AGEING POPULATION in the university presentations .pptx

okay

1. FRAILTY IN AGEING POPULATION

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 energy 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 of Frailty

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 in ageing

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 changes Cont….

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 with Ageing

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 HYPOTHESIS OF AGING Theories of Aging

10. Curve 1: Modern non-programmed aging theories – The evolutionary value of further life and reproduction is effectively zero beyond some species-specific age. Curve 2: Modern programmed aging theories – There is an evolutionary cost associated with surviving beyond a species-specific age. Curve 3: Medawar’s concept – The evolutionary value of survival and reproduction declines with age following a species-specific age.

11. Frailty as a Syndrome

12. Frailty as a Syndrome

13. Cycle of Frailty

14. Preventing frailty or its progression, adverse outcomes 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 for Ageing 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 Care of Frail Elderly

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 PDSA Cycle 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 Act P l an Do Study

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 Need evaluation/assessment – resources, framework Appropriate regulatory approaches Affordability! (Inequities are increasing) Multiple morbidities; need for integrated action