Gerontology and Geriatrics

1. Gerontology and Geriatrics Dr Gary Sinoff Department of Gerontology University of Haifa

2. Study of the Elderly • Focuses on aging and old age • Individual aspects • Social aspects • Young discipline

3. “Anyone can get old. All you have to do is live long enough.” Groucho Marx

4. Goals of Gerontology • To increase our knowledge about aging and old age • To improve the quality of life in old age

5. Goals of Geriatric Medicine • Maximize the positive aspects of aging. • The compression of morbidity. • Delaying the onset of chronic disease and maximizing function.

6. Definitions

7. 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.

8. 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

9. How do we define “old” today? Young Old: 65-74 Middle Old: 75-84 Old Old: 85+ 1942 1936 1923

10. Defining Old Age • Chronological Age • Biological Age • Psychological Age • Sociological Age

11. Chronological Age • Commonly used indicator – 65 and over • Limitations - People’s functional capabilities vary - May not capture the diversity of people

12. Demographics

13. Changing Global Age Structure 1996

14. Changing Global Age Structure 2025

15. 20 yrs increase in past 50 World and Regional Life Expectancy Source: United Nations, 2001

16. World Population Dynamics

17. TOP TEN

18. Regional Distribution of Population aged > 60 in millions Start Learning Chinese or Hindi

19. Life expectancy • Average number of years you can expect to live. • Increased largely because of reduction in early mortality • immunization, safety, engineering, food preservation/nutrition), • somewhat through medical innovation (antibiotics and diagnostics)

21. The Population Explosion

22. Growth of World Population 1830 1 billion thousands of years 1930 2 billion 100 years 1960 3 billion 30 years 1975 4 billion 15 years 1987 5 billion 12 years 1999 6 billion 12 years

23. The Grey Tsunami ? The Grey Tsunami ? R.O.M.P. Collingwood April 24, 2008 Dr. Carolyn Bennett M.P.

25. Squaring of the survival curve

26. The Demographic Transition

27. 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.

28. Population Pyramids for thefour demographic transition phases

29. 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

30. G = Get O = Out of M = My E = Emergency R= Room ע = עוף ח = מחדר מ = המיון ש = שלי GOMER

31. 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.

32. 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.

33. Principles of Geriatrics • Onset of a new disease affects a previous vulnerable organ system. • Due to impaired physiological reserves, older patients present at an earlier stage. • Multiple abnormalities which can be treated and small improvements yield dramatic improvements • Many findings which are abnormal in young, are common in the elderly. • Symptoms in elderly often from multiple causes, therefore the “law of parsimony” does not apply. • Treatment and prevention is equally or more effective than in younger.

34. “O” Complex of Geriatric Medicine DON’T FORGET “FAILURE TO THRIVE”

35. THE “CASCADE” OF OLD AGE

36. 25 T h o u s a n d s 20 15 10 5 1950 1960 1970 1985 1993 The Epidemiological Transition: Changing Pattern of Causes of Death Infectious Diseases Tuberculosis Diabetes Diseases of circulatory system Cancer Source: World Health Statistics, 1989, 1995

37. תחלואה ותמותה בתשישות

38. Disabilities

40. History and Examination

41. History

42. HISTORY • More time consuming • Depends on senses • Cognitive state • Ignoring symptoms • Atypical symptoms • Social problems • Non-verbal communication - smells - body language

43. 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

44. The Curse of the Modern Society • Mobile phones

45. All Systems BUT ALSO!!! • Social • Living Conditions • Past experiences • Economic • Family support systems • Activities • War experiences

46. 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.

47. PHYSICAL EXAMINATION

48. PHYSICAL EXAMINATION • Ask permission to initiate procedures • Need for assistive devices • Respect the patient’s beliefs • Allow ample time and area of privacy

49. GERIATRIC EXAMINATION • What components are often missed in routine exams? • Visual Impairment • Hearing Deficit • Malnutrition • Cognitive Impairment • Depression • Mobility • Urinary Incontinence • Physical Disabilities

50. 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)