HEALTH ISSUES of the ELDERLY DR KHURSHEED AHMED QURESHI M.D. (Med.) M.D. (PSM) GOVT MEDICAL COLLEGE SRINAGAR KAQ

Old age is a normal inevitable biological phenomenon “ You do not heal old age.. .. .. You can protect it, promote it or extend it ” Sir James Sterling “ Old age is an incurable disease ” .. .. Seneca KAQ

>60 years = 7.7% (Census of India 2001) AGE PYRAMID India Switzerland 80 yrs 50 yrs 01 yrs >60 years = 7.7% (Census of India 2001) >65 years = 3% (India), 12% (UK) KAQ

Greater proportion of disease burden Implications of the Ageing population (Socio-Economic and Medical point of view) Greater proportion of disease burden Greater demand on health services (2/3rd beds occupied in UK hospitals by old people) Greater Burden on economy KAQ

No evidence for a single mechanism Multiple and interacting causes Biology of Ageing No evidence for a single mechanism Multiple and interacting causes Free radical theory .. .. ..Knowledge incomplete KAQ

Physiological changes due to Ageing Body fat  (Obesity) Blood glucose  (Diabetes) Body water  (Anorexia) Vision  (Presbyopia, Lens opacity, Blindness) Lungs  elasticity (Dyspnea) Bone marrow  reserve (Anemia) Liver Function  (delayed metabolism of drugs) Bones  density (Fractures) CVS Hypotensive response to  Pulse (Syncope) Brain Atrophy (Dementia) KAQ

Health Problems of the Aged 1. Problems due to ageing process 2. Problems associated with long term illnesses 3. Psychological problems KAQ

1. Problems due to ageing process Senile Cataract Glaucoma Nerve deafness Bony changes affecting mobility Emphysema KAQ

2. Problems associated with long term illnesses Degenerative diseases of the heart/ blood vessels Cancer Diseases of the locomotor system Diabetes Accidents Chronic respiratory diseases Genito-urinary diseases KAQ

3. Psychological Problems Social mal-adjustment Mental changes Emotional disorder KAQ

Common illnesses during old age KAQ

Common illnesses during old age Hypertension Coronary heart diseases (IHD) Diabetes Stroke Psycho-social problems & Dementia Osteoporosis Falls & accidents Post Menopausal Syndrome Prostate enlargement (BHP) Cancers Miscellaneous (COPD, Parkinson’s Disease, Refractive Error, Deafness, Arthritis, Gout) KAQ

Hypertension KAQ

Hypertension B.P ≥ 140/90 (Hypertension) B.P 120/80 – 140/90 (Pre-hypertension) Risk factors a) Non modifiable : Age, Sex, Hereditary b) Modifiable : Obesity,  Salt,  Sat. fat, OCP Sedentary habits, Stress, Alcohol Prevention Life style modifications Regular (Life long) drug intake, if on treatment KAQ

Hypertension …Is it worth treating? Event Risk reduction Stroke 28-38 % Coronary heart disease 16-20% Congestive heart failure 16-18%

Obesity

Obesity OBESITY: Absolute growth of the adipose tissue Enlargement of fat cell size (Hypertrophic obesity) Increase in fat cell number (Hyperplastic obesity) OVERWEIGHT: Weight in excess of average Not always due to obesity Abnormal muscle development or fluid retention

OBESITY IN DEVELOPED COUNTRIES Most prevalent form of malnutrition. 20 to 40% of adults. 10 to 20% of children.

Metabolic Syndrome

Metabolic Syndrome Raised blood pressure (SBP more than 130) Raised fasting blood glucose Dyslipidemia (Low HDL, increased TG) Abdominal obesity (Waist Circumference more than 102 cm for men and more than 88 cm for women)

Life Style Modifications in the Prevention & Management of Hypertension & obesity Lose weight, if overweight Increase aerobic physical activity (30 – 45 mts/day) Reduce sodium intake (<6 gms/day [NaCl]) Limit alcohol (< 10z / day) Maintain adequate intake of dietary K+ & Ca+) Stop smoking Reduce intake of dietary saturated fats ↑ vegetables (↑K+), ↑ Fish Yoga and meditation Caffeine (causes acute rise, latter tolerance develops)

Coronary Heart Diseases (IHD) KAQ

Coronary Heart Diseases (IHD) (Impairment of Heart function due to inadequate flow of blood to the heart compared to its needs) Types a) Angina b) M.I (myocardial infarction) c) Arrhythmia d) CCF (Heart failure) Risk factors Smoking, Obesity, Hypertension, Hyperlipidemia, Diabetes, OCP Prevention Life style modification & alleviation of risk factors Brisk walking 45 min daily Adequate control of Hypertension and Diabetes KAQ

Ref.≈ CHD in Srinagar – 1997 (JAPI) ODD’S RATIO FOR ASSOCIATION OF C.H.D. PREVALENCE WITH LIFESTYLE RISK FACTORS Age ≥ 50 years 8.55 ↑ TC/HDL Ratio ≥ 3.5 8.13 Hypertension 6.63 Higher S.E. status 5.70 Obesity 5.44 Smoking 3.61 Absent prayers 2.12 Sedentary habits 1.86 High fat intake 1.62 Male sex 1.57 Income ≥ 2000(Rs.) 1.55 Literacy 1.40 Ref.≈ CHD in Srinagar – 1997 (JAPI)

Diabetes KAQ

Diabetes (Increased blood sugar levels due to insulin deficiency or Insulin resistance) Blood sugar fasting Blood sugar PP < 100 mg < 140 mg Normal 101 – 125 mg 140 – 199 mg Pre-diabetes ≥ 126 mg ≥ 200 mg Diabetes Risk factors Family history, Obesity, Sedentary habits, GDM, Drugs Prevention Life style modification, Exercises, food habits, Regular medication under close supervision for Diabetics KAQ

Magnitude of the Problem GLOBAL PREVALENCE 2013 2035 Diabetes 382 million 592 million (8.3%) (10.1%) Prediabetes 316 million 471 million (6.9%) (8.0%)

How much workout you need to compensate for this caloric intake…..

How much workout you need to compensate for this caloric intake…..

300 calories

300 calories

300 calories Ride a bike for one hour. or Walking leisurely for one hour. Jogging / Brisk walk for 45 minutes

Diet In Diabetes Total energy requirement: Varies with body wt./activity Males: 36 Kcal/kg/day Females: 34 Kcal/kg/day Proteins: 0.9-1 gm/kg/day Carbohydrate:40-60% of total energy intake Fats: 30-50% of total calories (see BMI) mainly polyunsaturated fats (anti- atherogenic properties) NOTE: Use ↑ fibre , type-A vegetables , ↑ fat replacers Use omega-3 fatty acids (fish oil) Use non- nutritive sweeteners (Saccharin Aspartame) Use ↑ micro-nutrients (anti-oxidants)

Dietary Changes? Identify food preferences Give high quality/low calorie diet Increase dietary fiber Proportion of energy dense foods like simple carbohydrates and fats to be reduced

Issues # Physical Inactivity *TV/Internet # Poor diet *Too much carbohydrates *Too little Proteins *Too little fiber *Poor omega 3/6 ratio *High invisible fat/salt

Stroke (CVA) KAQ

Stroke (CVA) Rapid development of cerebral dysfunction due to: a) Obstruction to blood vessels ( ≠ fat deposition) b) Rupture of blood vessel (Hemorrhage due to  BP) c) Transient Occlusion (TIA) Risk factors Hypertension, Diabetes, etc Prevention Adequate control of hypertension and Diabetes KAQ

Psycho-Social Problems & Dementia KAQ

Psycho-Social Problems & Dementia Dementia = Loss of memory Senile Dementia usually starts after 60 yrs Alzheimer's type dementia may start earlier with lot of associated handicaps .. .. ..Family and social support more important than medical treatment KAQ

Osteoporosis KAQ

Osteoporosis Reduction in the bone mass due to a) Calcium & Vitamin D deficiency b) Immobilization c) Mal-nutrition d) Drugs and Hormones e) Alcoholism f) etc .. .. ..etc * Commonly seen among post-menopausal women * May lead to fractures Prevention Balanced diet Regular exercises / Jogging HRT (Hormone replacement therapy) KAQ

Falls & Accidents KAQ

Falls & Accidents Risk factors Visual acuity Hearing Dementia Irrational use of drugs Interventions (Medical / Environmental) Proper lighting, Flooring & Furnishing Proper stairs with hand support Kitchen with firm non-movable table & handy shelves Bathroom with non-skid flooring with door locks removed Toilet with raised seats Bedrooms with bed at proper height Shoes with firm non-skid soles and low heels KAQ

Prostate enlargement (BHP) KAQ

Prostate enlargement (BHP) Prostate is a gland which surrounds urethra in males. Enlargement of the prostate leads to a) Difficulty in passing urine b) Straining with resistance in urinary flow c) Post void dribbling d) Nocturia Management a) Medical b) Surgical KAQ

Cancers KAQ

(Abnormal growth of cells with tissue invasion) Cancers (Abnormal growth of cells with tissue invasion) Common cancers among elderly of Kashmir a) Stomach / Esophagus b) Lungs c) Breast d) Colon e) Cervix f) Prostate Warning Signs a) Unexplained loss of weight b) Abrupt loss of appetite c) Change in Bowel habits d) Lump in the breast or Neck e) Abnormal bleeding f) Persistent cough and /or Hoarseness KAQ

TIME TRENDS IN CANCER Cancer death rates by site in United States

Other diseases among elderly Refractive Error / Cataract Hearing Impairment Gout & other types of Arthritis C.O.P.D./Chronic Bronchitis Parkinson’s Disease Post Menopausal Syndrome (females) KAQ

Reasons for special care of Elderly KAQ

Reasons for special care of Elderly Rising number of Greying world Changing dependence ratio of working population to pensioners (6:1 in UK) Social aspects Feeling of loneliness Being neglected Rejection & insecurity KAQ

PREVENTIVE HEALTH CARE KAQ

PREVENTIVE HEALTH CARE 3 levels of Prevention Primary prevention Secondary prevention Tertiary prevention KAQ

Preventive health care for the elderly KAQ

Primary prevention Health habits / Hygiene Life style modification Balanced diet Psycho-Social support Immunization Injury prevention Iatrogenesis prevention Osteoporosis prevention .. Do not compromise on your health for the pleasure of others. Discourage Smoking KAQ

Secondary prevention Early diagnosis and treatment Whole population strategy High risk strategy KAQ

Tertiary prevention Disability limitations Rehabilitation Care taker support Prompt foot care (Diabetics) Welfare schemes KAQ

Diet for the elderly Balanced diet a) Carbohydrates b) Proteins c) Fats (saturated/unsaturated) d) Vitamins / Minerals / Anti-Oxidants WHO recommendations for elderly 1. Increase complex carbohydrates (Veg, Fruits, Whole grains & legumes) 2. Reduction of dietary cholesterol to below 100 mg per 1000 Kcal/day 3. Reduce Saturated fats to less than 10% of total energy intake 4. Increase fiber 5. Optimal Salt intake 6. Proteins 1gm/Kg body weight KAQ

Common screening tests for elderly Self assessment ( look for pallor, nodes, lump, bleeding P/R, SOB) Lab tests : (CBC, Blood sugar, Lipid profile, Urine/Stool exam, KFT, LFT, ECG, USG) Cancer screening : UGI endoscopy (Stomach), LGI endoscopy (Colon), BSE/BCE (Breasts), Mammography, Tumor markers (PSA, CEA, CA125.. ..), Stool for Occult blood, PR exam KAQ

Take Home Message Maintenance of Socio- cultural environment Life style modification Regular exercises, Prayers, Yoga Balanced diet Drug precautions Immunization Participation in health education and counseling programmes KAQ

Thanks