24. Preventive Geriatrics care 2020.pptx

Preventive Geriatric care

1. PREVENTIVE GERIATRICS: PROBLEMS OF ELDERLY, PREVENTION AND CONTROL MEASURES:

2. PREVENTIVE GERIATRICS – PROBLEMS OF ELDERLY, PREVENTION AND CONTROL MEASURES: DEFINITIONS: GERIATRICS: Is a branch of medicine which deals with problems of old age. GERONTOLOGY: Science which deals with processes of ageing. PREVENTIVE GERIATRICS: Is a branch of Geriatrics which deals with prevention & control of disability & improving the quality of life of the aged people. The principles of Preventive Geriatrics – Sir James sterling Ross commented, “You do not heal old age, you protect it, promote it and extend it”. Ageing is a natural process, irreversible, always progressive, biological phenomenon and associated with decline mental functions. OLD AGE ACCORDING TO WHO: Young old – between the ages of 60 to 75 years Old – Old – between the ages 75 to 85 years Very old – age of 86 years and above All the Acharya have considered the Jara at the age of 60/70 years. Modern science – considered the old age at 60 years onwards.

3. Etymologically, the term Jara comprises of Jr + Ana+ Tap. The term Jara has been derived from the Sanskrit root, " Irisb vayohanow " which can be explained as " Vayah krta slata mamsadya vastha visesa " which means the muscles and other tissues are loosened under the influence of aging. Totally this term indicates of the' loss' in the period of life span. Classification of Vaya According to Candogyopanisad the total life span of 116 yrs is divided into: Childhood - Balya - 24 yrs Youth - Yavana 44 yrs Old - vrddha 48 Charaka : Bala Madhyama jeerna Shushruta : Bala - up to 16 years Madhya vaya – 16 to 70 years vriddha – 71 to 100yers

4. AGING PROCESS: Aging is two types – Natural aging ( Kalaja Jara ): which occurs at or after the proper age i.e. 60 years even after following daily regimens and seasonal routines and use of shodhana at propertime . appearance of signs and symptoms of aging at a perticular scheduled age is considered as Kalaja Jara . It is not curable and considered to be Yapya with treatment like rasayana . So, jara is a Swabhava bala pravritta vyadhi . 2. Premature aging ( Akalaja Jara ): occurs before the age of 60 and improper health care measures. Akalaja means “ Asamaye Jaata ”. Untimely. Premature. It is curable with rasayana drugs according to dosha and stage of aging. PROBLEMS OF ELDERLY: Social problems Economic problems Psychological problems Health problems

5. SOCIAL PROBLEMS: Social problems of aged is important because the physical wellbeing & mental health is affected. Loneliness & Social isolation. Rapid disintegration of joint family. Change in social contacts due to retirement. Bereavement -Death of spouse/ siblings ,close relatives,friends , or separation of their children after marriage. Diminished participation in social & cultural activities like marriages, ceremonies, visiting temples etc. Diminished role in the family & community. Even if they participate their role is not much appreciated. These factors leads to STRESS which in turn contributes to ILLNESS. Problems of leisure Absence of job Diminished social contact- Chronic disability associated with ageing process Due to death of close friends and relatives Lowered or loss of income. Change in the attitude of community towards elderly. Inability to adopt with changing environment.

6. ECONOMIC PROBLEMS: More common in women then men. CAUSES: Retirement of people employed in government services, local bodies, public sector & private organizations. Self employee like agriculturists, businessmen, daily wage earners who cannot earn their livelihood due to disease and disability etc.

7. GOALS OF GERIATRIC CARE: Provide a safe and supportive environment. Restore and maintain the highest possible level of functional capacity. Preserve individual autonomy. Maximize quality of life. Provide comfort and dignity for disabled & ill. Stabilize & delay progression of chronic diseases. Prevent acute medical illnesses, early detection and treatment.

8. HEALTH PROBLEMS: CARDIOVASCULAR SYSTEM: Degenerative diseases of heart & vessels Hypertension, Atherosclerosis, CHD PSYCHOLOGICAL PROBLEMS: Emotional disturbance Feel lonely, neglected & unwanted Anxiety, depression & suicidal tendencies Impaired memory Rigid outlook NUTRITIONAL EXCESS OR DEFICIENCIES: Obesity, Anemia, A vitaminosis , etc., SENSORY SYSTEM : Eyes : Senile cataract, glaucoma Ears : Nerve deafness, vertigo, tinnitus Skin : Loss of elasticity of skin leading to wrinkling and dryness. LOCOMOTOR SYSTEM: Articular disorders: Osteoarthritis, Spondylosis of spine – lumbar and cervical, Gout, Rheumatoid arthritis  Non articular disorders: Fibrosis's, Myositis

9. Fractures due to falls: Fracture neck of femur and hip. Fires, traffic collisions are extremely common. In case of crisis and conflict displaced older people are particularly vulnerable. Respiratory system: Chronic bronchitis, Emphysema, Asthma Central nervous system Cerebro vascular accidents Peripheral neuritis Alzheimer’s disease Parkinson’s disease Endocrine system Diabetes mellitus Hypothyroidism Malignancies Females: Ca cervix, ca ovary Males: lung ca, prostate ca G I System Dental caries & loss of teeth. Indigestion due to reduced metabolism & malabsorption . Constipation. Genito - urinary system Males : BPH Females: Uterine prolapse , Nonspecific vaginitis , cervicitis

10. PREVENTION AND CONTROL MEASURES AMONG ELDERLY: 1. Promoting joint family system . And make them busy - like small house hold works, part time jobs, social services, library facility, reading books, looking after agriculture land, gardening. 2. Social welfare measures – all aged group needs sympathy and assistance by their family members and community. 3. Provision of institutional care – for those people who have no house of their own or person to took after them. 4. One should provide medical and nursing care, home help, nutrition, physiotherapy, hearing aids, spectacles, dentures. 5. In primary prevention – explain biological changes in aging, personal hygiene, explain about smoking and alcohol, explain about walking etc.

11. 5.Provide clean house, fresh air, light, ventilation, prevent of accidents both inside and outside the home. 6.Provide balanced diet, food which improves bowel movements. 7.For behavioral changes – advice yoga and relaxation. 8.Protect by immunization, provide vitamin D, calcium supplement diet, antioxidant foods. 9.Protect against cancer and degenerative disorders. 10.Early diagnosis and give early treatment. 11.Provision of free medical care.

12. PREVENTION & CONTROL OF HEALTH PROBLEMS: The main objective is to protect, promote & restore the health of elderly people. PRIMARY PREVENTION: Health promotion: Health Education Explaining the biological changes in ageing. Personal hygiene. Regarding smoking, alcohol related diseases. Information on CD & NCD specific to old age. Availability & utility of health services. Over the counter drugs. Use of aids like visual, auditory, walking aids etc Information regarding elderly abuse.

13. ENVIRONMENTAL MODIFICATION: Maintenance of clean housing conditions. Need for fresh air, light & ventilation. Disposal of waste & human excreta. Vector control. PREVENTION OF ACCIDENTS BOTH INSIDE & OUTSIDE THE HOME. Slip resistant flooring Smooth pathways Hand rails in bathrooms Stairs- landing at short intervals Adequate lighting Contrasting colors

14. Nutritional intervention Principles of balanced diet. Food safety. Food which improve bowel movement. Life style & behavioral changes Physical exercises like yoga and relaxation Personal habits like alcohol, smoking & tobacco chewing. Specific protection : Immunization. Avoidance of injuries and falls Vitamin D, calcium supplementation. Certain food rich with antioxidant property- protect against cancer and degenerative disorders. SECONDARY PREVENTION Action which halts the progress of the disease at its incipient stage and prevents complication. Early diagnosis & treatment – Early recognition of CD & NCD, proper treatment, patient compliance & self care. Provision of free medical care.

15. TERTIARY PREVENTION: All measures available to reduce or limit impairments & disabilities,& minimize suffering caused by existing disability. Rehabilitation of elderly people with chronic diseases & care for terminal illness. Rehabilitation – medical, vocational , social and psychosocial. Measures include- Training to increase independence in self care; Educational and vocational measures aimed at achieving economic independence; Social measures to ensure full integration and acceptance in community.

16. Medical rehabilitation Appropriate exercise therapy for maintain the range of motion of joints, improving power in weak muscles and strengthening them. Restoring function of affected extremity. Provision of external appliance, splint or caliper, crutches, wheel chair etc., Relief of pain by means of physical modalities like heat, cold, electricity. Bowel/ bladder training to achieve continence. Psychosocial rehabilitation Rehabilitation is never complete unless the psychosocial aspects are duly taken care. Problems– loneliness, anxiety, depression, feeling of insecurity, behavioral disorders, affective disorders, personality disorders, suicidal tendencies, dependence, irritability, malingering, hysteria etc., The clinicians duty is to–explain, reassure, remove problems of the disabled about his disabilities, their effect on work and its possible solutions.

17. NGO’S IN GERIATRIC CARE: NGO’s are the first one to bring out the problems of elderly in India. Help Age India Action for Social Help Assistance Centre for the Welfare of Aged Geriatric Society of India Nightingale Medical Trust Cheru Resmi Centre SERVICES: Provision of food Day care centre Old age homes Medical and psychiatric care Financial assistance-income generation & micro projects. Counseling

18. LIST OF RASAYANA IN JARA: Amalaki rasayana Ashwagandha choorna Triphala rasayana Vidangadi yoga Chavanaprasha Dhatri rasayana Swarna makshika rasayana Amrutarnava rasayana

19. THANK YOU, GOOD LUCK