HEALTHY AGEINg designed for older population to teach ways to healthy ageing

Geriatrics

1. ADDING LIFE TO YEARS: A GUIDE TO HEALTHY AGEING PROF. KAUSER USMAN MD, FIACM, FIMSA, FICP, FACP(USA) FRCP ( Edin ) PROFESSOR, DEPT. OF MEDICINE, OFFICIATING HEAD, DEPT. OF GERIATRIC MEDICINE, KGMU, LUCKNOW

2. Learning Objectives • Understand the physiological changes of aging • Gain awareness of chronic diseases and their impact on older adults • Understand the importance of health promotion activities

3. Program Overview Aging and Health Geriatric Giant’s Health promotion: Lifestyle changes Screening and prevention Polypharmacy

4. Healthy Ageing

5. Rising Elderly Population: A Growing Challenge In India, individuals aged 60 years and above currently constitute approximately 10% of the total population. Can you estimate how much rise is expected by 2050? Nearly double by 2050 , reaching over 20%

6. Ageing Process • Generally involves physiological slowing down of organ functions • Varies greatly among individuals • Influenced by genetics, environment, lifestyle factors, and psychosocial well-being of an elderly

7. What changes do you expect as a part of ‘Normal Ageing’?

8. Physiological Changes of Ageing Heart Pumping effectiveness decreases Muscles Muscle mass decreases Brain Some loss of cell structure and function Skin Dryness, slower healing Kidney Less efficient Vision Decreases in depth perception, color perception, and peripheral vision Hearing Decreased acuity, esp. higher pitch Bones Mineral loss faster than replacement Taste Decreased taste buds, saliva production

9. Physiological Changes of Ageing

10. What’s normal? What’s not? • Aging vs. disease process vs. external factors • “Normal changes” of aging may be part of a disease process • Don’t assume symptoms are due to normal aging; never ignore any trivial symptom. Does every headache indicate high blood pressure?

11. Chronic Diseases A chronic disease is a long-lasting health condition that usually cannot be fully cured but can be managed to reduce problems and maintain daily life. Eg , Diabetes, Hypertension, Chronic Kidney Disease, Heart diseases, Stroke, COPD, Chronic Liver disease etc.

12. Geriatric Giant’s Immobility Instability Incontinence Intellectual impairment

13. Expanded Geriatric Giant’s Iatrogenesis Impaired homeostasis Sarcopenia Sensory impairment

14. Immobility

15. Instability Falls Gait Disturbance

16. Incontinence (urine and stool) Pelvic floor weakness Prostrate enlargement Urinary Tract Infection Stroke Diabetes Spinal cord injury

17. Intellectual Impairment Dementia Delirium

18. Iatrogenesis Too many medicines Polypharmacy : five or more per day and/or administration of more medicines than are necessary. This leads poor medication adherence and increased risk of adverse drug reactions.

19. Impaired homeostasis Mild UTI → Delirium Minor fall → Hip fracture +prolonged immobility Mild dehydration → Hypotension + acute kidney injury Normal dose of sedatives → falls, Confusion

20. Sarcopenia Muscle weakness or loss

21. Sensory Impairment Vision Loss Hearing Loss

22. Promoting Healthy Lifestyle Lifestyle Modification Screening of disease Prevention of disease

23. Lifestyle Modification Adopting a balanced diet rich in fruits, vegetables, whole grains, and adequate protein.

24. Micronutrient Supplement Micronutrient Relevance in Elderly Recommended Intervention Iron Prevents anemia and weakness Supplementation/fortification when deficient Folate (B9) & Vitamin B12 Supports cognitive and hematologic health Supplementation/fortification as needed Iodine Maintains thyroid and brain function Through iodized salt globally Vitamin A Immune and vision support Supplementation primarily in other target groups Zinc Immune resilience, inflammation control Address deficiencies through food or supplements Vitamin D & Calcium Bone health and fall prevention Supplement where dietary exposure is limited

25. Lifestyle Modification How much duration of exercise daily is adequate? A Sedentary lifestyle contributes to many chronic diseases such as Obesity, Diabetes, Hypertension, Dyslipidemia, Osteoporosis, Depression, cardiac illness, and Stroke

26. Lifestyle Modification How many hours of sleep do you think is adequate?

27. Lifestyle Modification Smoking and alcohol is the leading preventable cause of premature death, contributing to cancers, heart disease, stroke , liver cirrhosis and lung disease , but quitting—even later in life—significantly extends survival.

28. Lifestyle Modification Staying socially active and mentally engaged for overall well-being .

29. Are you aware of the diseases you need regular screening for?

30. Screening of Diseases in Elderly Cardiovascular screening Blood pressure : check regularly (every visit) Lipid profile : every 5 years (more frequent if high risk) Diabetes screening : fasting glucose or HbA1c ECG if symptomatic or at high risk

31. Screening of Diseases in Elderly Cancer Screening Breast cancer : mammography (40–74 yrs , every 2 years) Colorectal cancer : colonoscopy every 5 years / Fecal Immunochemical Test annually (45–75 yrs ) Cervical cancer : Pap smear after 21 years every 3 years (stop after 65 if 3 prior negatives) Prostate cancer : individualized annually in 55-69 years age (PSA testing not routine)

32. Screening of Diseases in Elderly Bone & Cognitive Screening Osteoporosis : DEXA scan (postmenopausal women and men > 70 yrs or patients with secondary risk factors) Cognitive decline : MMSE / MoCA screening for memory & function Fall risk assessment : gait, balance, vitamin D status

33. Screening of Diseases in Elderly Other Important Screening Vision & hearing : annual checkups Vaccination review : influenza, pneumococcal, shingles, tetanus Depression screening : simple questionnaires (e.g., PHQ-2/9) Nutritional status : BMI, muscle strength (sarcopenia)

34. Test for fall

35. Test for fall

36. Which vaccines do you think are most important for elderly to receive?

37. Vaccination in Elderly Influenza Vaccine Annual (before flu season) Prevents pneumonia, hospitalization & death Pneumococcal Vaccine PCV13 (conjugate) followed by PPSV23 1 year later (polysaccharide) Protects against pneumonia, meningitis, bacteremia Herpes Zoster (Shingles) Vaccine Recombinant zoster vaccine (RZV) preferred Given at ≥50 yrs (2 doses, 2–6 months apart)

38. Vaccination in Elderly Tetanus, Diphtheria, Pertussis (Td/Tdap) Booster every 10 years Important for wound protection COVID-19 Vaccine & Boosters As per the latest national guidelines (annually during the epidemic) High priority group due to severe disease risk

39. ENVIRONMENTAL CHANGES

40. Home safety modification Grab bars near commode Non slip mats in Bathroom

41. Home safety modification Avoid crowded furniture Light with motion sensor in gallery and bathroom

42. Mobility and Accessibility Stairlifts Install handrails

43. Healthy Living Environment Cross ventilated rooms Air conditioning in hot/cold weather

44. Healthy Living Environment Quit rooms for meditation Outdoor spaces for sunlight and physical activity

45. Social and Cognitive Environment Social activity centers Smart AI assitants

46. Eyewear and Hearing Aids Hearing Aids Spectacles

47. Technology and safety aids Smart wearable alert devices CCTV for alone elderly

48. Managing Polypharmacy Pill Boxes Smart pill dispensors

49. Walking Support in Paraparesis Patients Smart wheelchairs Robotic Exoskeleton

50. Social Support Family Support Community Engagement Healthcare and Social Services Technology-Based Support

51. Financial Support Govt. Schemes and pensions ( Rashtriya Vayoshri Yojana/pension schemes) Health Insurance Subsidy and Welfare programs ( Subsidised medicine and free vaccinations) Family and community-based financial Help (NGOs and Charitable trusts) Financial Planning and legal tools (Reverse mortgage and retirement planning)

52. Key Take Home Messages Stay Active 🏃‍♂️ Eat Well 🥦 Sleep Well 😴 Stay Connected 🤝

53. Thank You