CARE FOR ELDERLYAND

HOUSEBOUND PATIENTSBy:

Farah Adibah Kasmin2008402312

CONTENTSDefinition of elderly…

Epidemiology of aging

Changes during process of aging and how does it occur

What is geriatrics? Giant of Geriatric?

DefinitionWHO: People who are 65 years old or more.MALAYSIA : Elderly those with the age of 60

and above

“elderly” a chronological age of 65 years old or older, 65 ->74 years old “early elderly” and those over 75 years old “late elderly.

Geriatrics & Gerontology International, Volume 6, Issue 3,pages 149–158, September 2006

Epidemiology In 2006, almost 500 million people worldwide

were 65 and older. By 2030 1 billion (1 in every 8 of the earth’s inhabitants.)

MALAYSIA

Population of Malaysian >60 years in 1995 5.9%, 2000 6.6% 2009 7.1% (2.03M)

Projected percentage of elderly in 2020 9.8%

Department of Statistics Malaysia. 2010

THE AGING PROCESS

A process of gradual and spontaneous change, resulting in maturation through childhood,

puberty, and young adulthood and then decline through middle and

late age

CHANGES OCCURING DURING AGING

Overview

Alter the older person’s response to illnessshow great variability among individualsoften impacted by genetic and long-term

lifestyle factorscommonly involve a decline in functional

reserve with reduced response to stressors.

GeneralIncrease body fat

Prone to get obesityProne to get weight bearing disease(arthritis)Higher chances to get chronic diseases

eg: Diabetes and Hypertension

Reduce total body water Risk of dehydration

Age-Associated Respiratory changesCHANGES IMPLICATIONS

Decreased respiratory muscle strength; stiffer chest wall with reduced compliance.

Diminished ciliary & macrophage activity, drier mucus membranes.

Decreased cough reflex.

Decreased efficiency of ventilatory exchange.

Decreased cough & airway ciliary action -> mucus/foreign matter clearance reduced-> Increased risk of infection and bronchospasm with airway obstruction.

Increased risk of aspiration

Age-Associated Cardiovascular ChangesCHANGES IMPLICATIONS

Arterial wall thickening and stiffening, decreased compliance.

Left ventricular and atrial hypertrophy.

Sclerosis of atrial and mitral valves.

Reduced arterial compliance Reduced β-adrenergic response Reduced baroreceptor

sensitivity Reduced SA node automaticity

Decreased exercise tolerance-> fatigue, SOB

Risk of arrhythmias

Diminished peripheral pulses, cold extremities.

Increased blood pressure

postural hypotension

Age-Associated Gastrointestinal changesCHANGES IMPLICATIONS

Decreases in strength of muscles of mastication, taste, and thirst perception.

Decreased gastric motility with delayed emptying. Atrophy of protective mucosa.

Colonic contraction less effective & impaired sensation to defecate.

Liver size and blood flow are reduced -> hepatic reserve decrease.

Risk of malabsorption, fluid/electrolyte imbalances, poor nutrition.

Gastric changes: Increased risk (GERD), maldigestion, NSAID-induced ulcers.

Constipation. Risk of fecal incontinence.

Decreased metabolism of drugs. Risk of adverse drug reactions.

Age Associated Changes in Musculoskeletal System

CHANGES IMPLICATIONSDecreased muscle mass

Decreased myosin adenosine triphosphatase activity

Deterioration and drying of joint cartilage.

Decreased bone mass and osteoblastic activity

Sarcopenia: increased risk of disability, falls, unstable gait.

Risk of osteopenia and osteoporosis.

Limited range of motion, joint instability, risk of osteoarthritis.

Muscle weakness/ muscle fatigue

Age associated changes in CNSCHANGES IMPLICATIONS

Decrease in neurons, neurotransmitters, dendrites and synapses brain atrophy

Changes in autonomic regulation -> Compromised thermoregulation.

Reduced : Brain catecholamine

synthesis Brain dopamine synthesis

Impairments general muscle strength; reflexes; nerve conduction velocity, slowed motor skills and deficits in balance and coordination.

Decreased temperature sensitivity. hypo/hyperthermia

Slowed speed of cognitive processing.

Increased risk of sleep disorders, delirium, neurodegenerative diseases.

Age associated changes in endocrine functionCHANGES IMPLICATIONS

Impaired glucose homeostasis

Reduced thyroxine clearance

Increase ADH, reduce renin and aldosterone

Reduce testosterone production

Reduce vitamin D absorption and activation osteopenia

DMThyroid dysfunctionMetabolic abnormalities

(Low Na+, high K+)impotencefracture

Age associated changes in urinary systemCHANGES IMPLICATIONS

Decreases in kidney mass, blood flow, GFR

Reduced bladder elasticity, muscle tone, capacity.

Increased post-void residual, nocturnal urine production.

In males, prostate enlargement with risk of (BPH).

Reduced renal functional reserve; risk of renal complications in illness.

Risk of nephrotoxic injury and adverse reactions from drugs.

Increased risk of urinary urgency, incontinence, UTI, nocturnal polyuria.

References:Geriatrics & Gerontology International, Volume 6Primary Care Geriatrics 5th Edition. Ham, Sloane, Warshaw,

Bernard, Flaherty. 2007. MosbyEncyclopedia of Aging And Public Health By Sana Loue, Martha

Sajatovic

Thank you