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