Share your screen. Okay, so very good evening to everyone and I welcome you all again to the second session of our certification for the pediatric care specialist. and today we'll be discussing about geriatric syndromes okay so when we were talking about assessments of the pediatric yesterday i told you it is not a disease but then we are saying that it's a syndrome so does that imply that i am contradicting my own statement i'll say no okay now why we are calling geratrix as a syndrome because It is not a disease.
It is a group of things you can say or a group of instances or a group of problems that an elderly person will be facing in his or her life, which can accumulate to make the life of that particular person very hard. The patient or the subject will not be able to perform it in a proper way. manner okay just a minute okay so that's why we are calling this as a syndrome because it is a amalgamation it's a clubbing of multiple problem that the person is facing So we'll be discussing about what all problems that a geriatric patient may face in his or her life.
So again, the topics that we'll be covering will be introduction, geriatric health problems, primordial, primary and secondary preventions, mentorship preventions, and we'll discuss a bit about the rehabilitation and the national programs which are present for the elderlies, which we can educate them to. have a knowledge about and connect with the government as well for getting the benefits so as one of my very um you can say mentor one of my very good teacher one of my mentors he used to say as a physio we could uh we add life to the ears of the person who are loving so good health adds life to the ear always believe in this okay as a person who is living a healthy life no matter how long he lives if he's living a healthy life he'll always be feeling fulfilled that okay now i'm good enough i have to i don't have any kind of problems and i'm much more relaxed as compared to a person who is on bed or having many other difficulties in performing adls or not keeping their health in a very good shape so as compared to that a person with a good health maybe a shorter lifespan might be having a better view towards the life or a positive attitude so always make sure that as a physio we had life to the years not years to the life okay the aging in of the world's population is an integrator of improving global health for older people which are valuable resource for their societies and should be filled value okay so now as i told you yesterday india is a younger country now and there is a young country now but in next 25 to 30 years which are coming india will be old so i'm not talking only about india today but we are talking about the world as a cumulative aspect and we can say that it is an indicator now because the world population is aging quite rapidly so it's an indicator that we need to improve our global health Or we have to step up our game in the healthcare sector, especially for the older people, which are a valuable resource for the society. And they should be felt like they should feel always more valued.
They should be given more value and they should be taken care of in a better way. So we need to gear up now because we are going into that particular situation that our elders are not getting that much care, which is required for them. Is that clear? Yes, sir. Yes, sir.
So again, terminologies, if we check is aging is an age dependent or age progressive decline in the intrinsic physiological function, leading to an increase in the age specific mortality and decrease in the age specific reproductive range. So what is aging? Aging is an age dependent or age progressive decline in the intrinsic physiological functions. which leads to an age specific mortality and decrease in the age specific reproductive rate. So neither the elder will be able to reproduce that frequently or at all.
And the mortality of that person as the age advances, the mortality rate for the people will keep on increasing as the age will be advancing. Okay, so as the age gets advancing the Mortality rate will increase and the chances of death will be more by even smaller healthcare episodes or smaller instances of infections or any other kind of injuries. Coming to active aging, it's the process of optimizing opportunity for health participation and security in order to enhance the quality of life as people age.
Okay, so as physio... We need to be taking care of the active aging. We have to make sure that the aging process is not deteriorating. We have to make sure that the aging process is actually active.
Okay. So by active means the aging process is not making the people slow down or sit down or make them crammed up into their holes and like dependent on others. We have to make them more active.
so that their aging is more productive and more happy as compared to the others who are not working that well. Okay then gerontology is the study of the physical and the psychological changes which are incident into the old age and geriatrics and or clinical gerontology is the care of age preventive geriatrics the art and science of preventing disease in the geriatric population. and promoting their health and efficiency. So we fall in this particular category and now if any of you are from the research side, I would like you to take up gerontology as your topic for researchers and do more and more of the research in this particular field which will be like more beneficial for the health care of the elderly and for the future of ours also.
Okay. Coming to the geriatric population trends in India, in India the face of demographic transition, the India is currently in a phase of demographic transition as per the 2011 census. The elderly population in India is 90.75 millions and the life expectancy is 63 years for males and 66 years for females.
You can say that yes females live a longer life as compared to male but still the life expectancy of overall India this is an average. is quite low as compared to what the standards we are getting from all over the world. But still, you can see here, we are having a 90.75 million people who are elderly. And I can, what I have studied from many of the research articles and from the reports which have been published by the government, now this data has increased to more than 100 million people, from which we have around 50 million. of 50.75 million male and the rest are females.
Okay, so the geriatric population in India is on a trending phase now. Now, the transition, we are in the stage of transition. As we say, because now we are saying that India is a young country right now, but now we only have around 20 to 25 years when India will start turning.
older okay so we need to make sure that we are ready for the health care of elderlies and ready for taking care of our elderlies for that so geriatric medicine is a branch of medical science which deals with clinical preventive medical social rehabilitative and psychological aspect of the illness in eldest elderlies and the components for geriatric medicine will be preventive geriatrics geriatric syndromes psychogeriatrics medicine and surgery in old age geriatric rehabilitation geriatric pharmacology and geriatric healthcare services these are the some of the branches which are there in the geriatric medicine and we are a very integral part of the geriatric medicine as a part of the genetic rehabilitation. The goal is to keep the aged person independent and the aim is to maintain the health and the maximum independence by early detection and appropriate treatment of the diseases and the sympathetic care and support during the terminal illness. Okay so one the main goal for the geriatric medicine is see we cannot reverse the aging. We have to accept this and we have to make our patient also understand that we cannot reverse the aging process.
But what we can do, we can maintain the health and maximize the independence. Now, how we can do that? We can do it by early detection and appropriate treatments of the diseases. So, we have to make the society aware about the disease. benefits of regular health checkups, going for exercises, going for social meetings and discussing everything so that we can always have an early detection of the symptoms, which can be applicable for multiple diseases like cancer or any other problems and appropriate treatment of those diseases in a very acute stage only so that the recovery or the rehabilitation is much more easier as compared to a person who's there in the chronic stage.
Okay. And the second population that we be catering to is a sympathetic care and support to the people who are there in their terminal illness. We are, we cannot control the people like they should come to us only in the acute phase and we'll treat them only in the acute phase. But if a person of a chronic condition also comes to us, and we know that the patient is in his or her terminal phase. So we need to provide them a sympathetic care and a proper support during their terminal illness so that the limited amount of time that they are having, they are extracting the best out of it.
Is that clear to everyone? Yes, sir. Any doubts till now?
No, sir. Now coming to the risk of diseases in elderly. An older person will be susceptible to multiple illness.
So they can be prone to more infections, more prone to injuries, prone to psychological problems, prone to degenerative disorders, increased risk of diseases, increased risk of disability and increased risk of death. OK, so as the person is aging, the immune system is going down. So they are more prone for infections. The chances of fall in the people. Our elderlies are quite high.
I already told you yesterday about the fall prevention scales and about the birth balance scale. We need to assess it and we need to address the fear of fall in the patients. So the patient might be prone for more injuries because they are more prone for falls, more prone for fractures or more prone for...
delayed healing because of aging okay they will be prone for psychological upon see the biggest problems that an elderly will be facing is a psychological problem we discussed this yesterday also that once a person is retired i'm just talking about one day after the retirement it creates a lot of psychological pressure onto the subject till yesterday or till few hours back I was working, I was independent. Now I am getting only 30 or 40% of the money which I used to earn. And now I am bounded to my home, I have to be dependent. Now what will I do? So all these kind of negative thoughts will come into their mind.
And sometimes due to some mishap or you can just say this is the luck or something else. They are subjected to disability or they are subjected to a loss of very near and dear one. So again, this creates a void in their life because they are at a stage where they need a partner or they need a person who has been there for their whole life.
And if suddenly that particular person is not there, especially when they are at their weakest. this will create a psychological problem. They are prone for degenerative disorders.
Everyone is very, you can say, very familiar with this thing that the patients will be having osteoarthritis of knee, osteoarthritis of hip, problems with degenerative changes of spine, then degenerative changes in the brain, spinal cord, muscular atrophy and whatnot. All these things will cater to their musculoskeletal problems. They will be having an increased risk of disease because they are more prone for infections and the immune system is not working properly.
there will be an increased risk of disability. I told you because they are if they are having a more instance of fall they might be given some walker or an assistive device or they might be confined to a place or confined to a wheelchair. So they might be disabled for the rest of their part of their life. So creates a very big problem and then there is an increased risk of death because sometimes if the patient is having diabetes or having any other kind of disorders and the person is subjected to a stroke or a bleeding or an injury that might result in death of the patient has to so there is a lot of risk associated with elderly we need to understand that is that clear yes so health problems of the ages so we need to classify the health problems which are on the basis of due to the aging process, the problems that are associated with long-term illness and the psychological problem. So we need to address when we are assessing the patient, we need to classify our diagnosis or we need to divide the health problems as per the following basis as per the aging process, the problems associated with the long-term illness and the psychological problem and we need to address them differently for assessing the or treating the patient.
So problems due to aging process will be senile cataract, glaucoma, nerve deafness, osteoporosis, emphysema, failure of the special senses, changes in the mental outlook. All these things are because of the deterioration, which is happening in the patients because of the aging process. Okay.
Senile cataract, right? Cataract, which is happening because of the aging process and glaucoma, nerve deafness. Everyone is very familiar with all these terms.
Problem associated with the long-term illness are the degenerative diseases, cancer, accident, diabetes, disease of the locomotor system, respiratory illness and genitourinary system. All these problems are actually associated with long-term illness. A person will be diagnosed with diabetes. Nowadays, I have seen the trend in Indian population that according to some research articles, the mean age for...
getting a cardiac arrest or cardiac problem has reduced to minimum of 35 to 40 years the earliest a person can develop a cardiac problem is 35 to 40 years diabetes can be diagnosed in a age group of around 30 to 40 years cancer for cancer patients we are getting patients who are of around age group around 40 to 45 years okay So all these patients who are having these kind of diseases, which are a long running diseases, can have its impact on their aging process or on their life when actually they enter the pediatric population when they are 60 years or less. Is that clear? Is that clear?
Yes, sir. So in the image also, you can see. All the problems that an elderly can face, especially with the long-term illnesses. Okay.
Coming to the psychological problem. Mental changes. Impaired memory.
Rigidity of outlook. Dislike of change are some of them. Then there is a sexual adjustment and emotional disorder with social maladjustment lead to bitterness, inner withdrawal, depression, weariness of life and even suicide.
So mental changes. patients or the subjects who are falling into the geriatric category will complain of having an impaired memory. They will not be able to recognize or remember multiple number of things or take out the multiple number of tasks or do a multitasking procedure because of the impaired memory.
They will be having a rigid outlook. One of you asked me a question yesterday that a patient is coming to her clinic and they wanted to do some... resistant exercises or exercises with weights only and so what is that they are having a rigid outlook they are rigid to what they want Okay, so it's like dealing with a stubborn baby.
Just a minute. Hold on. Am I audible? Yes, sir.
Yes, sir. Right now you are audible. Yeah, actually, there is a power cut in my area.
So I guess that's why I asked. No, sir, everything is fine. Fine, fine.
Then coming to the sexual adjustments, okay? Then coming to the sexual adjustments, as I told you, when the person is elderly and he or she is having a normal life, but during this elderly phase, they are also feeling a decreased sense of libido, okay? Now the sexual activities will be reduced because of the changes in the hormones in females.
Then there are changes in the hormones of males. So there will be a menopause in females and also there is a menopause in males. There will be cyclic differences and there will be some detachments also.
Okay, so all these sexual adjustments needs to be taken care of. And as I told you earlier also, once a person... faces loss of a loved near one okay sexual adjustment is not only about sex okay it is also about that physical need or that care that okay that a person has mentally because it is a psychological problem that yes i have someone with me whether he or she is there you for taking care of me at least i have a piece for that but if a person faces a problem in that particular sense by loss of that particular person that creates a void and creates a very big psychological problem in the people's life i've seen that in my patients as well then emotional disorders with social maladjustments leading to bitterness people actually are not very easily adjustable okay now because they have been aged for so long now that flexibility is weird often they're not very easily adjustable see they have a different kind of outlook towards the life or the society what an younger person will be having they have a different kind of lifestyle they might be having a lifestyle where they need to get home by 10 and sleep maximum by 10 30 or 11 On the other hand, if you look at a lifestyle of a young person, they might start living their life after 11. They go for a party or they have dinner at 12, watch a movie till 2 and then sleep and then get up at 8 or 9. On the other hand, the elderlies are getting up at 4 or 5 of the morning.
So for them, this adjustment is very tough. may lead to bitterness and inner withdrawal because if nobody is listening to them nobody is trying to understand their problem what will happen they will withdraw themselves they will withdraw themselves from everyone so that nobody is able to find them or they are not getting hurt or they are not getting that bitterness or guilt feeling them now this withdrawal will lead to depression a weariness in life And these depression and weariness in life or a question about the life or self, a self-doubt will lead to suicide. So is that clear how emotional disorders are catching up slowly, slowly, slowly and getting into a bigger picture? Is this clear for everyone? Yes.
Yes, sir. So after this we have cardiovascular diseases. So there are five types of heart diseases among the elderlies.
They have hypertension, atherosclerosis, congestive heart failure, cardiomyopathies and stroke. So again you can see in the image coronary artery disease, heart valve disease, heart failure, heart rhythm problems or cardiac arrest and this we will be discussing more in when you will be studying about the cardiovascular rehabilitation with the in the elderlies. So these are the problems that an elderly will face in the cardiovascular condition. Hypertension, what is hypertension? It is a transitory or sustained elevation of the systemic arterial blood pressure of more than 140 by 90 mmHg and likely to induce a cardiovascular damage or another adverse consequence like stroke or hemorrhage or any other thing like that.
Now for the grading, a person who is having a range of 140 140 to 159 by 90 to 99 mmHg of blood pressure will be categorized as mild hypertensive. A person with 160 to 179 by 100 to 109 mmHg will be having a moderate hypertension. And a CV will be having more than 180 by more than 110 mmHg of the reading.
For us, for... getting classified as a severe case of hypertension. Long-term non-treated hypertension can cause damage to vital organs and result in stroke and etc. Okay, so everyone of you know that hypertension is one of the leading cause of other comorbid diseases. It can act as a precursor to other comorbid diseases which can lead to permanent disabilities in children.
Is that clear? Yes, sir. Locomotive and movement disorders? the musculoskeletal disorders, the majorly that a person which will be facing in an elderly will be osteoarthritis, rheumatoid arthritis, cow fibrositis or myositis. All these things are actually very common in elderly population and they will be suffering from any one of those or multiple of these problems when they visit you or they visit any of the healthcare provider for their treatment.
Osteoarthritis, you know, it's a leading cause of chronic disability in elderly. With age less than 45 years, we have 2% of the cases. Women of age 45 to 64 years, we have 30% of the cases which report with OA.
And women with 65 to years plus age have 68% of the cases having OA. Okay. So the incidence is more you can see from in the age group of 45 to 65, you have around 98% of the population which falls in this particular category, which are having OA.
Hip OA is more common in men and knee OA is more common in women. Obesity is a risk factor for knee and hand osteoarthritis. So obesity is again a risk factor for knee and hand osteoarthritis.
Obesity and diabetes can lead to these. particular type of disorders. Cancer, the danger of cancer looms large past midlife and in elderly cancer is a leading cause.
Sir, sorry to disrupt. Could you please switch on to the previous slide? It's going a little fast, sir.
It's difficult to jot down everything. Okay. So is that, is this fine?
Just one second. Yes. Thank you. Am I still going fast?
Not exactly, but no. Done, done, sir. Thank you. Coming to cancer, in elderly, the cancer is a leading cause of death. The incidence rises rapidly after the age of 40. In men, the cancer of the prostate is common after the age of 65. And in women...
It is the breast cancer, which is the most common. Okay. So you need to understand.
I just now I told you I've read the articles. Now this main age, I have not updated in this because I have to show you the article for this because now the mean age is actually getting down. The incidence is rising after 40, but now the incidence is for 35 to 40 years.
The patient can get cancer for this thing. And even. if the incidences rise after the age of 40, it is alarming because it is also we have around 20 years more to go for the patient 20 or 25 years more to go to classify as a geriatric patient.
And if the incidence is rising after 40 years, then we have a lot of time in which the disease can develop and can cause a long term illness, which can cause a lot of problems for our geriatric population. coming future is that clear yes Coming to the prostate cancer risk factors, the risk increases with age, but 25% of the diagnosis are made under 65 years of age. So again, here you can see that the 25%, one fourth of the diagnosis for prostate cancer is actually made under the age of 65. Family history of prostate cancer is very important.
That's why during the assessment, we need to listen to the patient very carefully and ask the questions. How come this is happening to you? What is your family history?
What was the other histories? Men with the family history of two or three folds have two or three folds increase in the risk of prostate cancer. A person where the family is having a risk have a history of prostate cancer. The risk for the person or a male will increase two to three times if they present with a history of prostate cancer.
the diet a diet high in saturated animal fat can double the risk of developing the prostate cancer. So we can say that the people who are having more of saturated animal fat can be at a double risk of having prostate cancer. So now this can be because of excessive like the animal fat is actually very hard to digest and because of the digestion process they release some kind of cytotoxins which can be toxic for the cells and they can again cause cancer and people who are eating more of the non-veg they are at a double risk of developing a prostate cancer is that clear for everyone yes sir coming to the breast cancer the age is 80 percent of the all-female breast cancer occurrence is among the women age 50 or plus now this incidence or these instances are also reduced now.
Now we ask the females to start checking their body for initial lumps or signs and symptoms of breast cancer starting from the age of 30 years because the menopausal changes or the hormonal changes are happening very rapidly in females nowadays and the most common disease that around I guess 80% of the females are reporting now are PCODs. the polycystic ovarian syndrome or the disease. Now this polycystic ovarian disease is causing a lot of problem in the hormone secretion which is causing hormonal imbalances and the instance of getting the cancer is getting more and more involved into this. There is a role of genetics also in the breast cancer, obesity, alcohol consumption, estrogen therapy and radiation exposures which can lead to breast cancer. Now this estrogen therapy is sometimes it is used in the PCOD treatments as well or any other kind of hormone replacement therapies.
So yes this can also be taken out. Diabetes it's a long-term illness due to the faulty carbohydrate metabolism. It's a leading cause of death as the population grows older. About 75% of the diabetics are over 50 years of age.
Now this is a disease. in which the Indians are on top of the world. India is known as the diabetic capital of the world because majority of our population is having diabetes type 2. Okay, and what is that? We just have a faulty carbohydrate mechanism.
Now, this faulty carbohydrate mechanism actually continues to grow or continues to incline and starts deteriorating. the person's body from inside and starts to hampering in their normal physiological functions like clotting or injury repair or filtration of the blood in the kidneys or formulation of hormones or in fact the simplest thing flowing of the blood a person with diabetes and uncontrolled diabetes will be having thicker blood as compared to a person who is not having diabetes and a thicker blood will lead to the person having a sluggish blood flow which can lead to thrombosormation or hypertension or any other problems okay is that clear yes sir yes so in this image also you can see that the doctor is saying that the you are a free diabetes. I can't help you unless you decide to eat less sugar or more sugar.
Okay, so we have to make sure we educate our population so that It's their choice because it's a lifestyle disorder type. It is a lifestyle disorder. It's a purely lifestyle disorder. Okay. So it is the choice of the person whether they want to benefit from the healthcare or not.
If they want, they have to decide to eat either low sugar or if they can't control, they can go for a high sugar. Then only we can help them. If they want to eat less sugar, we can help them in a different way. They want to eat more sugar. Then we have to treat them in a different way.
We have to give them external insulin. We have to give them other supports. But did they want to leave sugar?
We can easily manage it through exercises or diet modification or other things like that. Is that clear? Yes, sir. Coming to psychological disorders, the person will be subjected to depression, maniac depressive psychosis.
Alzheimer's disease and Parkinson's disorder. These all see Parkinson's is a neurological disorder but I have classified it here in the psychological disorder. Why? Because it will create a case of delirium also in the patient.
The patient will not be able to do much of the advanced movements or advanced decision making which will make the psychological aspect hampered in this particular case. That's why we always check for an MMSC in Parkinson's case, mini mental state examination, which I told you yesterday. It is very effective in Parkinson's case because we need to understand about the psychology of the patient, which actually plays an important role in the management of Parkinson's through rehabilitation. So what are the risk factors that a person can be having for this psychological issues? a social isolation, widowed, divorced or separated, low socioeconomic status, poor morbid medical conditions, uncontrolled pain, insomnia, functional limitation and cognitive impairment.
All these things are cumulatively functioning for impacting the psychological health of the person. A social isolation. I don't know how many of you have grandparents and if they are living in their own house, they might be having a society which they have formed for so many, such a long time.
Okay. And if you want to take them out of that particular society and you ask them to come and stay with you for a longer period of time, they will stay with you for a shorter period. But after some time, they start becoming uncomfortable. because it's not their society. They cannot gel up with that particular society and they will end up in having a social isolation.
And sometimes it also happens, I have seen in many old age homes that when they have certain expectations from their children, but when the children are not ready or not able to take care of their parents, they actually ship them to old age home. And there it... comes to them as a shock, comes to them as a social shock because they expected that their children will take care of them and now they have been socially isolated.
They don't have friends to talk with, they don't have relatives, they don't go out anywhere so it will cause a social isolation. Okay, the second point widowed, divorced or separated. Now this is the point which I have been emphasizing a lot today because I have seen patients, they remember their partner quite a lot once they face their loss, okay, be it male or female.
But I will say, I have seen males do miss their partners a lot because of that innate nature, the females are more caring and the males are more cared about, okay. So, be it in any case. The female will be always caring about the male, be it mother, be it a daughter, be it wife. The females are always caring for their male counterparts. So when they are withdrawn from that particular feeling, now they know this will not happen.
That is a big blow to them. especially for the males. That's why I'm more emphasizing on to this.
A lower socioeconomic status, yes, creates a very big problem. Because as I told you, the person was socially independent, socioeconomically independent at some point. They were earning quite a lot.
But now whatever they are earning is not getting enough because they are spending more on their health care expenditures or they have expended on something else or some other things are coming up and they have to churn out money for that. So that socioeconomic status, because it is getting down now. So they are living in a hand-to-mouth situation, which sometimes can create a depressive situation for the client. So comorbid medical conditions like, as I told you, diabetes is there or any other conditions like cancer or a heart surgery or a fracture will cause a patient to think more and more because they are more limited to the bed.
So they will think more and more about the problems. And how they are like a burden onto the family which will create a depressive environment. Uncontrolled pain.
Now the pain is one of the biggest factors which causes depression or psychological problems in the patients because this is a noxious stimuli which sometimes the patients cannot cannot handle and what they will do they'll try to end that by any mean and because of that they might go suicidal also okay so for that and controlled pain we need to make sure that the patient is at rest or ease maximum time insomnia see insomnia is very easy to understand even if you not sleep for two to three days continuously your mind will be tired and once your mind is tired you will start hallucinating, you will start having delirium, you will start having confused state and the patient might be going for more depression or having a psychological condition because of lack of that rest and that lack of serotonin which is needed for the body for your happiness. The body will be producing less of the serotonin because of the insomnia and that less serotonin will lead to depression. to the depression.
Coming to functional limitation and cognitive impairment, we have already discussed it in detail yesterday that a person when they are normal or working, they are functionally independent but once they get elderly or they get dependent on someone, it creates a lot of problem on them, on their mind that now I am dependent on someone and now I am of no use or I am good for nothing. So is that clear? What are the risk factors for the psychological aspects?
Yes. See, so from here you can make out that we are having multiple problems. We are having cartological problem, musculoskeletal problem and other problems.
But the major problem that an elderly person will be having is psychological issues. And these psychological issues will actually lead to the other issues like musculoskeletal or cardiovascular problems. Okay, so we need to address.
this very carefully. Coming to the problems like depression, it's a state of low mood and aversion to the activity that can have a negative effect on the person's thought, behavior, feeling, worldview or physical well-being. The median prevalence rate of depression among the elderly Indian population was determined to be 21.9 percent.
It is from the Annals of Saudi Medicine research was published in which 21.9 percent of the elderly adults population was going through depression it is an alarming rate or the alarming population because we can say that it is around one fifth one fourth to one fifth percent of the elderly population if i'm saying that we have around 100 million population of india is elderly and 50 percent or 50 million is male so out of those one fourth you You can you understand I'm saying one fourth one fourth will become for 50 percent will be coming to 12.5 million. OK, 12.5 million people will be having depression. It's a quite large number if you consider a population of 100 million of elderly and 1 billion for for the overall population. 12.5 billion is a quite a big problem. Coming to Alzheimer disease.
a brain disorder which generally destroys the ability to reason remember imagine and learn it's a diff it's different from mild forgetfulness normally observed in the older population the prevalence of alzheimer is 33 cases out of thousand population okay in india it is 33 uh patients of alzheimer's are seen in thousand uh population of elderlies okay this is different from the mild forgetfulness that generally the elderlies have in their lifestyle okay sometimes they say okay i forgot this sometimes they put their glasses on their head and go around in the house looking for their glasses and they forget this is not alzheimer's alzheimer's is when they usually destroy the ability to reason remember imagine and learn the there is a problem with the brain functionality at that particular time this is next alzheimer's disease is that clear depression and alzheimer's everyone is clear with this yes coming to parkinsonism everyone is familiar with the parkinsonism it's a syndrome atypical parkinson's or secondary parkinson's a neurological syndrome characterized by tremor hypokinesia rigidity and postural instability with a prevalence of 150 to 300 patients per one one lakh population which is according to the modern medicare.co.in you can go to this website and check for their datas okay and these are the various symptoms that the person will be having coming to the prevention so we have primordial prevention healthy lifestyle established during the childhood will actually pay for the good good you can say elderly life or good aging okay so the practices during the adolescence of the youth age continued later in life are helpful in delaying the processes and maintaining the quality of life so usually what we say you have in the adolescence or the young age you have to abstain from any kind of smoking drinking or drugs or and involve yourself in sports or social act activities cultural activities or sports or in fact some kind of exercises and if you start to continue them for a longer period of time you will be having lesser amount of problems in your later ages okay so the goal of the primordial prevention is add life to the years and not merely years to the life okay so this is the same thing what i wanted to tell you from my mentor that add life to the years not merely the years to the life coming to the this was primordial prevention coming to primary prevention now the area is potentially amenable to primary prevention in elderly is promoting healthy aging we have to make sure that the aging process is more healthy now we have to have healthy habits social activities coronary heart disc risk factors you have to screen them And we have to prevent them. Immunization, injury prevention, osteoporosis prevention. All these things are have to be checked and have to be catered for primary prevention. Is that clear?
Yes, sir. Coming to the health habits, leaving the habits like tobacco or alcohol as a. very good instance or very good impact on the human body.
Tobacco is used in any form should be discouraged that can be done through education, legislation, controlling the production, sale or consumption of the tobacco can be done as it contributes to diseases of the lung and oral cavity, heart diseases, cancer and this is of the peripheral blood vessels. Alcohol has a very big effect on the sensitivity of the effect sensitivity. Now the sensitivity to the effect of alcohol increases with the age.
Older people have decreased ability to develop tolerance to increasing amount of alcohol. The intake should be restricted to 60 ml per day. It is linked to liver disease, stomach ulcers, gout, depression, osteoporosis, heart diseases, breast cancer, diabetes, hypertension and many more disorders. Now alcohol and tobacco.
This I have One of my research papers only in which I have stated that the people who are drinking alcohol or the people who are having a cigarette. or the people who are having both things they have a lot of change in their reaction time and the population which i was using at that particular time was young adults i was not taking care of the or i was not catering to the older adults but young adults and at that point when i saw the results for the people who were taking both alcohol and tobacco simultaneously or they were regular in their lifestyle, I saw a drastic fall in the reaction time of those particular people. Okay. And this leads to a prediction of the person having more of the chances of fall in the near future because the reaction time will be so bad that once the patients or the person starts aging and this reaction time will further go down, the person will not be able to stand or walk or do the ADS without.
having a fall. So the instance of fall will increase, the instance of injury will increase, the instance of head injuries will increase, the instance of spinal cord injuries can increase with that. Now this is one of the papers which I did so I know it very well how much impact it would have on to the body. Coming to dietary modifications, saturated and trans fatty acids should be discouraged because they can cause problems with the cardiovascular system.
Salt intake should be limited because it is associated with hypertension. Mono and polyunsaturated fatty acids should be increased to intake and the fiber and increase the intake of fiber containing food. Okay.
The mono and polyunsaturated fatty acids should be increased and the intake of fiber rich food should be increased. Macro nutrient rich food should be given. Calcium and vitamin D rich food should be given. and the patient should be advised to drink more and more of water along with the physical activities which will help to maintain good health by controlling the weight, improving emotional well-being, improving blood circulation, increasing flexibility, balance, lowering the blood pressure and blood sugar, improving bone density and promoting good sleep. Okay, so all these things are actually associated with exercise or doing a regular workout.
Okay, so this will cater to many of the problems, be it in the psychological aspect or into the musculoskeletal aspect, it will actually affect everything. Okay, here you can say that it will improve the emotional well-being. How it will improve the emotional well-being? Because when you exercise or when you work out or when you play, it will give you the release of serotonin and will keep you happy.
And this serotonin will actually be in your system for a longer period of time so that you will be feeling more happy and less depressed at that particular time. Is that clear for everyone? Yes, sir. Social activities by involving these social activities like joining various social clubs, doing various cultural activities or recreational activities. Now, this is not applicable to elderlies, I'll say only.
This is applicable to you also. Nowadays, everyone is having so much of stress. I would ask every one of you to please, please go back into your mind. Think about yourself. There will be one hobby that you used to take up in colleges.
Now you have left it. But when you used to take up in college, you might have you might must have been feeling very calm or very happy after doing that. Now, just remind yourself how.
When was the last time you did that particular activity? Like for me, I like music, but it has been more than a year that I have touched any kind of musical instrument now. Okay, I can say that very clearly.
So this is not happening. I need to take out some time to be more engaged in the social activities or the activities which I feel they are very creative or recreational and will have an impact on elevating my mood. Okay.
So a person can be having the symptoms of stress. It can be lowered very easily just by having these kind of social activities incorporated. When you are there in the hospital or when you are there in a tertiary care center, have you seen a few years back, I guess, there was a video which was viral.
Again, they were my colleagues. I was working with Dabur at that particular time. And a patient was admitted in their home and we had set up an ICU for them at their home.
And there was a caretaker, there was a nurse, there was a physio. who were there at their disposal for every time. And it was the birthday or I guess some function was there or some festival was there.
So what they did, these people put on some Punjabi music, asked everyone of the family to come in front of the patient and dance, dance their heart out. In fact, the partner of that particular female was also dancing. He was 85 years. Once she saw everyone dancing and laughing, she had that hope and she was feeling so happy. She was dancing at that particular time.
If I'll get time, I'll share that video to you. If I'll get that video, I'll share that video. It went on to become viral also. Okay.
It was shown in some of the news items also that how a happiness session can elevate the life or the lifestyle of a bedridden patient as well. Okay. Coming to immunization, immunization in the immune system function is compromised. So elderlies are more vulnerable to infections.
So what are the immunizations that a person should get when they are elderly? Influenza above 65 years of age. Every year they should get immunized. A trivalent inactivated vaccine is administered with a dose of 0.5 ml intramuscularly.
Chemoprophylaxis with... aminotidine and ramitidine can be done for the influenza viruses pneumococcal pneumonia for age of above 65 years of age or once in a lifetime you have to do it administer a dose of 0.5 ml intramuscularly or subcutaneously the tetanus elderlies need to full course of tetanus toxoid again with a booster dose every 10 years And if the patient gets injured anyhow and there is an open wound, please make sure that the person gets a booster dose every time when the person gets injured. Is this clear about the social activities and immunization? Yes, sir. Immunization.
Would you please explain in detail? Usually in Indian, I'm actually talking about Indian scenario. The people are more, you can say, more susceptible for these particular kind of diseases like influenza or pneumococcal infections or tetanus in the elderly age. Because most of the diseases, the patients usually get immunization in the pediatric age only and they are fine with it. But the elderlies are more susceptible for these particular type of infections.
Now one more infection is coming actually, which is shingles. I have not listed it here because the vaccines still people are not very aware about. But shingles is a kind of disorder or a disease which is virus infected and it is very painful.
So sometimes, especially if the elderlies get that, they are in a lot of pain and can hamper their ideas. very actively so they you can also include shingles in their immunization plans as well so there is no any immunization plan for elder date for there is no waxings no no no like a children like a children no no there is no plan like that indra dhanush yojana for children for still now it is no it is no plan but But you're all researchers, you're all clinicians. You might come up with some plan.
If you can come up with some plan, please send it to the Ministry of Health and Family Welfare. You might be lucky that they'll take up your decision and they'll introduce it to you. We can only give suggestions. See, while doing the research as accommodations or research, it's our responsibility to publish our researches and do the researches which are actually helpful for the society. Okay.
So if you can come up with some kind of plan, okay, if we are giving these kinds of immunizations to the patient, they are living a healthier life, we have some data, compile it, send it to the ministry, they might think of, and who knows, it can become a plan which was introduced for children's plan for elderlies, which will be also incorporated. Is that clear? Okay, sir. Yeah, so thank you.
So coming to injury prevention, we need to be very sure that we prevent the injuries in the elderly because prevention is always better than cure. So we have to check for the osteoporosis. You can prevent the osteoporosis, regular physical activities, calcium and vitamin D3 rich diet should be given.
So osteoporosis can be prevented. Then what else you can do if even if there is osteoporosis, what you need to do is you need to make sure the patient does not fall. So you have to install slip resistance flooring material, non-slip treads, cap in the stairs, handrails on the both side of the corridor or the staircase. staircase having contrasting colors at the beginning and the end of the stairs you can see the images here okay so this is not anti-slip flooring handrails on the staircase and this is contrasting strips now these are anti-slip also because this will create a very clear visualization and the patient which will be having a problem with the depth perception will not trip and slip from these stairs is that clear These contrasts will actually help you to prevent that depth sensation. There are changes in the depth sensation and prevent tripping of the patient.
Coming to the secondary prevention, secondary prevention will be done with the help of a geriatric team, geriatricians, nurses, physiotherapists, social workers and healthcare workers. And you need to make sure and you need to remember that. Under and over investigation should be avoided. Know the age-related variables while interpreting the results.
Non-invasive tests are performed than invasive. Polypharmacy should be avoided wherever possible. And regular review of the medication is must.
The secondary prevention is where few people actually come into the role. You have an active role. And all these people actually contribute to the... we are at routine and we always make sure that in secondary prevention we do not under or over investigate the patient okay because if we under investigate we will not be having a proper diagnosis if we will over investigate the patient might be thinking that you might be trying to loop them or the things will be impacting their psychology i am always at the doctor i am always getting some tests done so there is some problems with me okay you need to know the age-related variables while interpreting the results okay always make sure i once i was taking your lecture yesterday i told you always go with your gut feeling remember i told you go with your gut feeling if you know that something is wrong there is something wrong if you know that something is not wrong there is there might be something not wrong okay so go with your gut feeling okay and always go for the non-invasive test first as compared to the invasive test because the patient will be in pain they are just like a big baby okay so you don't want the elderly to be in pain polypharmacy should be avoided wherever possible always try and do some activities like that the patient is not subjected to multiple drugs at one given point so working in a team Always have a discussion with your teammates, the doctors, the nurses or the specialists that can we reduce some of the medicine or can we not give them multiple drugs at one particular time?
Because what happens when these drugs actually come in group to the subject, it creates a lot of problem in the mind or in the heart of the subjects. And they feel very devastated, you can say, or very. lethargic about taking the drugs it's a burden for them so we can always prevent polypharmacy and actually it will prevent you also for any kind of reaction drug reactions if happens in the elderly it can be fatal okay and regular review of the medication is quite must in these particular cases is that clear for the secondary prevention what do you need to do in secondary prevention yes yes sir you Coming to the role of the government, as I told you, Ministry of Health and Family Welfare, MOHFW is the one who is responsible for taking care of the elderlies in India.
So they have a national program for the health care for the elderly, which is NPHCE. The program is expected to result in a healthy elderly community with better physical and mental health independence. The National Program for Health Care in Elderly has emphasized the major issues of health care for the elderly.
relevant to elderly population and the need to provide specialized pediatric services at the various levels of health care. Now what is the goal for them? The goal is to is to improve the access to promote a preventive, curative and emergency health care among the elderly person.
We have to promote the health care in the elderly person. We have to promote more of the preventive health care among the elderly person. We have to promote the curative health care among the elderly person.
And we have to promote the emergency health care among the elderly person or for the betterment of the elderly person. So what will be the objectives or what are the objectives for NPH? the CE is the to provide comprehensive comprehensive health care to elderly by preventive curative and rehabilitative services train healthcare professional in geriatrics including supportive care and rehabilitation to provide referral service to the elderly patient through district hospitals regional medicine students etc okay so the objective is simple simply to improve the health care and in like what you can say You improve the education of the elderlies for assessing their healthcare rights and improve the healthcare by improving the knowledge of the healthcare providers and provide the referral services to the elderly patient through the district hospital, regional medical institutions so that everyone can have good access to the specialist, whether they are anywhere in any part of the India.
Is that clear? Yes, sir. So there are multiple other national programs which are happening for a long period of time for elderlies.
One is National Policy for Older Persons, which is on there since 1999. Old Age Social Income and Security, which is OSS. Indira Gandhi National Old Age Pension Scheme. PACE, which is Program for All-Inclusive Care of the Elderly.
These are all the national programs which are still running in our country. And you can always go on to the Ministry of Health and Family Welfare website and have a look about these programs, how they are functioning and how a person can get benefited from these programs. There are certain NGOs which are working for the betterment of aged people in India, like HelpAge India, Age Well Foundation, Aged Care India, Elder Home Society, Aged Care Centre for Retired Person, etc. So all these...
NGOs are actually working very actively in providing a better lifestyle or better life to the elderlies in India. There are some multinationals or some startups which are also working for the healthcare of elderlies. Now obviously they are working more for the money but if we say at least they are working so I have name a few like IMOA, Eldercare or I guess Nightingale and Portia also have these kind of elderly care support.
Healthcare at home is having these kind of supports at patients or subjects home. So all these companies are now coming up and they have seen that the elder care is a big market in Indian healthcare industry. So they have started taking care of the elderlies in this particular manner. So thank you. this was it for the today's session i hope you had understanding about the geriatric syndromes what all the problems a geriatric person might be facing we have seen that they are facing cardiovascular problems musculoskeletal problem neurological problem but the major issue that you need to address being a physio also because you spend most of the time around 40 45 minutes with a patient so what you need to address is the psychological issues as well as a physio or as a medical need to understand the psychology of the patient also and try to be more empathetic or more supportive towards them and help them out in those particular situations as well okay so this was from my side if you have any kind of queries you can discuss it with me now