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AGEING POPULATION in the university presentations .pptx
- 2. At the end of the session, you will be able to: • Understand the physical and psychological changes in ageing population; • Discuss frailty as an example of such changes in ageing population; • Assess and plan to respond to frailty and other changes in ageing population.
- 3. • Multiple definitions available. • The condition of being weak and delicate… • Frailty is most often defined as a syndrome of physiological decline in late life, characterized by marked vulnerability to adverse health outcomes. • Frailty can be defined as a clinical state where there is a increase in individual’s vulnerability to develop negative health-related events (including disability, hospitalizations, and death). • Age-associated declines in physiologic reserve and functions… Frailty -Definition
- 4. • Physical frailty and psychological frailty • Aging-related state of vulnerability • High risk - for: mortality; falls; disability; hospitalization • Potential for treatment and prevention of frailty as well as its poor outcomes • Syndrome of shrinking, slowing and weakness, with low activity and low Frailty:Geriatricians’Perspective
- 5. • Frailty is a common geriatric syndrome. Estimated frailty prevalence is 7–16%. • The occurrence of frailty increases incrementally with advancing age, and is more common in older women than men, and among those of lower socio-economic status. • Chronic diseases, such as cardiovascular disease, diabetes, chronic kidney disease, depression, and cognitive impairment. • Physiologic impairments: Activation of inflammation and coagulation systems, anemia, atherosclerosis, autonomic dysfunction, hormonal abnormalities, hypovitaminosis etc. Why??…Understanding ofFrailty
- 6. • The cardiac output decreases, blood pressure increases and arteriosclerosis develops. • The lungs show impaired gas exchange, a decrease in vital capacity and slower expiratory flow rates. • Atrophic gastritis and altered hepatic drug metabolism are common in the elderly. • Progressive elevation of blood glucose. • Osteoporosis is frequently seen due to a linear decline in bone mass after the fourth decade. • Metabolism is altered – e.g. Reduced glucose tolerance, Reduced resting metabolic rate (RMR), and reduced kidney function. Physiological changes inageing
- 7. • Impaired digestion due to: deterioration of digestive enzyme production, decrease in the production of stomach acid, slower bowel movements caused by inadequate liquid and dietary fibre intakes. • Oral health problems: dry mouth or xerostomia due to inadequate production of saliva can affect more than 70% of the elderly population. • Loss of sensory perception: reduced taste perception (dysgeusia) and impaired ability to smell (hyposmia) • Deterioration or loss of sight may also negatively affect food intake Physiological changesCont….
- 8. • Cognitive impairment increases with age • 5-10% of elderly have dementia • Alzheimer’s disease is most prevalent type of dementia • Some cognitive functions decline with age, while others are stable or improve Intellectual Changes withAgeing
- 9. • Theories of aging can be divided into two categories: • those that answer the question “Why do we age?” and • those that address the question “How do we age?” • Theories or Hypotheses? About “How do we age?” • BIOLOGIC THEORY OF AGEING • ‘PROGRAMMED’ THEORY OF DEVELOPMENT • EVOLUTIONARY THEORY OF AGING • CROSS-LINKING/GLYCATION HYPOTHESIS OF AGING GENOME MAINTENANCE HYPOTHESIS OF AGING • NEUROENDOCRINE HYPOTHESIS OF AGING • OXIDATIVE DAMAGE/ FREE RADICAL Theories ofAging
- 10. Curve 1: Modern non-programmed aging theories – The evolutionary value of furtherlifeand reproduction is effectivelyzero beyond some species-specific age. Curve 2: Modern programmed aging theories – There is an evolutionary cost associatedwith survivingbeyond a species-specificage. Curve3:Medawar’s concept – The evolutionaryvalueof survivaland reproduction declines with age followinga species-specificage.
- 13. Cycle ofFrailty
- 14. Preventing frailty or itsprogression, adverseoutcomes • Prevention of frailty: • Preventing onset • Improving frailty • Preventing outcomes, minimizing associated risks – at times of stressors • Minimizing interactions: of frailty with other comorbidity • Medications tolerance • Treating the frail patient at times of stressors to decrease risk • Hospitalization • Surgery • Acute illness, bed rest
- 15. PH Goals forAgeing Population • Compression of morbidity • Active life expectancy • Support healthy conditions for people of all ages • Ensure effective PH and preventive approaches (all levels) for older people • Provide community and home- based supports • Effective care systems and competent work force to support healthy aging
- 16. Challenges in relation to: • Improve quality of acute hospital care - costly • Be aware of “cascade” of acute hospital care • Early detection and screening – resources, skills, willingness, social norms etc. • Comprehensive geriatric assessment – site, skills • Home-based vs palliative care alternatives • Rehab and improve survival Challenges and Solutions in Careof FrailElderly
- 17. Assessment of elderly people in hospital • The holistic assessment of older people. • The MDT members include doctors, nurses, physiotherapist (PT), occupational therapist (OT), dietician, clinical pharmacist, social worker (SW), specialist nurses (e.g. tissue viability nurse and Parkinson’s disease nurse specialist), hospital discharge liaison team and care givers. • Input from a clinical psychologist or old age psychiatrist may be needed depending on individual patients’ needs. • All members engage with patients and care givers to complete their assessments and intervention, followed by multidisciplinary meeting (MDM) to formulate ongoing care plan and follow-up.
- 18. Assessment and Management of elderly people • Multiple co-morbidities, physical limitations, increased functional dependence and complex psychosocial issues are common health problem of elderly people. • The elderly people are more vulnerable and could easily decompensate with minor stressors, resulting in increased frailty. • To improve outcomes for frail older people with multiple co- morbidities, admission should be to an Emergency Frailty Unit (EFU) having Acute Medical Unit (AMU) for elderly. • The physical illness or adverse effects of drugs are more pronounced in atypical presentation among elderly people and cognitive decline, delirium or inability to manage routine activities of daily living (ADLs) are common.
- 19. Medical Problems in Old Age (1) Common medical conditions seen in older people • Alzheimer’s disease • Normal pressure hydrocephalus • Temporal arteritis (giant cell arteritis) • Diastolic heart failure • Inclusion body myositis • Atrophic urethritis and vaginitis • Shingles (herpes zoster) • Benign prostatic hyperplasia • Aortic aneurysm • Polymyalgia rheumatic arthritis.
- 20. Common medical conditions in older age group • Degenerative osteoarthritis • Overactive bladder with urinary incontinence • Diabetic hyperosmolar non-ketotic coma • Falls and fragility hip fracture • Osteoporosis • Parkinsonism • Accidental hypothermia • Pressure ulcers • Prostate cancer • Stroke • Glaucoma and cataract Medical Problems in Old Age (2)
- 21. Two Key Drivers of Age- Friendly Health Systems Age-Friendly Health System: 4Ms Assess: Know about the 4Ms for each elderly people in your care Act On: Incorporate 4Ms in the Plan of Action
- 22. Putting the 4Ms into Practice Integrating the 4Ms into Care Using the PDSACycle • Provide care • Study your performance (M&E, CBA, CEA etc) • Understand your current state • Describe care consistent with 4Ms • Design or adapt your health workforce • Improve and sustain care Ac t Pla n D o Stud y
- 23. • Ask the older adult What Matters most, document it, and share What Matters across the care team • Align the care plan with ‘What Matters’ most • Review for high-risk medication use and document it • Avoid high-risk medications, and document and communicate changes • Ensure sufficient oral hydration • Orient to time, place, and situation • Ensure older adults have their personal adaptive equipment • Support non-pharmacological sleep 4Ms in an Age-Friendly Health System Hospital & Practice
- 24. • Screen for delirium at least every 12 hours and document results • Screen for dementia/cognitive impairment and document the results • Screen for depression and document the results • Consider further evaluation and manage manifestations of dementia, educate older adults and caregivers, and/or refer out • Identify and manage factors contributing to depression and/or refer out • Screen for mobility limitations and document the results • Ensure early, frequent, and safe mobility. 4Ms in an Age-Friendly Health System Hospital & Practice
- 25. Challenges & Opportunities for 4Ms Lack of a framework for the technological ecosystem Wide variety of country socio-economic- cultural contexts Need to engage all! Need political commitment and champions Put it within the existing health system – no parallel