GERIATICS AND THEORIES

OF AGING
PRESENTED BY: AQSA SHAFIQ MUGHAL
MAHAM ANIS
FATIMA SALLAHUDIN
 GERIATICS
• The term Geriatrics comes from the Greek ”geron” meaning "old man" and
“iatros” meaning "healer".
• Geriatrics is a sub-specialty of internal medicine (in commonwealth nations , a medical
specialty dealing with prevention, diagnosis and treatment of adult diseases) that focuses
on health care of elderly people.
• It aims to promote health by preventing and treating diseases and disabilities in older
adults.
 GERONTOLOGY
• The scientific study of the factors impacting the normal aging process and the effects of
aging.
• This subject promotes the reflective, critical, objective, and analytical practice of physical
therapy applied to the older adult.
• All physical therapists, not just those working in settings traditionally identified as
“geriatric,” should possess strong foundational knowledge about geriatrics and be able to
apply this knowledge to a variety of older adults.
• Indeed, older adults comprise at least 40% of patients across physical therapy clinical
settings
 KEY PRINCIPLES UNDERLYING CONTEMPORARY
GERIATRIC PHYSICAL THERAPY

Evidence-based practice
• Evidence-based practice is an approach to clinical decision making about the care of an
individual patient that integrates three separate but equally important sources of
information in making a clinical decision about the care of a patient.
• These three information sources are:
• (1) best available scientific evidence
• (2) clinical experience and judgment of the practitioner, and
• (3) patient preferences and motivations.
• The competent geriatric practitioner must have a good grasp of the current scientific
literature and be able to interpret and apply this literature in the context of an individual
patient situation.
• This practitioner must also have the clinical expertise to skillfully perform the appropriate
tests and measures needed for diagnosis, interpret the findings in light of age-related and
condition- specific characteristics of the patient, and then to skillfully apply the
appropriate interventions to best manage the problem.
• This is all done with clear and full communication with the patient to assure the goals and
preferences of the patient are a central component of the development of a plan of care.
 CLINICAL DECISION MAKING IN GERIATICS
PHYSICAL THERAPY

• The Clinical Decision Making Process is the process of establishing an appropriate

intervention for a client. Key to this process is the utilization of
• 1) evidence based practice
• 2) a client centered practice approach
• 3) the International Classification of Functioning, Disability and Health (ICF) and
• 4) the development of goals that are Specific, Measurable, Achievable, Realistic, and
Timed.
• In ICF, the term functioning refers to all body functions, activities and participation,
while disability is similarly an umbrella term for impairments, activity limitations and
participation restrictions.
• A challenge for physical therapists is to accurately interpret the underlying reason for the
patient/client’s presentation and then effectively achieve optimal outcomes.
• To do this, the clinician must incorporate the judicious use of examination findings into
the decision-making process to generate hypotheses for the cause of the patient’s
presenting complaint.
 THE GUIDE’S PATIENT/CLIENT
MANAGEMENT MODEL
• The Guide to Physical Therapist Practice describes a patient/client management model
composed of five components:
• Examination
• Evaluation
• Diagnosis
• Prognosis
• Intervention
• The Guide was constructed initially in the mid-1990s.
 THEORIES OF AGING

• In the review of the modern theories of ageing, Jin highlights

 three sub-categories of the programmed theory, and
 four sub-categories of the damage or error theory, and also relates some to how these
might be observed in ageing populations.
 THE PROGRAMMED THEORY

• 1) Programmed Longevity, which considers ageing to be the result of a sequential

switching on and off of certain genes, with senescence being defined as the time when
age-associated deficits are manifested.
• 2) Endocrine Theory, where biological clocks act through hormones to control the pace
of ageing.
• 3) Immunological Theory, which states that the immune system is programmed to
decline over time, leading to an increased vulnerability to infectious disease and thus
ageing and death
 THE DAMAGE OR ERROR THEORY

• 1) Wear and tear theory, where vital parts in our cells and tissues wear out resulting in
ageing.
• 2) Rate of living theory, that supports the theory that the greater an organism's rate of
oxygen basal, metabolism, the shorter its life span
• 3) Cross-linking theory, according to which an accumulation of cross-linked proteins
damages cells and tissues, slowing down bodily processes and thus result in ageing.
• 4) Free radicals theory, which proposes that superoxide and other free radicals cause
damage to the macromolecular components of the cell, giving rise to accumulated
damage causing cells, and eventually organs, to stop functioning.
 FURTHER THEORIES
DISENGAGEMENT THEORY
• Refers to an inevitable process in which many of the relationships between a person and
other members of society are severed & those remaining are altered in quality.
• Withdrawal may be initiated by the ageing person or by society, and may be partial or
total.
• It was observed that older people are less involved with life than they were as younger
adults.
• As people age they experience greater distance from society & they develop new types of
relationships with society.
• In America there is evidence that society forces withdrawal on
older people whether or not they want it.
• Some suggest that this theory does not consider the large number
of older people who do not withdraw from society.
• This theory is recognized as the first formal theory that attempted
to explain the process of growing older.
ACTIVITY THEORY
• Is another theory that describes the psychosocial ageing process.
• Activity theory emphasizes the importance of ongoing social activity.
• This theory suggests that a person's self-concept is related to the roles held by that person
i.e. retiring may not be so harmful if the person actively maintains other roles, such as
familial roles, recreational roles, volunteer & community roles.
• To maintain a positive sense of self the person must substitute new roles for those that are
lost because of age.
THE NEUROENDOCRINE THEORY
• First proposed by Professor Vladimir Dilman and Ward Dean MD, this theory elaborates
on wear and tear by focusing on the neuroendocrine system.
• This system is a complicated network of biochemicals that govern the release of
hormones which are altered by the walnut sized gland called the hypothalamus located in
the brain.
• The hypothalamus controls various chain-reactions to instruct other organs and glands to
release their hormones etc. The hypothalamus also responds to the body hormone levels
as a guide to the overall hormonal activity. But as we grow older the hypothalamus loses
it precision regulatory ability and the receptors which uptake individual hormones
become less sensitive to them. Accordingly, as we age the secretion of many hormones
declines and their effectiveness (compared unit to unit) is also reduced due to the
receptors down-grading
THE FREE RADICAL THEORY
• This now very famous theory of aging was developed by Denham Harman MD at the
University of Nebraska in 1956. The term free radical describes any molecule that has a free
electron, and this property makes it react with healthy molecules in a destructive way.
• Because the free radical molecule has an extra electron it creates an extra negative charge.
This unbalanced energy makes the free radical bind itself to another balanced molecule as it
tries to steal electrons. In so doing, the balanced molecule becomes unbalanced and thus a free
radical itself.
• It is known that diet, lifestyle, drugs (e.g. tobacco and alcohol) and radiation etc., are all
accelerators of free radical production within the body
THE MEMBRANE THEORY OF AGING
• The membrane theory of aging was first described by Professor Imre Zs.-Nagy of
Debrechen University, Hungary. According to this theory it is the age-related changes of
the cell's ability to transfer chemicals, heat and electrical processes that impair it.
• As we grow older the cell membrane becomes less lipid (less watery and more solid).
This impedes its efficiency to conduct normal function and in particular there is a toxic
accumulation
THE MITOCHONDRIAL DECLINE THEORY
• The mitochondria are the power producing organelles found in every cell of every organ.
Their primary job is to create Adenosine Triphosphate (ATP) and they do so in the
various energy cycles that involve nutrients such as Acetyl-L-Carnitine, NADH and some
B vitamins etc.
• Enhancement and protection of the mitochondria is an essential part of preventing and
slowing aging. Enhancement can be achieved with the above mention nutrients, as well
as ATP supplements themselves
THE CROSS-LINKING THEORY
• The Cross-Linking Theory of Aging is also referred to as the Glycosylation Theory of
Aging. In this theory it is the binding of glucose (simple sugars) to protein, (a process that
occurs under the presence of oxygen) that causes various problems.
• Once this binding has occurred the protein becomes impaired and is unable to perform as
efficiently. Living a longer life is going to lead to the increased possibility of oxygen
meeting glucose and protein and known cross-linking disorders include senile cataract
and the appearance of tough, leathery and yellow skin.