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AIM OF GERIATRIC MEDICINE Maintenance of health in old age by high levels of engagement and avoidance of disease Early detection and appropriate treatment of disease Maintenance of maximum independence consistent with irreversible disease and disability Sympathetic care and support during terminal illness

PHYSICAL IMPLICATIONS OF AGING Skin: Exhibits most obvious sign of aging Loss of underlying connective tissue, fat and oil glands wrinkles, sagging skin Aging skin appears thinner, paler, and translucent Increased sensitivity to heat/cold, bruising, and bedsores Develops "age spots" due to deposits of melanin pigment Contributing factors: nutrition; exposure to sun, chemicals/toxins; hormones, and heredity Hair: Hair color is due to pigment melanin- gradually decreases after age 30-40 Loses pigmentation turns hair gray/white Manifests earliest in scalp, followed by facial/body hair Alopecia- baldness/ hair loss is the norm Coarsening of hair common Nails: Become dull, brittle, ridged, thickened, grow slower Due to reduced blood flow to connective tissues The Cardiovascular System Overall reduction in blood flow occurs as we age

Heart of a 20-year old can pump 10 times the amount actually needed to preserve life After age 30, about 1% of reserve is lost/ year Results in: Normal atrophy of the heart muscle Calcification of the heart valves Arteriosclerosis ("hardening of the arteries") Atherosclerosis (intra-artery deposits) The reduced blood flow results in less strength due to: o Diminished oxygen exchange o Reduced kidney and liver function o Less cellular nourishment Other problems: Intermittent pain in the legs with walking Varicose veins Prelediction for Blood clots Changes in Respiratory System Maximum lung function decreases with age Diminished elasticity of airways and lung tissue Reduced ciliary activity decreased oxygen uptake/exchange Muscles of the rib cage atrophy, further reducing the ability to: o Breathe deeply o Cough o Expel carbon dioxide o Aggravating factors: Smoking, Pollution o Results in: o Lower stamina for work; easily fatigued o Shortness of breath

o Oxygen lack can increase anxiety o Susceptibility to pneumonia increased Skeletal System Changes Manifest changes that affect QOL significantly Osteoporosis is a common condition characterized by: Progressive loss of bone density Increased vulnerability to fractures Thinning of vertebrae loss of height; spontaneous fractures Reduction in height occurs by1 cm (0.4 inches) every 10 years after age 40 Height loss is even greater after 70 years The vertebrae calcify increasing rigidity, making bending difficult Joints Osteoarthritis- degenerative disease, most common chronic condition in elderly Rheumatoid arthritis- common connective tissue disorder Both impair mobility and the performance of daily activities of living Gastrointestinal System A reduction in stomach hydrochloric acid, digestive enzymes, saliva causes: Bloating and flatulence Impaired swallowing Reduced breakdown and absorption of foods Deficiencies in vitamin B, C, and K ; malnutrition is a real possibility Muscular System Progressive loss of muscle mass occurs as we age change in body shape Accelerated after age 65- causes weight loss Changes in body shape can affect balance, contributing to falls Elderly individuals with weak muscles are at greater risk for mortality than age-matched individuals Increase in amount and rate of loss of muscle increases risk of premature death

Physical inactivity is 3rd leading cause of death; plays role in chronic illnesses of aging Hormones Sex Hormones Men may exhibit slightly decreased levels of testosterone Women have decreased levels of estrogens, progesterone and prolactin after menopause Insulin The normal fasting glucose level rises 6-14 mg/dL every 10 years after age 50 Probably due to loss in number of insulin receptor sites in cells Can lead to diabetes- annual testing recommended Other Hormones Not significantly affected Immune System Overall effectiveness decreases, leading to: Increased infection risk Decreased ability to fight diseases Slowed wound healing Autoimmune disorders Cancers Female Reproductive System Menopause is obvious milestone of aging (cessation of periods > 1year) Loss of Reproductive Capacity occurs Normal around 50 years; occurs by age 40 in 8% women Secretion of estrogens, progesterone, and prolactin hormones are reduced Sex drive is not necessarily diminished Aging does not impair a womans capacity to have or enjoy sexual relationships Physical manifestations in Women Prolapse- descent of uterus may occur due to lax tissues

Urinary stress incontinence common Breasts lose tissue and subcutaneous fat flatten and sag Breast cancer risk increases with age The genital tissue atrophies; more prone to infections Male Reproductive System Men do not experience a sudden andropause Age is not a good predictor of male fertility Testosterone levels maintained/decrease slightly Decreases in the sex drive (libido) may occur Normal for erections to occur less frequently Aging alone does not impair a mans capacity to enjoy sexual relationships Physical Manifestations in Men Prostate grows in size- urinary problems Cancer of prostrate or bladder is commoner in older men Erectile dysfunction Erectile dysfunction may occur Is frequently related to diseases (diabetes) or medicines 90% of erectile dysfunction- has medical rather than psychological origin May be amenable to treatment Changes in Kidneys Normally no change Usually affected by diseases like high BP, diabetes and cancer Lead to increased risk for acute and chronic kidney failure Urinary tract infections are common Teeth and Mouth Fall of teeth is an obvious sign of aging All people eventually lose teeth- rate depends on several factors

Proper hygiene can preserve teeth longer Increased sensitivity to cold/heat common with attrition Loss can interfere with healthy eating habits- malnutrition common Nervous Tissue and Aging Aging has profound effects on mental faculties Brain tissue is irreparable changes are permanent Speed of communication between nervous tissues is decreased Transmission of messages within nerve cells becomes slower The brain and spinal cord lose nerve cells and weight Waste products collect in brain, causing plaques and tangles Changes result in: Lost or reduced reflexes problems with movement and safety Slight slowing of thought, memory, and thinking- a normal part of aging A change in thinking/memory/behavior are important indicators of disease ALL ELDERLY PEOPLE DO NOT BECOME SENILE Disease States Delirium, dementia, and severe memory loss are NOT normal processes of aging Caused by degenerative brain disorders such as Alzheimer's disease Illnesses unrelated to brain can cause changes in thinking/ behavior Severe infections can lead to confused states Diabetes- fluctuations in glucose levels can cause thinking/behavioral disorders SENSES All senses are controlled totally by the brain Aging increases minimum amount of stimulation before a sensation is perceived Any compromise in senses has tremendous impact on lifestyle Hearing and vision changes- dramatic effect on QOL Many changes can be improved with glasses, hearing aids, and lifestyle modifications

Communication problems common- lead to social isolation and loneliness HEARING 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 respond better Aging adversely affects both structures Acuity of hearing declines slightly after age 50 30% people > 65 have significant hearing impairment Impacted ear wax commoner with increasing age deafness, easy to treat Persistent, abnormal ear noise (tinnitus) - common in older adults VISION Visual acuity may gradually decline- not universal After age 55, most people need glasses at least part of the time Driving ability is impaired in 15% to 20% due to bad vision 5% become unable to read Trouble adapting to darkness or bright light Significant difficulty with night driving may be the first sign of a cataract Taste and Smell Taste does not seem to decrease until after age 60, if at all Sense of smell may diminish, especially after age 70- leads to poor hygiene, and unawareness of gas leaks etc Touch, Vibration, And Pain Aging can reduce sensations of pain, vibration, cold, heat, pressure, and touch Decreased temperature sensitivity increases the risk of frostbite, hypothermia, and burns After age 50, many people have reduced sensitivity to pain. Reduced feel of vibrations- loss of stability in motion


HEALTH PROBLEMS 1.Joint problems 2.Impairment of special senses 3. Cardio vascular disease 4.Hypothermia 5.Cancer, Prostate enlargement, Diabetes& Accidental falls

PSYCHOLOGICAL PROBLEMS Emotional problems Suicidal tendency 3.& Senile dementia, Alzheimerdisease SOCIAL PROBLEMS Poverty, Loneliness, Dependency, Isolation, Elder abuse, Generation Gap GERIATRIC TEAM Geriatricians Nurses Physiotherapist Social worker And Health worker

HOW TO TREAT. Investigation is an essential tool in the diagnosis of elderly patients. Under or over investigations to be avoided. Know the age related variables while interpreting the results. Non-invasive tests are preferred than invasive. The objective of the investigations is to improve the quality of life. One must try to get the diagnosis right, as wrong diagnosis is harbinger of wrong treatment Polypharmacy should be avoided whenever possible Regular review of medication is a must

Poor drug compliance could be due to poor advice Proper nutrition is vital for healthy living A well balanced nutritious diet is ideal for older age It is not the quantity but the quality

PREVENTION Primordial prevention Pre geriatric care Primary prevention Health education Exercise Secondary prevention Annual medical check-up Early detection ( Universal approach, Selective approach) Treatment Tertiary prevention Counseling and Rehabilitation Welfare activities (Sanjay Niradhar Yojana, Vridhashrama) Chiropody services Improving quality of life Cultural programme Old age club Meals-on wheel service Home help Old age home