Care for elderly

By:
Farah Adibah Kasmin
2008402312

CONTENTS
 Definition of elderly…

 Epidemiology of aging

 Changes during process of aging and how does it occur

 What is geriatrics? Giant of Geriatric?

Definition
 WHO: 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 illness
 show great variability among individuals
 often impacted by genetic and long-term
lifestyle factors
 commonly involve a decline in functional
reserve with reduced response to stressors.

General
 Increase body fat 
 Prone to get obesity
 Prone 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
changes
CHANGES IMPLICATIONS
 Decreased respiratory muscle  Decreased efficiency of
strength; stiffer chest wall ventilatory exchange.
with reduced compliance.  Decreased cough & airway
ciliary action ->
 Diminished ciliary & mucus/foreign matter
macrophage activity, drier clearance reduced->
mucus membranes. Increased risk of infection
and bronchospasm with
airway obstruction.
 Decreased cough reflex.
 Increased risk of aspiration

Age-Associated Cardiovascular
Changes
 Decreased exercise tolerance-
 Arterial wall thickening and > fatigue, SOB
stiffening, decreased
compliance.
 Risk of arrhythmias
 Left ventricular and atrial
hypertrophy.
 Sclerosis of atrial and mitral  Diminished peripheral
valves. pulses, cold extremities.
 Reduced arterial compliance
 Reduced β-adrenergic response  Increased blood pressure
 Reduced baroreceptor sensitivity
 Reduced SA node automaticity  postural hypotension

Age-Associated Gastrointestinal
changes

 Decreases in strength of muscles of
 Risk of malabsorption,
fluid/electrolyte imbalances, poor
mastication, taste, and thirst nutrition.
perception.
 Gastric changes: Increased risk
 Decreased gastric motility with (GERD), maldigestion, NSAID-
delayed emptying. Atrophy of induced ulcers.
protective mucosa.
 Constipation. Risk of fecal
incontinence.
 Colonic contraction less effective &
impaired sensation to defecate.  Decreased metabolism of drugs.
Risk of adverse drug reactions.
 Liver size and blood flow are
reduced -> hepatic reserve
decrease.

Age Associated Changes in Musculoskeletal
System
 Decreased muscle mass  Sarcopenia: increased risk of
disability, falls, unstable gait.

 Decreased myosin adenosine
 Risk of osteopenia and
triphosphatase activity osteoporosis.

 Deterioration and drying of  Limited range of motion, joint
joint cartilage. instability, risk of osteoarthritis.

 Muscle weakness/ muscle
 Decreased bone mass and
fatigue
osteoblastic activity

Age associated changes in CNS
 Impairments general muscle
strength; reflexes; nerve
 Decrease in neurons, conduction velocity, slowed motor
neurotransmitters, dendrites skills and deficits in balance and
and synapses  brain atrophy coordination.

 Changes in autonomic  Decreased temperature sensitivity.
hypo/hyperthermia
regulation -> Compromised
thermoregulation.
 Slowed speed of cognitive
processing.
 Reduced :
 Brain catecholamine synthesis  Increased risk of sleep disorders,
delirium, neurodegenerative
 Brain dopamine synthesis diseases.

Age associated changes in
endocrine function
 Impaired glucose  DM
homeostasis  Thyroid dysfunction
 Reduced thyroxine clearance  Metabolic abnormalities
 Increase ADH, reduce renin (Low Na+, high K+)
and aldosterone  impotence
 Reduce testosterone  fracture
production
 Reduce vitamin D absorption
and activation  osteopenia

Age associated changes in urinary
system
 Decreases in kidney mass, blood  Reduced renal functional
flow, GFR reserve; risk of renal
complications in illness.
 Reduced bladder elasticity,
muscle tone, capacity.  Risk of nephrotoxic injury
and adverse reactions from
 Increased post-void residual, drugs.
nocturnal urine production.
 Increased risk of urinary
 In males, prostate enlargement urgency, incontinence, UTI,
with risk of (BPH). nocturnal polyuria.

References:
 Geriatrics & Gerontology International, Volume 6
 Primary Care Geriatrics 5th Edition. Ham, Sloane, Warshaw, Bernard,
Flaherty. 2007. Mosby
 Encyclopedia of Aging And Public Health By Sana Loue, Martha
Sajatovic

 Thank you

Care for elderly

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