Geriatrics

• Geriatrics is the branch of medicine that focuses on health care of the

elderly. It aims to promote health and to prevent and treat diseases and
disabilities in older adults.
• Geriatrics was separated from internal medicine as a distinct entity in the
same way that pediatrics is separated from adult internal medicine and
neonatology is separated from pediatrics.
• People over the age of 65 are considered geriatric but there is no set age

1
 Gerontology
• Gerontology is the branch of biomedical sciences that studies factors impacting
the normal aging process and the effects of aging.
• It is considered as normal.

2
3
Geriatric physiotherapy

• Is the branch of medicine that studies rehabilitation and physical therapy

issues in elderly.
• It became a physical therapy specialty in 1989
• Since then physiotherapists have worked to understand the problems of
aging.
• It aims to promote health and to prevent disabilities in older adults.

4
Geriatric Rehabilitation

• Rehabilitation focuses on enhancing function & minimizing disability by means of

various therapeutic interventions.
• Goals include optimizing quality of life & functional independence.
• Geriatric rehabilitation addresses not only impairments stemming from acute events,
such as stroke or hip fracture, but also the deleterious effects of chronic diseases &
gradually progressive disability.

5
 Aging
• The process of “going old”
• It describe a variety of physiological changes in body systems which are
complex and variable.
• Common to all members of a given species.
• Progressive with time.
• Evidenced by decline in homeostatic efficiency and increasing probability
that reaction to injury will not be successful.

6
• Life span: “ maximum survival potential, the inherent natural life of species” In
human beings it is 110-120 years

• Life expectancy : “ The number of years of life expectation from year of birth”

7
Epidemiology
• In many developing countries, particularly Asia and Latin America, the elderly
population is expected to double by 2025. By 2050, there will be 2 billion over the
age of 60 and 80% will be living in developing countries (World Health Report 2003).

• In Pakistan, improved social conditions and advances in public health during the last
half century have contributed to a significant increase in the average lifespan (Sathar,
1991).

• Life expectancy at birth has improved to 62 years in men and 64 years in women
(Sanderson and Scherbov 2008).

8
• Survival has improved across the life course, including in later life (United
Nations, 2002). This means that more people in Pakistan are surviving to old age
than ever before.
• Pakistan’s demographic trends show that between 1990 till 2010, the population
aged 60+ years increased by 75.1 %. It is projected that the life expectancy will
increase to 72 years by 2023.
• WHO report (1998) projected that 5.6 % of Pakistan’s population was over 60
years of age, with a probability of doubling to 11 % by the year 2025

9
Ageism
• Ageism, also called age discrimination
• It is stereotyping of discrimination against individual or groups
because of their age.
• It is a set of beliefs, attitude, norms and values used to justify age
based discrimination.

10
Discrimination

• Age
•  Genotype
•  Hair / Looks / Color
•  Language
•  Intelligence /mental type / neurology
• Race / ethnicity / nationality
•  Rank / Class
•  Religion
• Gender
•  Size / Weight /  Height

11
Physical Changes of Aging
• Most physical changes that occur with aging are gradual and take place over
a long period of time. In addition, the rate and degree of change varies
among individuals.

• Factors such as disease can increase the speed and degree of the changes.
Lifestyle, nutrition, economic status, and social environment can also have
effects.

• If an individual can recognize the changes as a normal part of aging, the

individual can usually learn to adapt to & cope with change.

12
 Integumentary System
• Epidermis thinner & fragile
• Dermis less elastin & flexible
• Hypodermis thinner & less padding.. UV light …accelerates aging.
Dermal tissues atrophy & blood vessels become more fragile results in
Senile purpura

•Production of new skin cells decreases

•Oil and Sweat glands become less active
•Circulation decreases

13
• Hair losses color, and hair loss occurs
• Skin becomes less elastic & dry
• Itching is common
• Dark yellow or brown colored spots appear
• Fatty tissue layer of skin diminishes
• Lines and wrinkles appear
• Nails become thick, tough, and brittle
• Increased sensitivity to temperature

14
Care of Skin
1. Use mild soap
2. Bath oils or lanolin lotion
3. Bath or Shower once or twice a week
4. Brush Hair daily
5. Shampoo as often as needed for cleanliness and comfort
6. Care for sore or injuries immediately
7. Socks, sweaters, lap blankets, and layers of clothing will help alleviate
the feeling of coldness

15
Circulatory System
• Because of the need for oxygen and nutrients the elderly may experience:
• Weakness
• Dizziness
• Numbness in hands & feet
• Rapid heart beat

16
Heart
1. Heart becomes more rigid with decreased output
2. Heart beat less responsive to stress, less variable with each breathing
3. Irregular heart beat more common with aging
4. Systolic BP increases with age
5. Less efficient venous return prone to postural hypotension
6. Decreased ability to replace fluids lost while breathing
7. Cholesterol may accumulate on the walls of the arteries.
8. Diminished cardiac reserve

17
Circulatory System Care

1. Avoid strenuous exercise or over exertion, Periods of rest

2. Moderate exercise, according to individual’s tolerance, mainly conditioning
3. Prevent the formation of a blood clot (thrombus)= Support stockings
4. DO NOT wear tight bands around legs
5. If confined to bed = ROM exercises
6. High Blood Pressure = Diet low in salt
7. Decrease fat intake
8. Exercise as recommended by physical therapist
9. Fluid intake

18
Respiratory Changes
1. Respiratory muscles become weaker
2. Rib cage more rigid
3. Alveoli thinner & less elastic which decreases exchange of gases - emphysema
4. Bronchioles lose elasticity
5. Changes in larynx lead to higher pitched & weaker voice
6. Chronic diseases may decrease the efficiency of the respiratory system even
more severely changes may cause the elderly to experience:
Dyspnea
Breathing increases in rate
Difficulty coughing up secretions
Increases susceptibility to infections such as a cold or pneumonia
19
Respiratory Care
1. Alternate activity with periods of rest
2. Proper body alignment & positioning
3. Sleep in semi-fowlers position
4. Use 2 or 3 pillows
5. Avoid polluted air
6. Breath deeply & cough frequently
7. May need continuous oxygen therapy

20
Nervous system
1. 30,000-50,000 neurons die each day with diminishing reserve
2. IQ slowly decline after the age of 25??? IQ tends to remain relatively stable
over the lifespan.
3. Reduced short term memory
4. Interrupted & less deep sleep
5. Reduced pain, temperature,& vibration sensations
6. Reduced postural control & balance

21
Nervous System Changes

7. Blood flow to brain decreases & there is a progressive loss of brain cells - -
Interferes with
Thinking
Reacting
Interpreting
Remembering
8. Senses of taste, smell, vision, & hearing are diminished.
9. Nerve endings less sensitive.
10. Decreased ability to respond to pain and other stimuli.
11. Decrease in taste & smell frequently affects appetite.
22
Eye

1. Ptosis 8. Reduced contrast sensitivity

2. Dry eye 9. Changes in vision
3. Tearing 10. Problems reading small print
4. Flatten & uneven cornea with light 11. Seeing objects at a distance
scattering 12. Decrease in peripheral vision
5. Hyperopia (far sightedness) 13. Decrease in night vision
6. Smaller pupil requiring brighter light 14. Increased sensitivity to glare
to read
7. Slower dark adaptation

23
 Ear

1. Reduced sweat glands with increased ear wax affecting hearing

2. Cochlea degeneration
3. Hearing loss usually gradual
4. Person may speak louder than usual
5. Ask for words to be repeated
6. Not hear high frequency sounds
7. May not hear well in crowded places

24
• Decreased sensation to pain & other stimuli = more susceptible
• Burns , Frostbite , Cuts , Fractures or Muscle strain and other injuries
• Hallucinating
• Regressing in behavior
• Paying less attention to personal hygiene
• Inability to respond to simple commands or instructions

25
GIT
1. Salivary glands secrete less with dry mouth
2. Taste & smell senses decline
3. Less healthy teeth affecting chewing & nutrition
4. Stomach muscle weakened & less hungry
5. Small intestine villi absorb less Calcium,Vit B12 , folic acid
6. Large intestine muscle weakened & secretes less mucous prone to
constipation
7. Less liver blood flow & function with fall in toxic/drug clearance
8. Bile thicker with cholesterol prone to gall stones.

26
9. Fewer digestive juices and enzymes produced
10. Muscle action becomes slower & peristalsis decreases
11. Liver function decreases
12. Dysphagia is frequent complaint
13. Less saliva
14. Slower gag reflex
15. Loss of teeth
16. Poor fitting dentures
17. Slower digestion of food
18. indigestion

27
19. Decrease peristalsis
20. Increase flatulence (gas)
21. Constipation
22. Decrease sensation of taste
23. Poor appetite
24. Poor diet

28
Digestive Care
1. Good oral hygiene
2. Repair or replace damaged teeth
3. Relaxed eating atmosphere
4. High-fiber high-protein foods with different tastes and textures
5. Increased fluid intake

29
Urinary Changes

1. Kidneys decrease in size & become less efficient.

2. Reduced ability to excrete water, waste products & drugs
3. Less tolerate water depletion
4. Loss of circadian rhythm with nocturia
5. Bladder becomes less efficient, may not hold as much or may not empty
completely or incontinence.
6. Smaller & less expansible bladder with frequency of urine
7. Less contractible bladder with hesitancy
8. Bigger prostate with fair urine stream

30
Urinary Care:

1. Increase fluid intake

2. Decrease before bedtime
3. Regular trips to bathroom
4. Easy to remove clothing
5. Absorbent pads

31
Endocrine Changes
1. Increased production of some hormones and decreased of others
2. Immune system less effective
3. BMR decreases
4. Intolerance to glucose
Endocrine Care :
5. Proper exercise as advised by physical therapist
6. Adequate rest
7. Medical care for illness
8. Balanced diet
9. Healthy lifestyle
32
Changes in the bone
1. Continual loss of bone mass from the 4th decade
2. Hormonal change with more bone resorption than formation
3. Less calcium absorption
4. Shorter & stoop
5. Brittle with easy Fx.
6. New bone formation at the verge of joints
7. Cartilage thinner

33
Psychosocial Changes

Some individual cope with psychosocial changes, and others experience extreme frustration
and mental distress
Fears of a sick person:
1. Death
2. Chronic illness
3. Loss of function
4. Pain
Dealing with fears created by an illness:
5. Listening
6. Patience
7. Understanding
8. Provide support 34
Confusion and Disorientation
Six signs:
1. Talking incoherently
2. Not knowing their name
3. Not recognizing others
4. Wandering aimlessly
5. Lacking awareness of time or place
6. Hallucinating
• Regressing in behavior
• Paying less attention to personal hygiene
• Inability to respond to simple commands or instructions
35
Causes of temporary confusion / disorientation

• Stress and/or depression

• Use of alcohol or chemicals
• Kidney disease
• Respiratory disease
• Liver disease
• Medication

36