GERIATRIC HEALTH

You don’t heal old age.

You protect it; You promote it; You extend it.

Dr Anika Sulania
Assistant Professor
 Objectives:

By the end of the presentation student should be able to:

1. Define GERIATRICS and other related definitions

2. IDENTIFY common geriatric health problems
3. Define the preventive measures associated with it.
4. Describe common programme and policies in India
related to geriatric health
 Few Related Definitions

• Old age: Period beyond retirement usually taken as 65 yrs.

• Gerontology : The study of physical and psychological changes

which are incident to old age is called gerontology.
• Clinical gerontology or Geriatrics: The care of the aged is
called clinical gerontology or geriatrics.

-> It is the branch of medicine that focuses on health promotion

and the prevention and treatment of disease and disability in
later life.
 Continued……….

• Social Gerontology: focuses on the social aspect of growing

old. Professionals in this field strive to improve the
interactions between older adults and the rest of the world,
including family members, peers, and healthcare
professionals.

• Experimental Gerontology : It is concerned with research

into the basic biological problems of ageing, into its
physiology, Biochemistry , Pathology and Psychology.

• Geriatric Gynaecology:
 Classification of geriatrics:

• Elderly:65-74 years (Young old)

• Aged: 75-84 years (Middle-old)
• Very old : 85 or more years (Old-old)
 Related statistics

• In 2012, 11% of the world's population, were over 60.

By 2050, about 2 billion people are expected to be over
60, which represents 22% of the world's population.

• *In India- From 5.6% in 1961 the proportion has

increased to 8.6% in 2011, likely to rise by 19% by
2050 (Policy changes?).

• Old-age dependency ratio climbed from 10.9% in 1961

to 14.2%.

* Census 2011
 Continued…..

• Literacy among elderly persons increased from

27% in 1991 to 44% in 2011.
• The percentage of old aged people is increasing in
all countries, where made medical and social
services are well developed and standard of living
is high.
* Census 2011
 Problem associated with elderly growth

• Population ageing has profound social, economic and

political implications for a country:

1. strain on health care and social care systems, more

health and medical services, facilities and resources

2. Government spending on health care is increased with

the increase of average age of population

3. Due to increased longevity of life, pension bills

increases.
 Continued………..

4. Care of older persons in the families gets

increasingly difficult (Nuclear families)

Hence a country needs to be well prepared with

Appropriate social and economic policies need to be
made to mitigate its ill effects.
 HEALTH PROBLEMS OF THE AGED

1. Problems due to ageing process :

• With the passage of time, certain changes take

place in body leading to decrease to functions
• 2. Problems associated with long term illness

-Certain chronic diseases are more frequent among

older people than in younger people. These are
a. Degenerative diseases of heart and blood
vessels
• b. Cancer :
• Cancer is the leading cause of death in developed
countries.
• The incidence of cancer rises rapidly after the age of
40.
 Continued……..

• c. Diabetes:
• It is the leading cause of death as the population
grows older.
• About 75% of diabetics are over 50 yrs of age.
 Continued……….

• d. Accidents/ Falls:
• The causes of falls are as follows:
Simple accident
Black out
Collapse due to acute illness
• The bones become fragile due to a certain amount of
decalcification as a result of which they break easily.
• Fracture neck of femur is a very common geriatric
problem.
 Continued……….

• e. Diseases of loco-motor system:

• Fibrositis
• Myositis
• Neuritis
• Gout
• Rheumatoid arthritis
• Osteoarthritis
• Spondylitis of spine
 Continued……….

f. Respiratory illnesses :
• Chronic bronchitis
• Asthma
• Emphysema
g. Genito urinary system :
• In males the common problems are enlargement of
prostate, dysuria, nocturia, frequent and urgency of
micturition.
• In females Prolapse of varying degrees, non specific
vaginitis and ovarian tumors.
 Continued……….

• 3.Psychological Problems:
a. Mental changes These include
• Impaired memory
• Rigidity of out look
• Dislike of change
• Reduced income leads to a fall in the living
standards of the elderly. It leads to mental and social
consequences.
b. Sexual adjustment
c. Emotional disorders
• Percentage of elderly reporting various ailments
Ailment Reported
percentage
• 1.Visual impairment 88.0
• 2.Locomotive disorders 40.0
• 3.Neurological complaints 18.7
• 4.Cardio vascular disease 17.4
• 5.Respiratory disorder 16.1
• 6.Skin conditions 13.3
• 7.Gastro intestinal disorders 9.0
• 8.Psychiatric problems 8.5
• 9.Hearing loss 8.2
• 10.Genito urinary disorders 3.5
Areas potentially amenable to preventive health
care in the elderly

Primary –
1.Health habits: smoking, alcohol abuse, obesity,
nutrition, physical activity, sleep
2.Coronary heart disease risk factors
3.Immunization: influenza ,pneumovax, tetanus
4.Injury prevention, Iatrogenesis prevention
5.Osteoporosis prevention
 Continued…….
Secondary :
Screening for-

-Hypertension , Diabetes, Periodontal disease, dental caries

Sensory impairment, medication side effects,
-Cancers- Colo - rectal cancer, breast cancer, cervical cancer,
prostatic cancer
Nutritionally-induced anemias, depression, stress, urinary
incontinence, podiatric problems, fall risk , Tuberculosis
(high risk) , Syphilis (high risk) stroke prevention,
myocardial infarction
 Continued…….

Tertiary:

•Rehabilitation : physical deficits, cognitive deficits,

functional deficits
•Caretaker support, Introduction of support
necessary to prevent loss of autonomy
 PRIMARY PREVENTION
Condition Prevention Comments
strategy
1. Infection Immunization
a) Influenza Yearly Yearly
Though beneficial, it is not
possible as a national
programme, but may be
given in vulnerable group

(b) Pneumococcal Once at 65 years Repeated 6 yearly in

vulnerable group like
asplenic patients, patients
on dialysis
 Continued…….
Condition Prevention strategy Comments
2. Cigarette/ Counseling by Mass media
Tobacco physicians / health involvement to create
use workers / education by awareness
/Alcoholism mass media
3.Nutrition Counseling / health Mass media
education for balanced diet involvement
high in fruits & to create awareness
vegetables and change habits

4.Sedentary Counseling / health for Mass media programs

lifestyles exercises especially to create awareness
flexibility exercise aimed to about
improve balance benefit of exercise
benefit of exercise
 Continued…….
SECONDARY PREVENTION
Condition Screening Frequency Definitive test Corrective step

Visual Visual acuity 1 – 2 years Ophthalmological Cataract removal

Impairment (Snellen’s chart, examination or other
measures
Jaeger's chart)

Hearing Hearing tests 1 -2 years Audiometry Hearing aid,

other
impairment

measures
Hypertension Blood pressure 1- 2 years *********** Non -
management pharmacological
measures
 Continued…….

Breast cancer -Breast 1 – 3 years Biopsy Definitive

examination treatment
-Mammography

Cervical Pap smear in 1 – 3 years Biopsy Definitive

cancer women not treatment
screened
earlier in life

Malnutrition B.M.I ( Height 1 year Nutritional Diet

counseling/
and weight ) assessment Nutritional
supplements
PROGRAM & POLICIES
RELATED TO ELDERLY
NATIONAL POLICY ON OLDER PEOPLE (NPOP): 1999

• Promote health, well being and independence of

senior citizens
• Integrated Program for Older Persons: 90% financial
assistance for NGOs to set up geriatric care units: old
age homes, day care centers, mobile medicare units
• Assistance to PRI and self help groups
 Continued…….

• Sensitize, train and equip rural and urban health centers

and hospitals towards providing geriatric health care.
• Encourage NGOs and voluntary organizations to
formulate and strengthen a series of formal and informal
avenues that make the elderly economically self-reliant.
• Tax benefits could be explored as an encouragement for
children to look after their aged parents.
 INITIATIVES FOR SENIOR CITIZENS

• Reverse Mortgage

• Health Insurance for senior citizens

• Maintenance old Parents & Senior Citizens Bill

2007: Old age home, medical care, protection of
life & property
 NICE: NATIONAL INITIATIVE FOR CARE OF
ELDERLY

• Started by National Institute of Social Defense

• Care in deinstitutionalized setting

• Creating awareness, identification of needs, targeted

interventions, optimizing capabilities to improve
quality of life of elderly, creation of enabling social
environment and attitude
 AREAS OF INTERVENTION

• Self care
• Independent functioning
• Transportation & mobility
• Attitudes & perceptions
• Overcome marginalization/diminishing self
esteem
• Emotional dependence
• Communication skill
• Coping mechanism of problem solving
 ACTIONS TAKEN BY THE GOVERNMENT

1.Ministry of Social Justice & Empowerment

• Setting up of Old Age Homes, Day Care Centers, Mobile
Medicare Units through Grant in Aid to NGOs/
Voluntary Organizations

2. Ministry of Finance

• Higher Rate of Interest

• Personal Loan Scheme for Pensioners

 Continued…….

• Ashraya Deposit Plan

• Higher Returns
• Income Tax concession
• Varistha Pension Bima Yojana
• New Jeevan Akshay
 Continued…….

3. Ministry of Civil Aviation

• 50% Discount in Air Travel (subject to certain conditions)

4. Ministry of Railways
• 30% Discount in Rail Travel

5. Ministry of Road Transport & Highways

Road Travel concession in State Transport Buses
• Chandigarh , Delhi, Kerala, Maharashtra, Punjab , Rajasthan
 Continued…….

6. Ministry of Law & Justice

Free Legal Aid
• Subordinate/ High Courts
• Supreme Court
• Legal Aid Help-Line
• Speedier Disposal of Cases
• Maintenance of Older Parents

7. Ministry of Rural Development

• Schemes Transferred to States (2002-03)
• State Pension Scheme
• Annapurna
 Continued…….

8. Ministry of Consumer Affairs, Food & Public Distribution

-Antyodaya Programme: 35 g/month to 2.5 crore poorest of
the poor families

9. Ministry of Health
• Sunday Clinic in Delhi
Kerala and Maharashtra, 2 states have state level policy.
THANK YOU