversationTrouble making choices or handling moneyNot being able to keep track of what happens eachday


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High blood pressure, diabetes, poor nutrition,and social isolationHeart diseaseFamily history of dementiaPsychological factors like stress anddepression


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Executive Functioning include: Organization: attention, decision-making,planning, sequencing, problem solving

Regulation: initiation of action, self-control, self-regulationLanguage- coherent, sensibleWorking (immediate) MemorySpatial Memory

Verbal Memory


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The word dementia is used to describe the condition where

one has a progressive decline in memory and other cognitivefunctions that results in a change in the ability to conductone's usual activitiesDementias are neurodegenerative diseases which cannot becuredEach type characterized by specific effects on cognitive andmotor function Diagnosis of dementia is not generally given in absence ofimpairment in social functioning and independent living. Dementia seriously affects a persons ability to carry outdaily activities

People with dementia lose their abilities at different ratesEventually, patients may need total care


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Dementia symptoms may include:asking the same questions repeatedly,becoming lost in familiar places,being unable to follow directions,getting disoriented about time, people, andplaces, and

neglect of personal safety, hygiene, andnutrition.


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Definition: Is a progressive, neurodegenerative disease characterized inthe brain by abnormal clumps (amyloid plaques) and tangled bundles offibers (neurofibrillary tangles) composed of misplaced proteinsAD is the most common dementia in older adultsIncidence expected to more than double by 2050- from 377,000 in 1995 to959,000The proportion of new cases >85 will increase from 40% in 1995 to 62% in2050The annual incidence expected to shoot up by 2030 (baby boomers[persons born between 1946 and 1964] will be over age 65)Most of the increase will occur among people age 85 or olderEarly symptoms of AD, which include forgetfulness and loss of

concentration, are often missed because they resemble natural signs ofaging


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Caused by a series of strokes in the brainInfarcts result in irreversible death of brain tissueLocation/severity of compromised area governs

severity of symptoms/loss of functionSymptoms abrupt onset; progress step-wise asstrokes recurTreatment to prevent further strokes is veryimportant


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Anxiety Anxiety disorders- commoner as we get older as medical, psychological,and social problems build upOne in five older adults suffers anxiety symptoms severe enough tonecessitate treatmentPersistent or extreme anxiety can seriously decrease QOLCan be a sign of other problems like depression, dementia, physicalillnessAnxiety is often associated with over-arousalSpecific anxiety disorders include the following:

General Anxiety Disorder Most CommonPanic Attacks Previous History Present

Phobias- E.G. Unable To Urinate In Public Bathrooms; Inability To Eat In PublicObsessive Compulsive Disorder Usually Present At Younger AgePost-Traumatic Stress Disorder


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Delirium, or acute confusion, is a sudden change in mentalfunctionDelirium is usually a short-term, temporary problemMay persist for weeks to months in a substantial number ofpeopleIs a common complication of medical illness in elderlyOne-third of older adults arrive at hospital emergencydepartments in delirious stateIs strongly associated with poor outcomes amonghospitalized patients

Can be mistaken for dementia or schizophreniaDelirium common in people with dementia


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Parkinson's disease is a slowly progressive degenerative disease of thenervous systemAbout 50,000 Americans are diagnosed with PD each yearMany more undiagnosed as attribute symptoms to old ageAverage age of onset is 60; commoner as we grow olderCaused by loss of nerve cells in brain that produce dopamineUsually familialExposure to high levels of manganese, carbon disulfide or certainpesticides increases riskAn increased risk in people who live in rural areas in advanced countries(unproved)


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Depression is a serious medical illness characterized by:Persistent sad, anxious, or "empty" moodFeelings of hopelessness, pessimismFeelings of guilt, worthlessness, helplessnessLoss of interest or pleasure in hobbies and activities that wereonce enjoyed 1%2% of older women, and < 1% of older men have major depression Is a continuation of problem from earlier life in 30% 50% of cases Major depression may accompany disorders that result in dementia

Many older adults face cancer or grief that promote depression There is a strong link between major depression and increased risk of dying

from heart disease. Alcohol abuse causes depressed mood


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THE HEALTHY AGING MODEL


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THE HEALTHY AGING MODEL


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Healthy and active aging is a process to achievephysical, mental and social well being throughoutones life particularly in the later years

WHAT IS THE GOAL ?Disease & disability free life with high physical &cognitive

function and active engagement with lifein old age


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Functional capacity like ventilator capacity, musclestrength & cardiovascular output increases in childhood &peaks in early adulthood, eventually followed by a declineresulting in disease & disability in old age.

Rate of decline however gets accelerated by negativeadult life style factors like smoking, alcohol, lack ofexercise, improper diet as well as by environmental &external factors; Hence this decline can be slowed downor even reversed at any age through the individual himselfor the policy makers.


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Behavioural: smoking, alcohol, exercise, diet,drugsEnvironmental : pollution, home safety,rural/urban

Socioeconomic : family,community ,income,literacyPersonal : biology, genetics, coping mechanismsServices : primary care, health prom. disease

preven


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Cardiovascular : sedentary, obesity, lipids, BP, salt, diet, smok,Pulmonary: smoking, environmental pollutionNeurological: BP, smoking, alcohol, diet, depress,mentalDiabetes: diet,sedentary, obesity, inactivityMusculoskeleta l: sedentary, obesity, hormone deficiency Gastrointestinal: low fibre, alcohol, poor oral hygieneUrogenital: BP, hormone deficiency Infections: under nutrition, poor skin care and no vaccinationCancers: diet, smoking, chewing tobaccoSpl senses: sunlight, noise, diabetes, water fluoride, drugsAccidents : unsafe homes

K S Sunil. Primer on Geriatric Care. Pp 12-18, 2002


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Physical activityHealthy dietAvoid smokingJudicious medicationGood oral hygieneHealth screening

Social involvementMental activityImmunizationsHormones HRTClean environmentHome safety


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Benefits: Physiological, psychological and social.

if physical exercise could be dispensed as a pill, itcould be the most valuable prescription to preventdiseases (Edward Staneley)Varieties: Aerobic, resistance and balance

exercises.yogic, spiritual & exercise related to work,recreation, household and social interactionDuration: Brisk walk for 20-60 mts for 3-5 d/weekmorning walk better as he is fresh, walks with hiswhole body; in evening he walks only with his legs


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Low fat, low salt, adequate liquids, proteins,vitamins, calcium, micronutrients and high fibre,fruits and vegetables

Make them relish their food with good flavour,smell, colour, utencils and environment

Frequent small meals, no overeating


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It is never too late to quit smoking

Consuming alcohol in excess is different

from taking in moderation

Scientific methods are in place to give up

these addictions and to deal with problemsof withdrawl


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Properly understand directions of their useTake with or after food unless told otherwiseGet ingredients checked to avoid duplicationConsult doctor to avoid unnecessary medicinesNever hoard medicines you no longer requireDo not share medicines with anyone


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Active ageing is the process of optimizingopportunities for health, participation and securityin order to enhance quality of life as people ageAgeing is a social phenomenon involves friends,

work associates, neighbors, familyInterdependence and intergenerational solidarityare important tenets of active ageingHealthy life expectancy is also a synonym fordisability -free life expectancy Disability-free life expectancy is important to anageing population


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Autonomy is the perceived ability to control, copewith and make personal decisions about how onelives on a day-to- day basis, according to ones ownrules and preferences difficult to quantify

Independence is commonly understood as theability to perform functions related to daily living i.e. the capacity of living independently in thecommunity with no and/or little help from othersADLs (Activities related to daily living) - can bemeasured; e.g. bathing, eating, using the toilet andwalkingIADL (Instrumental activities of daily living);measurable; e.g. shopping, housework, makingmeals


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QOL is an individuals perception of his or her position inlife in the context of the culture and value system where theylive, and in relation to their goals, expectations, standardsand concerns

Incorporates a persons physical health, psychological state,level of independence, social relationships, personal beliefsand relationship to salient features in the environment.(WHO, 1994)

As people age, their QOL is determined by their ability tomaintain autonomy and independence

ADL and IADL are important measures of QOL


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In USA, > 90% of elderly persons consider themselves religiousand spiritualReligion is associated with better mental health and a greaterability to cope with stress, illness and disabilityProvides relief/support to elderly and their caregiversActive involvement in a religious community helps to maintainphysical functioning/healthElderly who attend services more likely to stop smoking,exercise more, increase social contacts, stay married, and livelongerReligious activities foster development of community and broadsocial support networksIncreased networking likelihood of awareness, early detectionof diseases, seeking treatment and adherenceavoids stigma


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MONITORING YOUR OWN HEALTH IS A GOOD ADAGEChronic diseases like diabetes, high BP, obesity, etc cause mostproblems in old ageMost chronic diseases can be delayed or severity reduced Adopt healthy lifestyle behaviors from childhoodKeep weight at BMI < 26Be physically active within limitationsEat nutritious food Avoid misuse of alcohol/drugs; smoking Avoid smoking

Make a social networkSave for care in old ageRegular screening for cancer/diabetes, high BP etcRegular medical examinations/dental checks


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Practicing a healthy lifestyleAvoid tobacco useUse screening for:

Breast, cervical, prostate and colorectal cancersDiabetesHigh Blood PressureCholesterol Regular physician visits Adherence to treatment


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Get adequate sleepMaintain contacts with family and friendsJoin a social groupSurround yourself with people whose company you enjoyVolunteer or get active with groups in your community.Try a part-time job at a place you would enjoy working for a few hours aweekIndulge in activities you always yearned to do, but never had the time forwhen younger!

"The secret of life is enjoying the passage of time. James Taylor


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Slowly Aging process- Calori restriction- IGF/Gh- Telomer


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Alhamdulilah

3,overview geriatri-menua sehat

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