CARE for the ELDERLY

EVELYN ABASOLO-LAO,M.D.,FPAFP
 CASE
P.J., 68 years old,male, had stroke
and with right sided deficits on the
upper and lower extremities.
He has anorexia and episodes of
depression due to his condition.
His caregiver is his wife ,L.J. who is
65 years old ,a retired teacher. L.J.
experiences stress as a caregiver.
 OBJECTIVES
To present the health status of
the elderly Filipinos.
To discuss the different
screening tools for the elderly.
To discuss the interventions that
can promote healthy lifestyle
and successful ageing.
 HEALTH STATUS of ELDERLY
FILIPINOS
MOST COMMON ILLNESS:

• Arthritis/Rheumatism

• HPN and CVD

• Depression: 1 in 4 older Filipinos

• Functional Health:

15% have difficulty of performing at least 1 ADL

19% have difficulty of performing at least one IADL

Source: Aging in the Phil

 ADL and IADL
ACTIVITIES of DAILY LIVING:

*Dressing,Eating,Ambulating(transferring),
Toileting, Hygiene(Bathing),Continence
INSTRUMENTAL ACTIVITIES of DAILY LIVING:

*Use of telephone, Shopping, Housekeeping,

Accounting, Food preparation, Transporting
 HEALTH STATUS of ELDERLY
FILIPINOS
HEALTH RISK BEHAVIOR:

• 50% smoked (82%men,33% women)

• 55% have ever drunk alcohol;28% current

drinkers (men>women)
 HEALTH STATUS of ELDERLY
FILIPINOS
LEISURE, RELIGIOUS ACTIVITIES, SOCIAL
INVOLVEMENT

• 69% watching TV

• 6 out of 10 exercise daily

• 14% exercise once a week

• 51% attend religious services weekly

• 25% member of non-religious organisation

• 12% know how to use cellphone

 HEALTH STATUS of ELDERLY
FILIPINOS

HEALTH CARE UTILIZATION:

• Health Insurance 15% of older Filipinos

(88% PhilHealth)

• Mainly rely to children or spouse

 HEALTH STATUS of ELDERLY
FILIPINOS
LIVING ARRANGEMENT:
• Predominantly living with children (7 in 10)
• 4.5% live alone (more in women)
• 8 in 10 older Filipinos support the idea of
having homes for older person in the Phil.
 HEALTH STATUS of ELDERLY
FILIPINOS
HEARING:

• 93% reported could hear but only 56%

could hear well

VISION:

• 94% have vision in both eyes; 57% uses

corrective glasses
 Why do we need to promote
health and wellness in the elderly?

REASONS:
promote quality of life
reduce disability
reduce pressure on health
services
Top Diseases Among the ELDERLY

WorldWide Philippines

1. Heart Disease 1. Heart Disease**

2. Cancer 2. Stroke**

3. CVD 3. Cancer**

4. COPD 4. Accidents

5. Pneumonia 5. Pneumonia*

6. Diabetes 6.TB*

7. Accidents 7. HPN**

8. Septicemia 8. COPD**
Problems Associated with Ageing

Functional Decline
Sensory Impairment
Increase Incidence of Diseases
and Accidents
Increase Incidence of
Psychosocial Issues
Goals in Caring for the Elderly

Maximum disease prevention

Maintenance of function

Preservation of mental health

Promotion of self esteem

Prolonging autonomy

Assisting in attainment of life satisfaction

 LEVELS OF PREVENTION

1.Primary
2.Secondary
3.Tertiary
 PRIMARY HEALTH
PREVENTION

Health Education
Health Promotion : Healthy Life Style
Specific Protection: seat belts, helmet
Immunization:Tetanus Toxoid, Flu,
Pneumonia, Varicella
 SECONDARY HEALTH
PREVENTION
Functional assessment

Perception assessment

Cognitive assessment

Depression assessment*

Nutritional assessment*

Environmental assessment

Social support assessment

 FUNCTIONAL ASSESSMENT
Activities of Daily Living

Dressing (Grooming)

Eating (Feeding)

Ambulating ( Transferring)

Toileting

Hygiene (Bathing)

Continence
FUNCTIONAL ASSESSMENT
(IADLs)
Using the telephone

Shopping

Housekeeping (Laundry)

Accounting/Managing money

Food preparation

Transportation

Taking medicines
 Perception Assessment
Visual Acuity

Ask: “Do you have difficulty driving or

watching TV,or reading,or doing any daily
activities bed. of your sight”.

If YES, then; Test each eye with Snellen

chart.

POSITIVE SCREEN: Yes to question and

inability to read >20/40 on Snellen chart.
Perception Assessment

HEARING

Whisper Test,Rubbing the Finger,

Tuning Fork

POSITIVE SCREEN:

Inability to hear 4/6

 Leg Mobility
Time the patient after asking:

“Rise from chair.Walk 20 feet (3

meters) briskly ,turn.walk back to
chair,and sit down”

POSITIVE SCREEN:

Unable to complete the task in 10

seconds
 Urinary Incontinence
ASK:

“In the last year,have you lost your

urine and gotten wet”

“Have you lost urine in at least 6

separate dates.”

POSITIVE SCREEN:

Yes to both questions

Nutritional Assessment
NUTRITION/WEIGHT LOSS

1. Ask : “Have you lost 10 lbs over the past 6

months without trying to do so”

2. Weigh the patient

POSITIVE SCREEN:

Yes to the question or weight <100 lbs

Cognition Assessment
MEMORY

Mini-Mental Status***

Three item recall test, Draw a clock test

POSITIVE SCREEN:

Unable to remember all three items after

one minute.
Depression Assessment

Mini-Mental Status**

Ask: “Do you often feel sad or

depressed.”

POSITIVE SCREEN:

Yes to the question.

10 MINUTE GERIATRIC SCREENER
VISION

HEARING

LEG MOBILITY

URINARY INCONTINENCE

NUTRITION

MEMORY/COGNITION

DEPRESSION

PHYSICAL ASSESSMENT (ADL&IADL)

Environmental Assessment
SAFE HOME FOR THE OLDER ADULTS

hand rails on both sides of any stairway

well-lit stairways,paths,walkways

rugs secured by nonslip backing or adhesive

tapes

grab bars and nonslip mat or safety strips in

the bath or shower

smoke alarms and plan for fire escape

Social Support Assessment

Ask whether they live alone or

have a companion.

Ask how many times they are

visited by the family.
Ask about financial source or
financial assistance.
SECONDARY PREVENTION
Medical management of identified disease

Regular intake of maintenance

medication

Monitoring of blood sugar or BP

Regular visit to the doctor

Appropriate referrals: SPMC,

Brokenshire, Barangay Districts
TERTIARY HEALTH PREVENTION

Rehabilitation and occupational

therapy

Environmental control and

protection

Addressing psychosocial health

* participation in voluntary work

or community affairs
 SUGGESTED INTERVENTIONS
F - Functional Independence
R - Restoration of muscle size and strength
A - Adequate nutrition
I - Instability management and prevention
L - Loneliness and depression prevention
T - Testosterone,Thyroid ,endocrine checks
Y - Yearly comprehensive geriatric assessment
- Camagay,D.M. 1999
 Functional Independence
Support the ageing parents in preserving their
independence (eating, bathing, dressing,transferring
and going to the toilet)
Providing assistive devices for doing ADL
(walkers,canes)
Allowing the elderly in doing light and safe household
chores
Providing transport or companion in attending
community activities
Encourage performing skills for their neighbors -
boost their self-esteem
 Restoration of Muscle
Size and Strength

Physical Activity: walking, dancing, tai chi,

and gardening

Regular Exercises improve muscle size

and strength, improve balance, and
enhance socialisation and self-esteem

Restores good appetite and prolongs sleep

Adequate Nutrition Should be
Provided
Social support is very important

Supplementation with vitamins and

micronutrients

Regular family get together in the

ancestral home or mall can delay the
onset of old age anorexia

For special cases: enteral and parenteral

nutrition
Instability Management and
Prevention
INTERNAL FACTORS: Clinical conditions,
psychological factors (fear of falling)

EXTERNAL FACTORS: environmental

barriers that impede optimal functioning
like mobility ( no rump or handrails) and
self care such as toilet is slippery,loose rugs
and dimly lit room or pathways

Physical activities and exercise also have a

role in the prevention of instability and falls
Loneliness and Depression
Prevention
Prevention of loneliness , isolation and
depression is still the optimal
intervention.

Periodic assessment of the psychological

state of the older person is important.

Family conference and counselling are

needed for those with difficulties in
adjusting with families in later years
Thyroid Problem Check-up
Frail elderly may have uncorrected
endocrine deficiencies which
accounts for their physical and
mental slowing e.g.. hypothyroidism

Careful endocrine evaluation is

important, and give appropriate
treatment is there is a need
 Yearly GERIATRIC Screening

EXAMINATION FREQUENCY

PE and Counselling annual

Mammogram annual

FOB annual

DRE annual

Paps Smear annual

 Yearly GERIATRIC Screening

EXAMINATION FREQUENCY

Sugar annually

Cholesterol/Lipid profile annually

Sigmoidoscopy every 3-5 yr

ECG/Thyroid Function test annually

 IMMUNIZATION

Tetanus immunization 0-1-6;10yrs

Flu yearly

Pneumonia every 5 years

Zoster vaccine
 Healthy Life Style
Diet - low salt, low fat
Target Ideal Weight
Exercise
Stop smoking
Stop alcohol drinking
When Dementia Complicates Care
The caregiver is the second victim - the hidden
patient.

The FP must provide education,support, and advice

to help families better understand and cope with
Alzheimers.

REFER:

-difficulty in distinguishing between depression &

dementia

- occupational competency is needed or driving ability

- management of resistant behavioural and

psychological symptoms
 Managing STRESS
to caregiver
1.Take Care of Your health: Get enough rest, sleep
, exercise and nutritious food.Regular check-up

2.Involve Others: Make a list of jobs that needs

help

3.Maintain Social Contact: Having fun,

laughing ,avoid isolation

4.Get Help from Community Services & Org: refer

5.Talk About It: share your experiences or your

feelings
 Managing STRESS
to caregiver
6. Deal Constructively with Negative Feelings: Hold a
family meeting to resolve conflicts

7. Talking to Older Parents about Independence:

Being direct, but non-confrontational

8. Make a List: List of questions about finances

9. Dealing with Resistance: Act firmly but with

compassion

10.Focus on key points: Ask your parents their

worries about the future

Eva Irene Y.Maglonzo

 12 S to prevent
STRESS
1.Spirituality 7.Scheduling

2.Share your problems 8.Shopping

3.Sports 9.Spa

4.Singing 10.See places

5.Siesta 11.Speak out

6.Sex 12.Slow down

 ROLE OF THE FAMILY
Caring environment
ADL done to promote
independence
Respect and understanding
Encouragement and support
 CASE
P.J., 68 years old,male, had stroke
and with right sided deficits on the
upper and lower extremities.
He has anorexia and episodes of
depression due to his condition.
His caregiver is his wife ,L.J. who is
65 years old ,a retired teacher. L.J.
experiences stress as a caregiver.
 CASE RESOLUTION
P.J. (patient)

Problem:

1. Medical Condition: Stroke, Immobility

2. Risk of Manutrition

3. Depression

Management:

Primary,Secondary,Tertiary Prevention
 CASE RESOLUTION
L.J. (wife, caregiver)

Problem:

1. Stress (caregiver fatigue)

2. need for wellness program

Management:

Primary,Secondary,Tertiary Prevention
 SUMMARY
I. Health Status of Filipino Older
Adult

II. Geriatric Screener: 1. Vision, 2.

Hearing, 3. Mobility, 4. Urinary
Incontinence, 5. Nutrition & weight
loss, 6.Memory, 7. Depression, 8.ADL

II. Interventions: FRAILTY and CARE

 REFERENCES
Textbook of Family Medicine by Z.E.Leopando

Bates’ Guide to Physical Examination

The Filipino Physician Today by E.I.Y.Maglonzo

 SPMC
GERIATRIC
PROGRAM
 VISION/MISSION
VISION:
“ Senior Citizen : embracing ageing with joy”

MISSION:
To promote health & wellness and disease
prevention and early Dx and Tx of diseases.

To promote socialisation and procurement of

maintenance medication.
 ACTIVITIES
organized the Geriatric Club

started Fast lane for Senior Citizen

conducts Health Lectures,Screening,Dx and

Tx of Diseases, Immunization,Counselling

assists Geriatric Club meeting every last

Friday of the month: scheduled activities

Health Summit every October/Christmas

Party
 SC PRIVILEGES
lifetime PHIC member

20% SC discounts and VAT exempted

exempted in paying taxes IF minimum wage earner

5% disc. on light and water

free medical services DOH hospital

free flu and pneumonia vaccine in GHU

Expanded SC Act 2010(RA9994)

 ADVOCACY

“ Make the REST of your life,

the BEST of your life.”

ADVICE: participate in community work, be a

volunteer, join a SC organization , share your
expertise, be involved in church activities,etc.