Community Geriatrics.

 Old age is an incurable disease 

• Geriatrics or geriatric medicine is a sub-specialty of internal medicine and family medicine that focuses on health care of elderly people.

•  It aims to promote health by preventing and treating diseases and disabilities in older adults

  Community Geriatrics.

• Caring for older patients means not only understanding their diseases and knowing who the support people are in their lives, but also creating a plan of care that includes their social, financial and personal goals.

•  There is no set age at which patients may be under the care of a  geriatric physician, a physician who specializes in the care of elderly people.

•  This decision is determined by the individual patient's needs, and the availability of a specialist.

WORLD’S DEMOGRAPHICS• Today worldwide there are 600 million

persons aged 60 and above.

• The elderly population will get double by 2025, and will reach virtually 2 billion by 2025.

• The percent age of population >65 years will be higher in developed countries but absolute number will be higher in developing countries.

Cont….

• By 2025 countries with highest % of people with >65 are expected to be:-

-Japan(28%) -Italy(27.1%) -Germany(24.6%)

• However as India and China have largest population so in 2002, greater no. of people>80 years lived in China followed by US and Indiia.

INDIAN DEMOGRAPHICS

• In India elderly population is over 82 million.

• Indian elderly population is expected to reach the mark of 177 million, almost double by the year 2025.

• A nation gets labeled as ‘aging’ when the 60+ age group in its population crosses 7%.

India has earned such distinction of graying nation with about 7.7% of older population.

Average old age population of India, 1961-2050

1961 1991 2001 20500

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150

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population

population

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General problems in old age Economic problems

Sociological changes

Spiritual changes 

1.Cardiovascular changes:Elevated blood pressureVenous stasisExertion and fatigueReduced cardiac efficiencyThickening of blood vesselsArrhythmias and murmurDilated abdominal aortaDecreased physical activity

System wise changes

2. Respiratory systemDecreased physical abilityIncreased potential for infectionsDecreased gas exchangeAspirationDecreased elasticity of alveolar sacsSkeletal changes of chestDecreased cough strengthDysphagiaCommon diseases are Asthma, bronchitis and emphysema

3. Gastrointestinal systemDifficulty in chewingDry mouthDifficulty in digesting starches and fatty foodsDecreased appetiteFeeling of fullnessMalnutritionHeart burn after mealsconstipation

NEUROLOGICAL SYSTEM

• Reduced speed in nerve conduction

• Increase confusion

• Loss of environment clues

• Reduced cerebral circulation

• Slow to respond and react

• Slow learning

Accidents •  Bones become fragile• Accidents are more common in home than 

outside• Fracture neck of femur is very common .

                    CancerThe leading cause of death of death after 40 years of age .

                        

Percentage of elderly reporting various ailments

Ailment Reported percentage

Visual impairment 88.0

Joints, muscles disorder 40.0

Neurological complaints 18.7

Cardiovascular disease 17.4

Respiratory disorder 16.1

Skin conditions 13.3

Psychiatric problems 9.0

Hearing loss 8.2

                                                   Report of commission on health in India  1997

 Various Levels of healthcare     Primordial prevention • Pre geriatric care     Primary prevention • Health education • Exercise •  Immunization- influenza, and tetanus        

Secondary prevention • Screening for hypertension, diabetes periodontal 

disease dental caries • sensory impairment medication side effects • colon-rectal cancer breast cancer, cervical cancer 

and prostatic cancer nutritionally-induced anaemia's depression, stress urinary incontinence podiatric problems fall risk 

• Annual medical check-up•  Early detection ( Universal approach, Selective 

approach) • Treatment 

     Tertiary prevention•  Rehabilitation - physical deficits cognitive deficits 

functional deficits • Caretaker support -Introduction of support necessary 

to prevent loss of autonomy . • Counselling and Welfare activities ( Sanjay Niradhar 

Yojana, Vridhashrama )•  Improving quality of life • Cultural programme • Old age club  •  Home help • Old age home

How government help old age people 

• Government announced a National Policy on older persons in January  1999.

• This policy identifies principal areas of intervention as security, healthcare, nutrition, welfare and protection of life and property.

• A national  council for older persons (NCOP) was constituted to operationalise this policy .

• 234oldage home,398 daycare centers and 40 mobile medical units are operational under this policy.

• Under  National Social Assistance Programme, old age pension is being provided to more than 4 million aged people.

• Old Age Social and Income Security  (OASIS) was launched to examine policy questions, connected with Old age income security.

• Health care is provided to the older people under Bhavishya Arogya Mediclaim and Rural Group Life insurance Schemes .

• Help Age India is the largest voluntary organization  working for the cause and care of the older people.

• Help Age India supports various programmes to make life easier for older people like

   1. Free cataract operations   2.Mobile medical units   3.Old age homes and care centers.   4.Adopt a gran  (grand parent).   5. Income generation and micro –credit.

NATIONAL PROGRAMME FOR THE HEALTH CARE                         OF THE ELDERLY                                 (NPHCE)

   NPHCE   is an articulation of the International and    national commitments of the Government as envisaged   under the UN Convention on the Rights of Persons with     Disabilities (UNCRPD), National Policy on Older Persons    (NPOP) adopted by the Government of India in 1999.

NPHCE would operate through NCD cells under the programme constituted at State and District levels

teri.level

District HospitalDaily Geriatric Clinic

Geriatric Ward (10 beds)

                CHC/PHCGeriatric Clinic on fixed days

                 Sub Centre         Home-based Care

Regional Geriatric Centres Geriatric Ward (30 beds)

National NCD cell

       District NCD

        State NCD

You do not heal old age. you protect it; you promote it; you extent it. -Sir James Sterling Ross