gerontology and geriatrics dr gary sinoff department of gerontology university of haifa
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Gerontology and Geriatrics Gerontology and Geriatrics
Dr Gary Sinoff
Department of Gerontology
University of Haifa
Study of the Elderly
• Focuses on aging and old age
• Individual aspects
• Social aspects
• Young discipline
“Anyone can get old. All you have to do is live long enough.”
Groucho Marx
Goals of Gerontology
• To increase our knowledge about aging and old age
• To improve the quality of life in old age
Goals of Geriatric Medicine
• Maximize the positive aspects of aging.
• The compression of morbidity.
• Delaying the onset of chronic disease and maximizing function.
Definitions
DEFINITION OF AGING
A PROCESS OF IRREVERSIBLE ACCUMULATION OF DELETIRIOUS CHANGES IN THE CELLS AND TISSUES WITH ADVANCING AGE [TIME] THAT INCREASE THE RISK OF DISEASE AND/ OR DEATH.
Aging Process
• Variable and complex
• The life span for humans is based on several factors but is seems to be limited to 120 years
• Difficult to distinguish between aging and disease
• Normal aging is an inborn or innate process
How do we define “old” today?
Young Old: 65-74 Middle Old: 75-84 Old Old: 85+
1942 1936 1923
Defining Old AgeDefining Old Age
• Chronological Age
• Biological Age
• Psychological Age
• Sociological Age
Chronological AgeChronological Age
• Commonly used indicator – 65 and over
• Limitations
- People’s functional capabilities vary
- May not capture the diversity of
people
Demographics
Changing Global Age Structure 1996
Changing Global Age Structure 2025
World and Regional Life Expectancy
0
10
20
30
40
50
60
70
80
90
1950-55 1975-80 2000-05 2025-30 2045-50
World
More Developed
Less Developed
Least Developed
Source: United Nations, 2001Source: United Nations, 2001
20 yrs increase in past 50
World Population Dynamics
TOP TENTOP TEN
Regional Distribution of Population aged > 60 in millions
0
100
200
300
400
500
600
700
Oceania NorthAmerica
SouthAmerica
Africa Europe Asia
195019902025
Start Learning Chinese or Hindi
Life expectancyLife expectancy
• Average number of years you can expect to live.
• Increased largely because of reduction in early mortalityimmunization, safety, engineering, food
preservation/nutrition), somewhat through medical innovation
(antibiotics and diagnostics)
Life Expectancy by Age
0
5
10
15
20
25
1960-62 1970-72 1980-82 1989-91 Year of Birth
Male 65
Male 75
Male 85
Female 65
Female 75
Female 85
The Population Explosion
Growth of World PopulationGrowth of World Population
18301830 1 billion
19301930 2 billion
thousands of years
100 years
3 billion4 billion5 billion6 billion
196019601975197519871987
19991999
30 years
15 years
12 years
12 years
The Grey Tsunami ?
R.O.M.P.
Collingwood
April 24, 2008
Dr. Carolyn Bennett M.P.
The Grey The Grey Tsunami ?Tsunami ?
Squaring of the survival curve
The Demographic Transition
Demographic Transition
Stage 1: Death rates and birth rates both high.
Stage 2: Fall in death rates, Population increases.
Stage 3. Decline in birth rate stabilizes population.
Stage 4. Birth and death rates both low, population stable.
Stage 5 (new). Higher death rates than birth rates, populations contract.
Population Pyramids for thefour demographic transition phases
Approach to Illness in the Older Patient
In older adults, the presenting problem is just the “tip of the iceberg” of a pathological process, which takes careful diagnostic assessment to uncover
GOMER
G = Get
O = Out of
M = My
E = Emergency
R= Room
וףע = ע
דרח = מח
יוןמ = המ
ליש = ש
To be old is to be sick
• Most seniors are healthy and active.
• Three quarters of the seniors report their health to be good, very good or excellent.
Most seniors live in nursing homes.
• Just 5% of males and 9% of females in NH.
• Most are over 85 years of age.
• Decline of percentage since 1970’s.
Principles of Geriatrics
1. Onset of a new disease affects a previous vulnerable organ system.
2. Due to impaired physiological reserves, older patients present at an earlier stage.
3. Multiple abnormalities which can be treated and small improvements yield dramatic improvements
4. Many findings which are abnormal in young, are common in the elderly.
5. Symptoms in elderly often from multiple causes, therefore the “law of parsimony” does not apply.
6. Treatment and prevention is equally or more effective than in younger.
““O” Complex of Geriatric MedicineO” Complex of Geriatric Medicine
DON’T FORGET “FAILURE TO THRIVE”
THE “CASCADE” OF OLD AGETHE “CASCADE” OF OLD AGE
Source: World Health Statistics, 1989, 1995
Infectious Diseases Tuberculosis
Cancer Diseases of circulatory systemDiabetes
1950 1960 1970 1985 1993
5
10
15
20
25Thousands
The Epidemiological Transition:
Changing Pattern of Causes of Death
תחלואה ותמותה בתשישות
Disabilities
33.4%
52.5%
8.7%
18.7%
1.1%
9.1%
0
10
20
30
40
50
60
% with any disability % with severe disability
65+15-640-14
History and Examination
History
HISTORY
• More time consuming• Depends on senses• Cognitive state• Ignoring symptoms • Atypical symptoms• Social problems• Non-verbal communication
- smells - body language
Body Language
• Very important when a language barrier exists
• Usually at a subconscious level
• Components of body language eye contact
facial expressions
proximity
posture
gestures
The Curse of the Modern Society
• Mobile phones
All Systems BUT ALSO!!!
– Social– Living Conditions– Past experiences– Economic– Family support systems– Activities – War experiences
Sympathy or Empathy
Sympathy The act or capacity of entering into or sharing the
feelings or interests of another wherein whatever affects one similarly affects the other.
versus
Empathy The action of understanding, being aware of, being
sensitive to, and experiencing the feelings, thoughts, and experience of another.
PHYSICAL EXAMINATION
PHYSICAL EXAMINATION
• Ask permission to initiate procedures
• Need for assistive devices
• Respect the patient’s beliefs
• Allow ample time and area of privacy
GERIATRIC EXAMINATION
• What components are often missed in routine exams?– Visual Impairment– Hearing Deficit– Malnutrition– Cognitive Impairment– Depression– Mobility– Urinary Incontinence– Physical Disabilities
Remember
...‘the elderly patient is admitted to hospital not because of social problems but because of medical problems with social consequences or social problems with medical consequences’
(Isaacs, 1992)
Time and Money
• TIME: Average length of time spent on care giving was about eight years, with about one-third of the respondents providing care for 10 or more years.
• MONEY: Almost all respondents reported helping the care recipient with some expenses, most frequently with food, transportation, or medications.
American Society on Aging, 2000
The vast majority of long-term care is provided informally and privately, at
no public cost.
Caregiver for Elderly Getting to and from doctor
and other appointments.
Communicating with health care professionals.
Contacting or helping someone communicate with community service organizations.
Assisting someone to pay their bills.
Helping someone clean their home.
Assisting someone or arranging for home repairs.
Arranging for or helping someone to arrange for Meals on Wheels.
Helping arrange for home health care or hospice services.
שיעור הבא
Physiology
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