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

2. 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
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3. >60 years = 7.7% (Census of India 2001)
AGE PYRAMID
India Switzerland
80 yrs
50 yrs
01 yrs
>60 years = % (Census of India 2001)
>65 years = 3% (India), % (UK)
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4. 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
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5. 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
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6. 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)
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7. Health Problems of the Aged
1. Problems due to ageing process
2. Problems associated with long term illnesses
3. Psychological problems
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8. 1. Problems due to ageing process
Senile Cataract
Glaucoma
Nerve deafness
Bony changes affecting mobility
Emphysema
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9. 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
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10. 3. Psychological Problems
Social mal-adjustment
Mental changes
Emotional disorder
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11. Common illnesses during old age
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12. 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)
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13. Hypertension
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14. 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
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15. Hypertension …Is it worth treating?
Event
Risk reduction
Stroke
28-38 %
Coronary heart disease
16-20%
Congestive heart failure
16-18%

16. Obesity

17. 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

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

19. Metabolic Syndrome

20. 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)

21. 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)

22. Coronary Heart Diseases (IHD)
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23. 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
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24. Ref.≈ CHD in Srinagar – 1997 (JAPI)
ODD’S RATIO FOR ASSOCIATION OF C.H.D. PREVALENCE WITH LIFESTYLE RISK FACTORS
Age ≥ 50 years
↑ TC/HDL Ratio ≥
Hypertension
Higher S.E. status
Obesity
Smoking
Absent prayers
Sedentary habits
High fat intake
Male sex
Income ≥ 2000(Rs.)
Literacy
Ref.≈ CHD in Srinagar – 1997 (JAPI)

25. Diabetes
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26. 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 – 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
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27. Magnitude of the Problem
GLOBAL PREVALENCE
Diabetes million million
(8.3%) (10.1%)
Prediabetes million million
(6.9%) (8.0%)

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

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

30. 300 calories

31. 300 calories

32. 300 calories
Ride a bike for one hour. or Walking leisurely for one hour. Jogging / Brisk walk for 45 minutes

33. Diet In Diabetes Total energy requirement:
Varies with body wt./activity
Males: 36 Kcal/kg/day
Females: 34 Kcal/kg/day
Proteins: gm/kg/day
Carbohydrate:40-60% of total energy intake
Fats: % 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)

34. 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

35. 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

36. Stroke (CVA)
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37. 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
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38. Psycho-Social Problems & Dementia
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39. 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
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40. Osteoporosis
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41. 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)
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42. Falls & Accidents
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43. 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
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44. Prostate enlargement (BHP)
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45. 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
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46. Cancers
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47. (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
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48. TIME TRENDS IN CANCER Cancer death rates by site in United States

49. 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)
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50. Reasons for special care of Elderly
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51. 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
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52. PREVENTIVE HEALTH CARE
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53. PREVENTIVE HEALTH CARE
3 levels of Prevention
Primary prevention
Secondary prevention
Tertiary prevention
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54. Preventive health care for the elderly
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55. 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
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56. Secondary prevention Early diagnosis and treatment
Whole population strategy
High risk strategy
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57. Tertiary prevention Disability limitations Rehabilitation
Care taker support
Prompt foot care (Diabetics)
Welfare schemes
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58. 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
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59. 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, CA ),
Stool for Occult blood, PR exam
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60. 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
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61. Thanks