RIZKI WAHYUDI / 37F/ 226080461

GERIATRIC MEDICINE IS NOT INTERNAL MEDICINE

FOR OLDER PEOPLE

The myth
There are some myths that we have to busted in serving geriatric, among others is
1. Most patients lost by internists are visiting specialist
2. Patients that visit geriatricians are have been neglected by internist for so long
3. Pediatric is not internal medicine for children
The confusion
Some people may would confuse what the difference internal medicine and geriatric medicine.
 Internal medicine
1. Grew from application from scientific knowledge into practice in late 1800
2. Scientific approach to medicine was uniqe
3. Elderly care has been traditionally clubbed with mentally ill/poor/disabled
 Geriatric medicine
1. Started in mid 1900s following large number of WW1 veterans needing care and voices
demanding improved facilities
2. Majority of the patient seen by both – overlap
3. Care provided by internists appears to be similar but this rapidly changing

The future
In United states 13% of the population are more than 65 years old, account for 43% of annual
inpatient care spending and Projected increase to 19% by 2030

The problem
1. Older patients are mistreated
2. Growth rate of older population
3. Older persons is the main users of healthcare services
4. So few interested being general physicians

Uniqueness of gerontology
1. Focused in quality of life
2. Multidisciplinary teams
3. Provide a comprehensiveness
4. Attention to disability and discharge planning
5. Knowledge at therapeutic intervention at multi levels from pathology to environmental
modification.

The way forward

1. Collaboration (Combine resources and aducators)
2. Innovative care delivery system (improve acces, optimize health)
3. Communication tech tools
4. Health information technology

GERIATRIC SYNDROME
Geriatric syndrome is clinical conditions that do not fit into defined disease conditions. Common
characteristics are complex, multi factorial, often in older persons, and many organ systems.
The new four are Frailty, osteosarcopenia, oropharyngeal difagia, and sleep disorder.
1. Frailty
Frailty is progressive physical decline and lack of resilience to stressor. The prevalence
arround 7-12% in community living persons. It can be indentified by Fried criteria or
Rockwood criteria
Fried Criteria
 Weakness, slowness, exhaustion, physical activity, wight loss
Non frail = 0
Pre frail = 1-2
Frail = >2
to manage this condition we can give education, behaviour therapy, physiotherapy,
and vitamin D supplementation.

2. Osrteosarcopenia
Osrteosarcopenia is complicated osteoporosis with sarcopenia, increase in bone density
and progressive generalized loss of skeletal muscle mass.
Clinical presentations are multiple falls, frequent fractures, weakness, also decrease in
height due to vertebral collapse and khyposis.

3. Oropharyngeal dysphagia
Oropharyngeal dysphagia are any difficulty in forming, propelling or moving the food
from oral cavity to esophagus. Its can be aspiration, choking, and faringeal food residue.
 Screening method : EAT 10 and SSQ
 Diagnosis : videofluroscopy (gold standard)
 Management : fluid adaptation, adequate nutritions.
4. Sleep disorders
People with Normal sleep cycle will experience NREM (N1, N2, N3) and REM (the
phase of dreams). 4-5 cycle of sleep in normal individual each lasting 70-120 minutes.
Structural, hormonal and physiological brain changes with age, time spent in N1/N2
increase, N3/REM be deeper phase reduce.
Associated factors are multiple comorbidity and polypharmacy.
To manage this conditions, there are view things we can applicated :
 Education and sleep hygine
 Reduce stimulants
 Comfortable sleep environtment
 Regular exercise and food
 Hypnotherapy
 Benzodiazepines, iron replacement in RLS
 Why is Healthy Ageing Important?

Introductory Comments
• The proportion of older persons in population is increasing rapidly across the globe but in this
century it is more in the low and middle income countries encompassing many Asian nations
with certain prominent features – rising life expectancies, feminization of ageing and setting in
of chronic diseases besides still garbling with acute health problems with limited socioeconomic
resources.
• Thus Demographics and epidemiological transitions demand healthy ageing approach across
the life course.
• It is extremely pertinent that in the coming decades focus is on improving and maintaining
adult population’s well being through healthy ageing initiatives.

The concept of healthy ageing

• The World Health Organization defines healthy or active ageing as 'the process of developing
and maintaining the functional ability that enables wellbeing in older age'. It incorporates
physical, mental and social health dimensions – as a holistic aspect.
• This is an extremely important concept in ageing societies as it emphasizes on life course
approach, a right based perspective and life long provisions for wellbeing comprising of both
social and health care empowering facilities. It is a universal and all inclusive perspective.
• Healthy Ageing is an individual lived experience, it is dynamic. The intent to age well should
be fostered early in life by families, communities and societies.

Misconceptions need to be removed

• Often healthy ageing is viewed as the absence of disease or infirmity. This is a narrow
understanding.
• Ageing does over a period of time bring certain changes in circumstances. Managing these
challenges well is about adopting healthy ageing practice which also involves understanding
heterogeneity in ageing and each older adult adopting their own path towards healthy ageing.
• It is a process to attain and maximize functional ability, use of assistive technologies and other
measures to achieve it are all relevant tools.
What is key to healthy ageing
• Main focus should be to keep older adults safe within the broader scope of healthy ageing.
• It thus entails possession of multiple abilities which allow to: meet basic needs; learn, grow and
make decisions; be mobile; build and maintain relationships; and contribute to society in
socioeconomic sense as a personal and societal resource.
• We need to have proactive approach for healthy ageing only then quality of life in later years
can be sustained and improved.

There is compelling need to understand benefits of healthy ageing

• It increases wellbeing and participation, aids in recovering from illness more quickly, reduces
the risk of getting chronic disease, improves flexibility and agility, thus prevents falls which is a
growing necessity in ageing societies across the globe.
• By adopting the concept of healthy ageing, societies commit towards improving the lives of
older people, their families and the communities.
• Various healthy ageing initiatives add quality of life by reducing age related vulnerabilities.

It is imperative to understand that

• Many factors influence healthy aging. Some of these are not in our control, such as genetics,
but many environmental factors can be controlled.
• Taking care of physiological and mental health are adaptable conditions whose negative and
positive impacts can be determined and regulated.
• Achieving healthy ageing is within a person’s reach. Research done in the past and present
supports and identifies actions that contribute towards maintaining healthy ageing which
contributes towards maintaining quality of life for dignified living in later years as a person ages.

Important aspects to remember

• For compression of morbidity which is pertinent part of healthy ageing concept – taking care of
physiological and cognitive health by staying physically and mentally active, eating healthy,
making smart choices in diet, staying socially engaged, pursuing tasks that bring healthy
outcomes.
• Healthy ageing is the present and future agenda of all societies and it is crucial that
governments support this be having age related policies and programs for its people.