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Geriatric Medicine
From the Greek "geron" meaning "old man" + "Latreia" meaning "the treatment of disease".
The branch of medicine concerned with diagnosis, treatment, and prevention of disease in older people & problems specific to ageing.
Gerontology – study of physical and psychological changes incident to old age.
- Provide a safe 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 and ill
- Stabilize and delay progression of chronic diseases
- Prevent acute medical illnesses, early detection, and treatment
- A natural process
- Biological ageing🡨 /🡨 Chronological ageing
- Ageing = growing old: old age is not a disease but a normal and inevitable biological phenomenon
- Senescence = deterioration in vitality or biological efficiency that accompanies ageing
Healthy Ageing
- WHO defines healthy ageing as “the process of developing & maintaining the functional ability that enables wellbeing in older age”
- Functional ability is about the capabilities that enable people to be and do what they have reason to value
- A comprehensive global strategy and Action Plan on Ageing & Health has been developed by WHO
- 60 – 74 years are young old (Frisky)
- 75 – 84 years are middle old (frail)
- =/>85 years are oldest old, extremely old or infirm (Fragile)
- The magnitude: between 2015 - 2050, proportion of world’s population >60 yrs will double from 12% to 22%
- In sub-Saharan Africa, it is estimated that the population of the aged is expected to rise from 46 million in 2015 to 161 million by 2050.
- By 2030, people aged 60 years and older will outnumber children younger than 5 years.
- In 2050, 80% of older people will be living in LMIC.
- The pace of population ageing is much faster than in the past.
- 1st October – international day of older persons
- 15th June – world elder abuse day
- 2021 - 2030 the decade of Healthy Ageing as declared by the UN General Assembly
Nigeria Demographic Transition
- Population: 218,541,212
- Life expectancy: 53.07 years (M - 52.28; F - 52.68)
- Death rate in the population (2022 est): 8.7 deaths per 1000
- Fertility rate per woman: 4.62 children born
- Population of elderly: 3.3% (2022 est)
Health Issues by Gender
| Both Genders | Male | Female |
|---|---|---|
| Ocular Diseases | Benign Prostatic Hypertrophy | Menopausal Problems |
| Hearing Defects | Prostatic Cancer | Urinary Incontinence |
| Reduced Muscular Strength & Coordination | Male Sexual Dysfunction | Cancers & Other Disorders of Female Genital Tracts |
| Accidents & Injuries | Osteoporosis | |
| Nutritional Deficiencies | ||
| Dental Problems | ||
| Cardiovascular Diseases | ||
| Increase Susceptibility to Infections | ||
| Degenerative Neurological Disorders |
Health Issues of Aged People
- Physical problems due to ageing
- Problems associated with long-term illness
- Psychological problems
- Social problems
- Economic problems
Problems Due to Ageing
- Senile cataract
- Glaucoma
- Nerve deafness
- Osteoporosis (Mobility)
- Emphysema
- Failure of special senses
- Changes in mental outlook, etc.
Changes in Sensory Abilities
- Decrease in vision
- Reduction in hearing
- Reduced sense of feeling, touch, and pain perception
- Decreased ability to tolerate and differentiate hot and cold
Circulatory Changes
- Blood vessel elasticity (HBP, heart attack, and stroke)
- Irregular heartbeats (dysrhythmia)
- Weak/damaged heart muscle
Musculoskeletal System
- Significant reduction in the size and strength of muscles contributing to physical instability and falls
- Loss of bone strength and density
- Reduced range of motion
- Chewing and digestion problems
Gastric, Renal, and Hepatic Systems
- Changes in gastric and intestinal function affecting nutritional intake
- Malnutrition and constipation
- Fluid and electrolyte imbalance
- Reduced enzyme production for metabolizing medications
- Drug accumulation leading to toxic levels
Integumentary System
- Skin and associated structures lose elasticity and thickness (increased injury susceptibility)
- Decreased ability to perspire (heat-related emergencies, difficulty recognizing onset of shock)
Immune System
- Decrease in systemic and cellular immune responses
- Less obvious signs and symptoms of infections in geriatric patients compared to younger patients
Respiratory System
- Diminished breathing capacity
- Loss of muscle strength and endurance (reduced cough and throat clearing ability)
- Higher rate of infection: pneumonia, influenza
- Decreased flexibility of chest wall
- Reduced ability to take deep breaths
- Risk of hypoxia or CO2 build-up leading to confusion and weakness
Problems Associated with Long-Term Illness
- Degenerative diseases of heart and blood vessels
- Cancer
- Accidents
- Diabetes
- Diseases of locomotor system
- Respiratory illnesses
- Genito-urinary system disorders, etc.
Psychological Problems
- Mental changes
- Impaired memory
- Depression
- Delirium
- Sexual adjustment
- Emotional disorders
- Social maladjustment
- Inner withdrawal
- Elder abuse
- Loneliness, boredom, grief, and worrying about the future (separation of children after marriage)
- Death of spouse/siblings or close relatives
Social Problems
- Loneliness and social isolation
- Rapid disintegration of joint family
- Changes in social contact due to retirement
- Diminished participation in social & cultural activities like marriages, ceremonies, visiting mosques/churches, etc.
- Diminished role in the family & community
- All of these lead to stress which in turn contributes to illness
Economic Problems
- More common in women than men
- Retirement of people employed in government services, local bodies, public sector, and private organizations
- Self-employed individuals like agriculturists, businessmen, daily wage earners who cannot earn their livelihood due to disease and disability, etc.
- Independence
- Participation
- Care
- Self-fulfillment
- Dignity
- Instability
- Inanition (malnutrition)
- Intellectual impairment
- Impoverishment (earnings)
- Incontinence
- Incoherence (delirium)
- Insulin resistance (DM)
- Immobility
- Lifestyle and healthy ageing
- Diet and nutrition
- Exercise
- Weight control
- Smoking cessation
- Moderate alcohol consumption
- Social activities
Preventive and Community Geriatrics (Geriatric Health Care Principles)
- Individuals become more and more heterogeneous/dissimilar as they age
- Ageing doesn’t produce an abrupt decline in organ function but disease always does
- Ageing process is accentuated by disease and attenuated by modification of risk factors e.g., smoking, sedentary lifestyle, and obesity
- Investigation is an essential tool for diagnosis but under/over investigations are to be avoided
Levels of Prevention
- Primordial
- Primary
- Secondary
- Tertiary
- Quaternary
Primordial Prevention
- Health education
- Explaining the biological changes in ageing
- Personal hygiene
- Regarding smoking, alcohol, and related diseases
- Information on communicable diseases and non-communicable diseases specific to old age
- Availability and utility of health services
- Over-the-counter drugs
- Use of aids like visual, auditory, walking aids, etc.
- Information regarding elderly abuse
Primary Prevention
- Nutritional intervention
- Principles of balanced diet
- Food safety
- Food that improves bowel movement
- Lifestyle and behavioral changes
- Physical exercises: walking, indoor games
- Personal habits: alcohol, smoking, and tobacco chewing
- Environmental modification
- Clean housing conditions
- Fresh air, light, and ventilation
- Disposal of waste and human excreta
- Vector control
- Prevention of accidents
- Slip-resistant flooring
- Smooth pathways
- Handrails in bathrooms
- Stair-landing at short intervals
- Contrasting colors and adequate lighting
- Immunization
- Avoidance of injuries and falls
- Vitamin D, Calcium supplementation
- Food rich in antioxidants: to protect against cancer and degenerative disorders
Secondary Prevention
- Early recognition of communicable diseases and non-communicable diseases, proper treatment, patient compliance, and self-care
- Provision of free medical care
Tertiary Prevention
- All measures available to reduce or limit impairments and disabilities, and minimize suffering caused by disability
- Rehabilitation of elderly people with chronic diseases and care for terminal illness
- Rehabilitation – medical, vocational, social, and psychosocial
- Re-settlement, restoration of patient to his/her own environment
- Global Approach
- For healthy and active ageing, there is a need to focus on action across numerous sectors and aiding elderly people to contribute effectively not only to their families but also to communities and economies.
- The World Health Assembly adopted the “Global Strategy and Action Plan for Ageing and Health” (GSAP) in 2016.
- The objective of this strategy is to provide a framework to achieve healthy ageing for all.
- From 2020 to 2030, the World Health Organization (WHO) has declared the decade as the Decade of the Elderly.
- February 10, 2021: The Federal Government of Nigeria approves the National Policy on Ageing for older persons in Nigeria.
- This policy requires that state parties protect the rights of older people, including by preventing discrimination against them, guaranteeing their access to healthcare, social protection and support, and ensuring that they are among those prioritized in any humanitarian emergencies.
- The National Senior Citizens Centre is a corporate entity established by the National Senior Citizens Centre Act 2017, under the purview of the Federal Ministry of Humanitarian Affairs and Poverty Alleviation with the mandate to identify the needs of senior citizens in Nigeria.
- Family members play a significant role in care for elders.
- Family: Providing up to 90% of home care.
- No institutionalized center approved yet in Nigeria.
- Those aged 65 years and above make up 3.1 - 3.3% or approximately 6 million of the total population of 214.5 million.
- Breakdown of family structure and absence of social security system.
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