Geriatric Care

Introduction
‘Old age is a incurable
disease’
Seneca

‘You do not heal old age.

You protect it; you
promote it; you extend
it’
Sir James Sterling Ross
 Geriatric care
• Geriatrics is the branch of medicine that focuses on
health promotion and the prevention and treatment
of disease and disability in later life.
• The term itself can be distinguished from
gerentology, which is the study of the aging process
itself.
• The term comes from the Greek geron meaning "old
man" and iatros meaning "healer",
• This was proposed in 1909 by Dr. Ignatz Leo
Nascher, former Chief of Clinic in the Mount Sinai
Hospital Outpatient Department (New York City)
and a "Father" of geriatrics in the United States.
• "Geriatrics" is cognate with Jara in Sanskrit which
also means old.
 Need of Geriatric care
• India is undergoing demographic
changes.
• with the declining birth rate at 34 per
cent and increasing life expectancy the
geriatric population, which is at 7 per
cent now, is expected to reach 10 per
cent by the year 2030.
• India is only the second country after
China to have world’s largest geriatric
population.
 Need of Geriatric care continue….
• According to the 2001 census, India is home to more than
76 million people aged 60 years and over.
• This age group, currently only 7.4% of the population, is
expected to grow dramatically in the next few decades.
• at present, 10.5% of Kerala's population is older than 60
years while in Dadra and Nagarhaveli, this proportion is
only 4%.
• Regions with more favourable health indicators seem to be
aging faster and the demand for specialist services will
soon be evident in such places.
Implications of demographic figures

• Larger number of elderly requiring care

• Considerable period of life after 60 or 70
years requiring care
• No decline in the number or proportion of
other vulnerable population requiring care
• Competition among various group of people
for resources.
 Challenges of health care of elderly
• Health care needs of elderly are
different from those of other age
groups
• The structural, functional, mental
and emotional status of elderly is not
the same as of younger population
• The manifestation and course of
disease can be very unpredictable
and may require specialized care.
• The goal of health interventions is
more likely to care than cure.
Consequently restoration of
functions and improvement in
quality of life than eliminating the
disease.
 Myths related to old age
• Most elderly live in developed countries.
( over 60% of elderly live in developing countries i.e 355 million out of 580
millions and by 2020 it will be 700 millions out of 1000 millions)
• Elderly are all the same
( elderly are diverse group some lead active healthy lives others of much
younger may have poor quality of life due to many contributing factors
such as
– Participating in family and community life
– Eating balanced and healthy diet
– Maintaining adequate physical activity
– Avoiding smoking and alcoholism
– Genetic component
• Men and women age same way
(Men and women age differently. Women live longer than men and having
biological advantage until menopause as hormones protect them from
ischemic heart diseases for example)
Myths related to old age continued
• Elderly are frail
( Far from being frail, the vast majority of elderly remain
physically fit and well into later life and able to care for
themselves. It is a minority of elderly who are very old and
became disabled to the point that they need assistance for
the activities of daily living.)
• Elderly have nothing to contribute.
(Elderly make innumerable contribution to their families,
society and economies)
• Elderly are an economic burden on the society.
( most elderly around the world continue to work in both paid
and unpaid jobs making a significant contribution to the
economic prosperity of their community e.g. in agriculture
men and women continue working till very late in life and
in developed world there is recognition that let the people
work till they can.)
 Problems of old age

• Economic problems
• Social problems
• Mental problems
• Physical problems
 Economic problems

• On retirement income reduces to half

• The working capacity declines with age
• Provident fund and bank balance is already
spent on making houses and settling the
children
• Big sum of money is needed to spend on
medical care
 Table 1: Percentage of elderly economical
dependents in India Compiled from 42nd NSSO, 1986/8

Degree of Male Female

dependence Rural Urban Rural Urban

Not 51.6 45.71 8.78 4.84

dependent
Partially 16.20 16.90 13.71 9.13
dependent
Fully 32.74 37.39 77.51 86.04
Dependent
 Social problems

• loss of status after retirement

• might loose spouse, other near and dear ones or good
friends
• sons, daughters and young friends get busy in their own
affairs
• there is a painful feeling of futility and loneliness which is
increasing more due to nuclear families
• the needs of old age such as mixing up with relatives,
playing with children, becoming useful to society, feeling
of wanted and needed were well taken care in joint
families earlier
 Mental problems

• Mental changes are inevitable in old age

• A certain degree of cerebral atrophy in universal
in elderly and is associated with loss of memory
and slowing of reflexes
• Sexual changes aggravate mental tension
• Senile dementia is well known entity
• Depression associated with social isolation
• Suicidal tendencies may increase
• A comparative study to assess emotional well
being of senior citizen staying in old age home
verses senior citizens staying in families revealed
that
• 90% of senior citizens in old age home were in
border line emotional well being(61-80 score),
5% were having positive emotional well being
(81-100 score) and another 5% were having
negative emotional well being (40-60 score).
• Whereas 92% of senior citizens living with
families were having positive emotional well
being (81-100 score) and only 8% were having
border line emotional well being(61-80 score).
This difference was statistically significant.
Naik Nisha
• A comparative study on quality of life among
senior citizens living in home for aged and family
setup in Erode district showed that
• majority of senior citizens living in home for aged
had moderate quality of life but none of senior
citizens reported high quality of life. Similarly in
family set up majority of senior citizens moderate
quality of life.
• But overall mean score was higher among senior
citizens living at family set up than living in home
for aged.
Kavitha AK
 Physical problems
• There are physical changes in the body with the
aging process such as
– loss of elasticity of skin
– thinning and loss of hair
– brittleness of bone
– weakness of muscles
– slowness of movements
– unsteadiness of gait
– sluggishness of reflexes
– immune system of body decline
– metabolism begins to slow down
– kidney loose 50% of its efficiency
– lungs loose 30-50% of their breathing capacity
Physical problems continues…..
– Taste and smell sense decline that may give rise to lack of
appetite
– Pupil shrink reducing the amount of light reaching the retina
– Lens becomes hard and clouded leading to cataract
– organ functions deteriorate can cause
o impairment of special senses especially hearing and sight
o deterioration of heat regulating mechanism of body
o hypertension and coronary diseases
o Obesity
o osteoporosis and osteoarthritis
o prostate enlargement
o Diabetes
o Cancer
o cardiac and respiratory problems
o Accidents
o disability
A study to assess the health complains and related self
care abilities among the geriatric population highlights
that among 117 elderly
• subjects dental problems (93.1%) headed the topmost rank
and the skin problems (20.5%) the last.
• The other health complaints reported were vision (80.3%),
general weakness (80.3%), musculoskeletal (65.8%),
falling memory (51.2%), chest and lung problem
(50.4%), digestive (39.3%), addiction (48.7%),
neurological (46.1%), urinary (27.3%), hearing (27.3%),
blood pressure (24.9%).
• In musculoskeletal system females had more problems
(80.7%) than males (53.8%) Similarly in failing memory,
urinary complains and hearing impairment females
had higher problems than males .
• In chest lung problems, addiction males had more
problems than females.
Bhutia TK.
On assessing health problems 100 elderly at old age home it was observed
that
• most residents had cataract (52%), anemia (38%),osteoarthritis (37%),
gastroesophageal reflux disease (32%), hypertension (28%),
• diabetes (24%), constipation (15%), sensorineural hearing loss (14%),
coronary artery disease (13%), chronic obstructive airway disease (11%),
• upper respiratory tract infection (7%), depression (6%), glaucoma (6%),
benign prostatic hypertrophy (6%),
• optic nerve atrophy (4%), low backache (4%), constipation (4%),
• hypothyroidism (3%), rheumatoid arthritis (3%), corneal opacity (3%),
conjunctivitis (3%), blindness (3%), anorexia (3%), knee joint pain (3%),
fracture (2%),pulmonary tuberculosis (2%),
• arrythmias (2%), carpal tunnel syndrome (2%),hydrocele (2%),
• dementia (3%), sciatica (2%), eczema (2%), senile tremors (2%),
• chronic fatigue syndrome (2%), and obesity (2%).
• Besides, chronic alcoholic liver disease, Parkinson's Disease, piles, prolapsed
intervertebral disc, schizophrenia, hiatus hernia, dermatitis, diabetes, fibroid
uterus, lumbar spondylosis, ascites,dysentry, herpes Zoster, migraine, urinary
incontinence, lymphadenopathy,deviated nasal septum, vertigo, pyorrhoea and
corneal opacity were also seen.
Government of India WHO India Country Office Collaborative Programme
• A quasi experimental study on lacrimation and
associated symptoms of mild dry eyeby
application of warm compress among geriatric
population at village Dhanas UT Chandigarh
revealed that 42% of geriatric population was
suffering from mild dry eye warm compress was
applied on the eyelids of 36 subjects of
experimental group for seven days and tear level
of experimental group and control group was
assessed on first and seven days, It was observed
that tear level and symptoms improved
significantly in experimental group on seventh
day.
Madhu Malini
• Study on intensity of knee joint pain by
‘Application of moist heat’ among geriatric
population found that 48% of geriatric
population was suffering from Knee joint pain.
Moist heat was applied at knee joint twice a day
on 43 subjects of experimental group. Intensity of
pain was assessed in experimental as well as
control group on first and 8th day. It was observed
that intensity of knee joint pain and intake of pain
killers reduced significantly in the experimental
group.
Parminder Kaur
 Elder abuse

• Elder abuse is often defined as a single, or

repeated act, or lack of appropriate
action, occurring within any relationship
where there is an expectation of trust
which causes harm or distress to an older
person (WHO)
 Elder abuse
• There are several types of abuse of older people that are
universally recognised as being elder abuse and these
include:
• Physical: e.g. hitting, punching, slapping, burning,
pushing, kicking, restraining, false
imprisonment/confinement, or giving too much medication
or the wrong medication;
• Psychological: e.g. shouting, swearing, frightening,
blaming, ridiculing, constantly criticizing, ignoring or
humiliating a person. A common theme is a perpetrator
who identifies something that matters to an older person
and then uses it to coerce an older person into a particular
action;
 Elder abuse
• Financial: e.g. illegal or unauthorized use of a person’s property,
money, pension book or other valuables (including changing the
person's ‘will’ to name the abuser as heir), often fraudulently
obtaining ‘Power of attorney’ followed by deprivation of money or
other property, or by eviction from own home;
• Sexual: e.g. forcing a person to take part in any sexual activity without
his or her consent, including forcing them to participate in
conversations of a sexual nature against their will;
• Neglect: e.g. depriving a person of food, heat, clothing or comfort or
essential medication.
• In addition some countries also recognise the following as elder abuse:
• Rights abuse: denying the civil and constitutional rights of a person
who is old, but not declared by court to be mentally incapacitated.
This is an aspect of elder abuse that is increasingly being recognised
and adopted by nations
• Self-neglect: elderly persons neglecting themselves by not caring
about their own health or safety.
 Management of geriatrics
• Prevention and management of illness or
disability
• Maintenances of general health and
nutrition
• Prevention of accidents
• Combating ageism
 Prevention and management of
illness or disability
• Periodical medical check ups, usually annually to rule out
the chronic diseases at the beginning itself
• Immunization
• Acceptance and adaptation to the demands of chronic
disease
• Continuity of care
• Monitoring drug usage
• Maintaining family and neighbour support system
• Management of crises
• Financing the health care
• Planning for the old age
 Maintenance of general health and nutrition
• Physical activity
• Regular contact with family and friends
• Participating in political, social or civic concerns
‘Satat udyog Shant man’ means be busy be calm
‘Keeping too busy to be ill and too healthy to be
old’
• Keeping busy in
– social work
– religion pursuits
– Loneliness has to be decreased by suitable hobbies,
social service etc.
– Joining the clubs or groups of senior citizens
 Maintenance of general health and nutrition

• Adequate nutrition
• Use of dentures if needed
• Adequate fluid intake, fresh fruits,
vegetables to alleviate constipation
• Having good sleep as sleep is very
important for mental health
• Self health monitoring and self care
 Prevention of accidents

• Developing safe environment and habits to

compensate sensory loss and slowed or
unsteady reactions to danger
• Limiting driving
• Wearing comfortable and suitable clothes
and shoes
• Good house keeping
• Using stick for support
 Management of Elderly abuse
• Educate individual about occurrence of
elderly abuse
• Implement safety plan ( Placement in safe
home, court protection order, hospital
admission)
• Refer patient or family members
(counseling services, legal assistance)
• Follow up
 Government Policies
• Old age pension
• Traveling concession
• Reservation of seats for elderly
• Separate queue for senior citizens
• Special reservation in housing schemes for
pensioners
• Old age homes
 Management Continued
• Kerala government has already announced a
policy for health care of elderly in 1997 and
draft bill is already ready in 2004.
• Older person living alone should be encouraged
to register with the police stations and a
separate cell should be set up at police stations
to keep a vigil on such older persons in their
jurisdiction.
National Policy for Older Persons
• Announced in January, 1999.
• Objectives: to encourage individuals to make provision
for their own as well as their spouse’s old age;
• to encourage families to take care of their older family
members;
• to enable and support voluntary and non-governmental
organizations to supplement the care provided by the
family;
• to provide care and protection to the vulnerable elderly
people,
• to provide health care facility to the elderly;
• to promote research and training facilities to train geriatric
care givers and organizers of services for the elderly;
• to create awareness regarding elderly persons to develop
themselves into fully independent citizens.
World Elder Abuse Awareness Day
(WEAAD)
• In 2006 the United Nations designated June
15th as World Elder Abuse Awareness Day
(WEAAD) and an increasing number of
events are held across the globe on this day
to raise awareness of elder abuse, and
highlight ways to challenge such abuse.
 Specialized education for geriatric
care
• Post Graduate Diploma in Geriatric Medicine for
MBBS doctors
• Six – Month Certificate Course in Geriatric Care
 1-year Post Graduate Diploma in Integrated
Geriatric Care
• 3-Month Certificate Course, the NGO trainees are
exposed to different techniques and tools relevant
for geriatric care
 Organizations working for elderly
• Help age India
• Servants of people
society
• Geriatric society of
India
 Geriatric care in Chandigarh
• Geriatric friendly low door buses
• Separate queue for senior citizens
• Pavements for walking on the road sides
• Parks
• Free once a weak medical check up and
medication by help age India in low socio
income colonies
• Old age homes
 References
1. Naik Nisha. A comparative study to assess emotional well being of senior citizen staying
in old age home verses senior citizens staying in families. Nightingale Nursing Times
2007; 2;10;January:37-38.
2. Kavitha AK. A comparative study on quality of life among senior citizens living in home
for aged and family setup in Erode district. Nightingale Nursing Times 2007;
3;4;July:47.
3. WHO. Aging exploding the myths. Ageing and health programme. WHO publication
1999. cited by Nightingale Nursing Times 2005; 1;8;Oct:36-40.
4. Bhutia TK. A study to assess the health complains and related self care abilities among
the geriatric population. Unpublished MSc Nursing thesis, Cllege of nursing, PGIMER,
Chandigarh 1997.
5. Dey AB. Health care of older people. A manual for trainers of nurses. WHO publication.
Ministry of health and family welfare 2003.
6. Mahajan BK, Gupta MC. Textbook of preventive and social medicine. 2nd edition 1995.
Japee brothers medical publishers (P) LTD.
7. Malini M, Walia I, Kaur Sukhwinder. A quasi experimental study on lacrimation and
associated symptoms of mild dry eye by application of warm compress among geriatric
population at village Dhanas UT Chandigarh. Nursing and Midwifery Research Journal
2007;3(4):152-161.
8. Kaur Parminder, Walia I, Saini SK. Study on intensity of knee joint pain by ‘Application
of moist heat’ among geriatric population. Nursing and Midwifery Research Journal
2007;3(4):162-171.
9. NICE training resources. Ministry of social Justice and empowerment, government of
India. trainingresourcemht!http://nic.nisd.gov.in
10. PIB Press release. Programme for care of older person. mh!
http//socialjustice.nic.in
11. Elder abuse. Wikipedia, the free encyclopedia.
12. WHO. Evaluation of health status and health needs of old age home residents
and establishment of minimum standards of health services in long stay
institutions in India.Final report. Government of India World Health
Organization India Country Office Collaborative Programme 2006-2007.
13. Park K. Park’s textbook of preventive and social medicine. 17th edition.
Jabalpur:M/s Banarsidas Bhanot Publishers 2000.
14. Mahajan BK, Gupta MC. Textbook of preventive and social medicine. 2nd
edition. New Delhi: Jaypee Brothers Medical publishers (p) Ltd 1995
15. Tandan Lavanya. Elder Abuse. Nightingale Nursing Times 2005; 1;6;June:24-
28.