Geriatric care

1. GERIATRIC
CARE
Presented By
Dr Nikhil Bansal
J.N.M.C.,Wardha

2. INDEX
INTRODUCTION
PHYSIOLOGICAL CHANGES DUE TO AGING
HEALTH PROBLEMS OF THE AGED
PSYCHOLOGICAL PROBLEMS
PREVENTION AND MANAGEMENT
a. PREVENTIVE HEALTH CARE
b. INTERVENTION IN REHABLITATION
SERVICES PROVIDED BY THE GOVT.
NON-GOVT. ORGANISATIONS

3. What is GERIATRICS ??????
The care of aged is called
geriatrics or clinical
gerontology.

4. The study of the physical &
psychological changes which are
incidental to old age is clinical
gerontology.
What is clinical gerontology???

5. AGING

6. AGEING
It is a progressive and generalized impairment
of body functions resulting in, loss of adaptive
responses to stress and increasing the risk of
age-related diseases.
People more than 60 yrs are considered
elderly.
Old age is not a disease but a normal and
inevitable biological phenomenon.

7. Theories of aging
Genetic theories-
somatic mutation of genes.
genetically determined life span.
cross linkage/loss of important cellular components
and DNA.
Random damage theories-
 accumulation of toxic metabolites and free oxygen
radicals.
 reduced physiological capacity and wear-n-tear of
cells of vital organs.
non-enzymatic glycosylation of proteins.

8. Branches of geriatrics
Gerontology
Clinical gerontology
Social gerontology
Geriatric gynecology
Experimental gerontology
Preventive gerontology

9. Demography of geriatric
population
World population: current >6.7688
billion(2009)
projected >8 billion (by 2025)
India has 16.94% of total population(2009)
Population of elderly(>65 yrs) in the world:
early 20th century-approx 12 million.
In 2009-approx 80million.
Population of elderly(>65yrs) in India:
approx 8% of total population.

10. Indian population

11. PHYSIOLOGICAL CHANGES DUE TO
AGING

12. Physiological changes due to aging
and their consequences
Problems in elderly are multi-faceted and
often a single problem may be the result
of a complex chain of decompensation of
body functions.

13. HEALTH
PROBLEMS
OF THE
AGED

14. Health problems of the aged
Physical problem
Psychological problems
Social problem
Economical

15. Physical problems
Ailments % of occurrence
Visual complaints 88 %
Locomotor system
disorders
40 %
Neurological
complaints
18.7 %
Cardiovascular system 17.4 %
Source: Report of the Independent Commission on Health in India

16. Respiratory system 16.1 %
Skin conditions 13.3 %
GI tract 9 %
Psychiatric complaints 8.5 %
Hearing loss 8.2 %
Genito-urinary
complaints
3.5 %
Source: Report of the Independent Commission on Health in India

17. Visual complaints
88% of the complaints in old age is
visual problems like
Cataract
Glaucoma
Retinopathy

18. Eye /Ear
Physiological
changes
ConsequencesEffects
Denaturation of
lens protein
Cataract Blindness
Loss of
accommodation
Presbyopia
Corneal
clouding
Arcus senilis

19. Lax eyelids and
reduced
lacrimation
Ptosis and dry
eyes
Xerosis
Retinal
degeneration
Defective colour
vision
Blindness
Degeneration of
cochlear hair cells
Presbyacusis Deafness

20. Locomotor system disorders
It forms 40% of the old age
complaints
They are:
Fibrositis
Osteoarthritis
Rheumatoid arthritis
Myositis
Neuritis
Gout
Spondilitis of spine

21. MUSCULO-SKELETAL SYSTEM
Irreversible loss
of motor units
and fibres
Reduced
muscle strength
Locomotor
disability
Deposition of
fat
Loss of
mineralisation
OsteoporosisPathological
fractures
Wear-n-tear of
articular
cartilage
OA and RA Mobility
problems

22. Neurological complaints
Neurological problems form 18.7% of
the old age complaints
These are:
Dementia
Parkinson's disease
Alzheimer’s disease

23. CENTRAL NERVOUS SYSTEM
Degenerative
changes
Impaired cognition
and behavior
Alzheimer's
disease and
other
dementias
Reduced
transmitter
substance
synthesis
Bradykinesia Slow
activities
Impaired
thermoregulation
Hypo/hyperthermia

24. Cardiovascular complaints
CVS disorders for 17.4% of the
different old age complaints
These include:
Atherosclerosis
Thrombus formation
Myocardial Infarction
Hypertension

25. Cardiovascular system
Reduced
cardiac
myocytes
Reduced
cardiac output
Syncope
Reduced nodal
activity and
conduction
Arrhythmias
and heart
blocks
Heart failure
Rigid and
narrow blood
vessels
HypertensionSyncope, IHD
and stroke

26. Respiratory complaints
Respiratory condition make 16.1% of
the old age complaints
These are:
Chronic bronchitis
Asthma
Emphysema

27. Respiratory system
Reduced cough
reflex and ciliary
action
AspirationRTI’s and pneumonias
Reduced lung
elasticity
DyspnoeaCOPD, asthma
Reduced alveolar
surface area
Hypoxia/hypercapnia

28. Skin conditions
Skin conditions form a major part of
old age complaints
Skin conditions include:
Senile wrinkles
Scaly lesions
Scaly dermatosis
Blistering diseases
Neoplastic disorders

29. Skin and its appendages
Loss of elasticity of skinWrinkling
Loss of hair Alopecia and baldness
Brittleness of fingernails
Slurred speech

30. Gastrointestinal complaints
GI disorders for about 9% of the old
age complaints
These are:
Peptic ulcer
Constipation
Ulcerative colitis
Carcinoma of GIT

31. Gastro-intestinal tract
Reduced gastric
acidity and
intestinal
motility
Non-ulcer
dyspepsia and
constipation
Poor absorption
and deficiency
states
Reduced
regenerative
capacity of
hepatocytes
Impairment of
metabolism
and
detoxification
Hepatic failure

32. Endocrine system
Impaired glucose
tolerance
hyperglycemia Diabetes
mellitus
Impaired thyroid
function
Hypo/hyperthyroidism
Disturbed vit.D
metabolism
Osteomalacia Fractures
Reduced sex
hormones
synthesis
Impotence in males
and Reproductive
organ cancers in
females

33. Hearing loss
Hearing complaints form about 8.2%
of the old age complaints
These include
Nerve deafness
Conductive hearing loss

34. Genito-urinary complaints
These form about 3.5% of the old age
complaints
They are:
Enlargement of prostate
Dysuria
Nocturia
Frequency and urgency of micturation

35. Genito-urinary tract
Reduced no. of
nephrons
Impaired
excretion
Accumulation
of toxins in the
body
Reduced renal
blood flow and
reduced GFR
Impaired
excretion
Accumulation
of toxins in the
body
Reduced
bladder
capacity
Urinary
incontinence
UTI
Prostatic
hyperplasia in
men
BHP Frequency

36. Geriatric Gynecology
Atrophy of
vaginal and
urethral mucosa
UTI’s and
atrophic
vaginitis
Carcinoma
cervix
Weakening of
pelvic muscles
Prolapse of
uterus
Ulceration and
carcinomatous
change

37. Haematology
Reduced bone
marrow reserve
Anaemias
Reduced T-cell
function
Non-resolving
infections
Prone to
infections
Increased
synthesis of
auto-antibodies
Auto-immune
disorders

38. Psychiatric complaints
These form 8.5% of the old age
complaints
These include
Alzheimer’s disease
Depression
Anxiety
Delirium
Schizophrenia
Personality disorder
Suicide and deliberate self harm

39. others
Atrophy of
mucous
membrane of
mouth
Reduced food
intake and change
of taste and smell
Nutritional
deficiency
states
Loss of teeth same as above
Decreased no. of
taste buds
same as above
Decreased
salivation
same as above
Decreased
sensation of
smell
same as above

40. PSYCHOLOGICAL PROBLEMS

41. Psychological problems
More reliable and are independent of age
But, elderly patients less willing to talk
about psychological problems
Pay attention to:
anxiety
physical discomfort
adaptation to a new lifestyle

42. PSYCHOLOGICAL SYMPTOMS
Sleep
Interest
Guilt (“Are you a burden to others?”)
Energy
Concentration
Appetite
Psychomotor changes
Suicidality (“Do you wish you could
die?”)

43. SIGNS AND SYMPTOMS IN
GERIATRIC DEPRESSION
SYMPTOMS
MOOD
COGNITIVE
VEGETATIVE
VOLITIONAL
SIGNS
APPEARANCE
BEHAVIOUR
PSYCHOMOTOR
RETARDATION
PHYSCHOMOTOR
AGITATION

44. INCIDENCE IN ELDERLY
MAJOR DEPRESSION
3% community dwelling
14% two years after spouse dies
15% medically ill
25% long-term-care settings

45. Social problems
Abuse
Dependancy
Insecurity
Rehabilitation

46. Abuse
Abuse of the old
Mistreatment of older people – referred
to as ‘‘elder abuse’’ – was first described
in British scientific journals in 1975
under the term ‘‘granny battering’’
The abuse may be of a physical nature,
it may be psychological (involving
emotional or verbal aggression), or it
may involve financial or other material
maltreatment.

47. Elder Abuse
It refers to ill-treatment of an elderly person.
It can be-physical abuse
-psychological abuse
-financial abuse
-sexual abuse.
It is a very sensitive issue and requires a high
index of suspicion.

48. Abuse is generally divided into the
following categories:
Physical abuse – The infliction of pain
or injury, or physical or drug induced
restraint.
Psychological or emotional abuse .

49. Financial or material abuse – The
illegal or improper exploitation or use of
funds or resources of the older person.
Sexual abuse – Non-consensual sexual
contact of any kind with the older
person.
Neglect – The refusal or failure to fulfill
a care giving obligation. This may or
may not involve a conscious and
intentional attempt to inflict physical or
emotional distress on the older person.

50. DEPENDANCY
PHYSICAL, FINANCIAL, FUNCTIONAL and
other dependancy has a major affect on the
self esteem of the old.

51. Insecurity
Insecurity of being abandoned by
their children.

52. Rehabilitation
This is one of the main problem of old
age.

53. Economical problems
No or inadequate source of income
Total economical dependence on
children for their daily needs

54. Need for geriatrics
Elderly population will keep on rising due to
advancing medical technology.
Diseases present atypically and at an earlier
stage.
Often a multi-organ system involvement.
Worsening of pre-existing diseases are
frequent.
Burden over the health care system.
Burden over the nations economy.

55. Health Care Expenditure
Elderly are seen as consumers of services rather
than the producers.
The world geriatric population accounts for
>1/3
rd
total health care expenses.
In the US >12% geriatric population accounts
for almost 30-35% of personal health care
expenditure and by yr 2040 will use nearly half
of the nations total personal health care
resources.

56. PREVENTION AND
MANAGEMENT

57. Prevention and Management of
Health Problems in Geriatrics
One of the most important measure of how
civilized we are is how we treat our elderly.
According to Sir James Sterling Ross ”you do
not heal old age, you protect it, you promote it
and you extend it.”

58. Components of assessment
Physical
Functional
Psychological-
cognitive
affective
Socio-economical
Environmental

59. Assessment of the elderly
AIMS –
Cost effective use of services.
Maintaining the elderly active.
Providing quality care up to the max. satisfaction of
the user.

60. Evaluation of newly discovered
risk factors
Severe functional disability-
 hospitalization and detailed assessment.
Mild to moderate dysfunction-
 cause found-
drugs+ caregiver support+ rehabilitation
cause not found
caregiver support+ rehabilitation.
Functional evaluation reveals good function-
assurance.

61. Multi-disciplinary Geriatric
Assessment (Geriatric Clinic)
The concept of geriatric clinic suits best for
assessment and management of diseases and
disabilities in the elderly.
Components-
Gerontologist/Physician
Physiotherapist
Occupational therapist
Ophthalmologist
Audiologist
Psychiatrist
Dietitian
Nurse and
Social worker.

62. Scope-
This facility is available only at tertiary and few
secondary health care centers.
In a primary health care set-up, a trained physician, a
trained nurse and a physiotherapist should be able
to assess the elderly fairly well.

63. PREVENTIVE HEALTH CARE

64. Preventive Health Care in Elderly
The role of prevention in geriatrics is to delay
the onset of age-related decompensatory
problems of body functions.
It includes-
Primary prevention.
Secondary prevention.
Tertiary prevention.

65. Primary prevention
Health habits-
Inadequate nutrition
Addiction to smoking & alcohol
Lack of exercise
Inadequate sleep
Predisposing factor for coronary heart disease
Modifiable-
smoking, obesity, HT, DM, hyperlipidemia, hypercholesterolemia,
etc.
Non-modifiable-
age, sex, genetic factors, etc.

66. Immunization-
 Influenza
 Pneumococcal
 Tetanus.
Osteoporosis prevention-
Calcium and vit-d supplementation.
Hip protector devices.

67. Injury prevention
Burns accidents and falls should be prevented
by;-
Removal of obstacles
Keep the floor dry
Bright lighting
Flat shoes
Railing/holding bars in bathrooms
Low level switches
Easy and safe access to water.

68. Secondary prevention
Screening helps in early detection of
modifiable risk factors and their
adequate management.
Hyper/hypotension, diabetes mellitus
Dental problems
Drug adverse effects
Cancers
Infections
Nutritional deficiency states
Eyes /ears
Screening

69. Early detection and treatment is an
important step in secondary prevention of
disease and disability.

70. Tertiary prevention
It deals with rehabilitation and caregiver support.
Rehabilitation is a problem solving process focused on the
patients functional abilities.
Rehabilitation team includes; a physician, a
physiotherapist, an occupational therapist, a speech and
language therapist, a psychiatrist, a dietitian, a nurse and a
social worker.

71. INTERVENTIONS IN
REHABILITATION

72. Interventions in rehabilitation
Hard interventions-
drugs.
 physiotherapy.
 occupational therapy.
 aids and adaptation.
speech and language therapist.
Soft interventions-
advice.
education.
counseling.
encouragement.
listening.

73. Supporting the caregiver
Social attitude
Physicians support
Organization of “day care centers”
Hospitalization in c/o chronic illness
Counseling the caregiver

74. Prevention and management
of elder abuse
Assessment of physical and mental capacity of
the elderly.
Assessment of general quality of care
Assessment of relation with the abuser
Assessment of abusers for their problems
Counseling the abusers
Institutionalization in old age homes

75. SERVICES BY THE GOVT

76. Laws in India to protect the old
people
Section 125(1) (d): If any person having sufficient
means neglects or refuses to maintain his father or
mother, unable to maintain himself or herself, a
Magistrate of the first class may, upon proof of
such neglect or refusal, order such person to make
a monthly allowance for the maintenance of his
wife or such child, father or mother, at such
monthly rate not exceeding five hundred rupees in
the whole, as such Magistrate thinks fit, and to pay
the same to such person as the Magistrate may
from time to time direct.

77. Section 125(3): If any person so ordered fails
without sufficient cause to comply with the order,
any such Magistrate may, for every breach of the
order, issue a warrant for levying the amount due
in the manner provided for levying fines, and may
sentence such person, for the whole or any part
of each month’s allowance remaining unpaid after
the execution of the warrant, to imprisonment for
a term which may extend to one month or until
payment if sooner made

78. Sl. No. Name of the
Ministry/Department
Facilities/Benefits
given to Senior Citizens
1 Ministry of Social Justice
& Empowerment
1.Ministry of Social
Justice &Empowerment
announced the National
Policy on Older Persons
which seeks to assure
older persons that their
concerns are national
concerns.

79. Sl. No. Name of the
Min./Department
Facilities/Benefits given to Senior
Citizens
2.The Ministry is also implementing
following schemes for the benefit of
Senior Citizens:
a.The Scheme of Assistance to
Panchayati Raj Institutions/Voluntary
Organisations/Self Help Groups for
Construction of Old Age
Homes/multi-service centres for
older persons. Under this Scheme,
one time construction grant for old
age homes/multi-service centre is
provided.

80. Sl. No. Name of the
Min./Departm
ent
Facilities/Benefits given to Senior
Citizens
b. An Integrated Programme for Older
Persons has been formulated by
revising the earlier scheme of
“Assistance to Voluntary Organisations
for Programmes relating to the Welfare
of the Aged”. Under this Scheme,
financial assistance up to 90% of the
project cost is provided to NGOs for
establishing and maintaining old age
homes, day care centers, mobile
medicare units and to provide non-
institutional services to older persons.

81. Sl. No. Name of the
Min./Department
Facilities/Benefits given to
Senior Citizens
2. Ministry of Rural
Development
1.Under the National Old Age
Pension Scheme, Central
Assistance of Rs. 75/- p.m. is
granted to destitute older
persons above 65 years. This
Scheme has been transferred
to the State Plan w.e.f. 2002-
03.

2.Under the Annapurna
Scheme, free food grains
(wheat or rice) up to 10 kg.
per month are provided to
destitute older persons 65
years or above.

82. Sl. No. Name of the
Min./Department
Facilities/Benefits given to
Senior Citizens
1 Ministry of Social Justice &
Empowerment
Ministry of Social Justice &
Empowerment is the nodal
Ministry responsible for welfare
of the Senior Citizens. It has
announced the National Policy on
Older Persons covering all
concerns pertaining to the
welfare of older persons. The
National Policy on Older Persons
recognizes a person aged 60
years and above as a senior
citizen.

83. Sl. No. Name of the
Min./Department
Facilities/Benefits given to
Senior Citizens
2 Ministry of Finance Income tax rebate upto an
income of Rs. 1.85 lakh p.a.
Higher rates of interest on
saving schemes of senior
citizens. A Senior Citizens
Savings Scheme offering an
interest rate is 9% per annum
on the deposits made by the
senior citizens in post offices has
been introduced by the
Government through Post
Offices in India doing savings
bank work.

84. Sl. No. Name of the
Min./Department
Facilities/Benefits given to
Senior Citizens
3 Ministry of Road Transport
and Highways
i) Reservation of two seats for
senior citizens in front row of the
buses of the State Road Transport
Undertakings.
ii) Some State Governments are
giving fare concession to senior
citizens in the State Road
Transport Undertaking buses and
are introducing Bus Models, which
are convenient to the elderly.

85. Sl. No. Name of the
Min./Department
Facilities/Benefits given to
Senior Citizens
4 Ministry of Health & Family
Welfare
Separate queues for older
persons in hospitals for
registration and clinical
examination.

86. Sl. No. Name of the
Min./Department
Facilities/Benefits given to
Senior Citizens
5. Department of
Telecommunications
i) Faults/complaints of senior
citizens are given priority by
registering them under senior
citizens category with VIP flag,
which is a priority category.
ii) Senior citizens are allowed to
register telephone connection
under N-OYT Special Category,
which is a priority category.

87. Name of the
Min./Department
Facilities/Benefits given to
Senior Citizens
6 Ministry of Railways a) Indian Railways provide 30%
fare concession in all Mail senior
citizens aged 60 years and above.
b) Indian Railways also have the
facility of separate counters for
Senior Citizens for tickets.
c) Ramps for wheel chairs
movement are available at the
entry to important stations.
d) Specially designed coaches
with provisions of space for wheel
chairs, hand rail and specially
designed toilet for handicapped
persons have been introduced.

88. Name of the
Min./Department
Facilities/Benefits given to
Senior Citizens
7 Ministry of Civil Aviation 1. Indian Airlines is providing 50
per cent Senior Citizen Discount on
Normal Economy Class fare for all
domestic flights to Indian senior
citizens who have completed the
age of 65 years in the case of
male senior citizens and 63 years
in the case of female senior.
2. Air is offering discount to
senior citizens of 60 plus on flights
to , and . Further, Air has now
decided to reduce the age of 60
plus .

89. Name of the
Min./Department
Facilities/Benefits given to
Senior Citizens
8 Ministry of Consumer
Affairs, Food and Public
Distribution
1.i) Under the Antyodaya Scheme,
the Below Poverty Line (BPL)
families which also include older
persons are provided food grains
at the rate of 35 kgs. per family
per month. The food grains are
issued @ Rs.3/- per kg. for rice
and Rs.2/- per kg. for wheat.
2.(ii) Under the Annapoorna
Scheme being implemented by
the States/UT Administration, 10
kgs. of food grains per
beneficiary per month.

90. Name of the
Min./Department
Facilities/Benefits given to
Senior Citizens
9. MCD(municipal cooperation
of India)
1.(i)MCD, has opened a separate
counter to facilitate the senior
citizens for submission of
property tax bills. (ii) A rebate
of 30% of the property tax due
on the covered space of a
building up to one hundred sq.
mtrs. of the covered space has
been allowed by the
corporation in the case of any
self-occupied residential
building singly owned by a
man who is 65 years or more
in age.

91. Facilities/Benefits
given to Senior
Citizens
10 Miscellaneous 1.(i) Courts in the
country accord priority
to cases involving older
persons and ensures
their expeditious
disposal.
2.(ii) Under the Old Age
Pension Scheme,
monthly pension is
given at variable rates
to the destitute old by
various State
Governments/UT
Administrations.

92. HELP AGE INDIA

93. Helpage India
Helpage India supports the following programmes to
make life easier for older people:
1.Free cataract operation
2.Mobile Medicare units
3.Income generation and micro-credits
4.Old age home and day care centers
5.Adopt a grant parents
6.Disaster mitigation

94. References
Park Textbook of Preventive and
Social Medicine
Oxford Book of Public and Health
New Oxford textbook of Psychiatry
www.who.int
http://socialjustice.nic.in/

95. Acknowledgement
We would like to thank the PSM dept and
respected HOD, Dr. Goyal Sir for giving us
this wonderful oppurtunity to learn about
and present this assignment on the topic
Geriatric care.
We would like our guide Dr. Mudey Sir for
his guidance
Special thanks to Dr. Wagh sir and Dr.
Dhawale sir.

97. THANK YOU