ELDERLY and DISABILITY

1. ELDERLY and DISABILITY Sharon Gondodiputro dr., MARS.,MH Dept. Of Public Health Faculty of Medicine Unpad

2. Fact Sheets !!!! About Elderly • The world population is rapidly ageing • Between 2000 and 2050, the proportion of the world's population over 60 years will double from about 11% to 22%. The number of people aged 60 years and over is expected to increase from 605 million to 2 billion over the same period.

3. By 2050 the world will have almost 400 million people aged 80 years or older. Never before have the majority of middle-aged adults had living parents. • By 2050, 80% of older people will live in low- and middle-income countries

4. The main health burdens for older people are from noncommunicable diseases • Already, even in the poorest countries the biggest killers are heart disease, stroke and chronic lung disease, while the greatest causes of disability are visual impairment, dementia, hearing loss and osteoarthritis. • Many of these problems can be easily and cheaply prevented.

5. The need for long-term care is rising • The number of older people who are no longer able to look after themselves in developing countries is forecast to quadruple by 2050. • Many require long-term care, including home-based nursing, community, residential and hospital-based care.

6. Effective, community-level primary health care for older people is crucial • Good care is important for promoting older people's health, preventing disease and managing chronic illnesses.

7. Supportive, “age-friendly” environments allow older people to live fuller lives and maximize the contribution they make • Creating “age-friendly” physical and social environments can have a big impact on improving the active participation and independence of older people

8. Healthy ageing starts with healthy behaviours in earlier stages of life • These include what we eat, how physically active we are and our levels of exposure to health risks such as those caused by smoking, harmful consumption of alcohol, or exposure to toxic substances.

9. We need to reinvent our assumptions of old age • Society needs to break stereotypes and develop new models of ageing for the 21st century. Everyone benefits from communities, workplaces and societies that encourage active and visible participation of older people.

10. Caring for older family members is a normal, but often a stressful situation, may be manifest through illness in the caregivers • Human biologic aging is characterized by the progressive constriction of each organ system’s homeostatic reserve (homeostenosis) • Begins in the third decade, progressive, but varies in speed for each individual • Pra lansia = 49 -59 tahun • Lansia > 60 tahun

11. Is influenced by : • genetic factor, • diet, • environment and • personal habits

12. Several principles from this concept: Individuals become more dissimilar as they age, rejecting any stereotype of aging Abrupt decline in any system/function …..> almost certain due to disease, not to normal (or usual) aging “ Normal aging” can be attenuatedto some extent by modification of risk factors. In the absence of disease, homeostenosis should not cause symptomsor impose restrictions on activities of daily living.

13. THE AGED RELATED CHANGES AND THEIR CONSEQUENCES

16. THE FRAIL ELDERLY

17. THE FRAIL ELDERLY • Syndrome that results from a multisystem reduction in reserve capacity • Increased risk of disability and death from minor external stresses …..> extraordinarily thin tightrope in an attempt to balance physiologic function

18. FIVE CLASSIC GERIATRIC PROBLEMS • FALLS • DEMENTIA • DEPRESSION • URINARY CONTINENCE • IRRATIONAL DRUG THERAPY (POLYPHARMACY)

19. APPROACH TO THE PATIENT • Priorities : in elderly are likely to differ from those of younger people ……> Quality of life • Caregiver issues : requires attention as well as the patient, since the health and well being of the two are closely linked.

20. COMPREHENSIVE GERIATRIC ASSESSMENT • Physical assessment • Mental status assessment • Functional assessment • Social assessment • Home environment assessment

21. Physical Assessment History taking : • Auto/Allo anamnesis • visual impairment • hearing loss • Falls • Incontinence • drug ingestion • dietary patterns • sexual dysfunction • depression and anxiety

22. Interviewing older patients and their family members • Be prepared to spend more time with older patients and more slowly • Always address the patient first • Involve caregivers and family members early in the patient’s care • Recognize the emotional concerns underlying any explicit requests • Do not make significant changes in a treatment plan based solely on the family’s report without evaluating the elderly patient directly

23. Physical examination: Very private, do not mention anything, with respect and kindness. • General examination: vital signs • Special senses : eyes and ears • Mouth and denture • Neck • Breasts • Cardiovascular system • Abdomen and urinary tract • Gait and balance : “The get up and go” • Neurological system

24. Mental status assessment • Geriatric Depression scale • Cognitive testing : dementia (intelectual impairment) • Conversational probing: for patients who follow the news or reading, television • Draw a clock test: ask the patient to draw a clock with the hands at a set time ex 15 min before 03:00 • Folstein’s Mini Mental Status Examination (MMSE) • Elderly Cognitive Assessment Questionnaire (ECAQ)

25. Geriatric Depression scale A score > 5 points is suggestive of depression. A score > 10 points is almost always indicative of depression. A score > 5 points should warrant a follow-up comprehensive assessment.

28. Elderly Cognitive Assessment Questionnaire (ECAQ)

29. Assessment of Decision Making Capacity :Capacity to make decision for medical intervention : four components: • Ability to express a choice • Ability to understand relevant information about the risks and benefits of planned therapy and the alternatives including no treatment • Ability to understand the situation and its possible consequences • Ability to reason

30. Functional assessment Information about function can be used in a number of ways: • As baseline information • As a measure of the patients’s need for support services or placement • As an indicator of possible caregiver stress • As a potential marker of spesific disease activity • To determine the need for the therapeutic interventions

31. Measurement: • Activities of daily living (Katz):

32. Social and economic assessment Evaluates the patient’s perception of his own health status, his environment, his family situation, financial status and leisure activities

33. Home environment assessment The main objectives : • To understand the home environment of the elderly and home hazards • To see the interaction between the elderly’s functional abilities and the home environment • To see how care can be optimized taking into considerations the home situation • To detect any potential hazards that may predisposed the elderly to falls

34. Areas of assessment • Housing : accesibility, social services, transportation, medical services, amenities • The house/flat: type and location, number of rooms, lift, stairs and walkway, lighting, hazards, entry and exit • Room: flooring, ventilation, telephone location, furniture arrangement, lighting, hazards, bed • Living room: Furniture arrangement, wiring, hazards, chairs and table • Bedroom: bed, lighting,flooring,hazards • Toilet/bathroom: grips,bars, railings, toilet type, flooring, drainage, non slip measures, hazards • Kitchen: storage space and accesibility, sharps, hot water, oven, flooring and hazards.

35. Polypharmacy