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Geriatric presentation

  1. The Health of The Elderly inThe Health of The Elderly in Rehabilitation For Health PromotionRehabilitation For Health Promotion and Preventive Medicineand Preventive Medicine Assoc. Prof. S.Ufuk Yurdalan, Ph.D. ,PTAssoc. Prof. S.Ufuk Yurdalan, Ph.D. ,PT 9 Eylul University,9 Eylul University, School of Physical Therapy and RehabilitationSchool of Physical Therapy and Rehabilitation İzmir-TRİzmir-TR
  2. TerminologyTerminology older , elderly , geriatric , gerontologyolder , elderly , geriatric , gerontology adult , individuals , people ..men &womenadult , individuals , people ..men &women aged over 65 & octogenariansaged over 65 & octogenarians
  3. What is geriatric ???What is geriatric ??? Geriatric is the medical branchGeriatric is the medical branch dealing with the care of the aged.dealing with the care of the aged.
  4. WhenWhen dodo we old ???we old ??? ““ Forty is the old age of youth; fifty is the youth ofForty is the old age of youth; fifty is the youth of old age.old age.““ young oldsyoung olds 65 -7465 -74 old oldsold olds 7575 -- 8484 oldest oldsoldest olds 85 +85 +
  5. DemographyDemography During the first 50 yrs of the 21st century, theDuring the first 50 yrs of the 21st century, the world population 65 and over is expectedworld population 65 and over is expected to triple.to triple. The number of people 80 yrs and older grew at anThe number of people 80 yrs and older grew at an average rate at 159% between 1960-90, and is expectedaverage rate at 159% between 1960-90, and is expected to continue growing at 70% until 2020 among countriesto continue growing at 70% until 2020 among countries belong to OECD.belong to OECD. Family Community HealthFamily Community Health Vol.26,No:4,pp.338-349,Aug 2003Vol.26,No:4,pp.338-349,Aug 2003
  6. Survival curves in humanSurvival curves in human
  7. How big is the increase in years ofHow big is the increase in years of active life?active life?
  8. WHAT IS THEWHAT IS THE ELDERLYELDERLY POPULATION IN EUROPE ???POPULATION IN EUROPE ???
  9. Population PyramidsPopulation Pyramids Asia (1995 and 2025) Latin America (1995 and 2025) Europe (1995 and 2025)
  10. WhereWhere do we meet the elderly ???do we meet the elderly ??? familyfamily elderly communitieselderly communities hospitalshospitals dispensarydispensary hospices …hospices …
  11. Who are interested in the elderly ???Who are interested in the elderly ??? Multi-professional teamMulti-professional team geriatrics, PT’s & OT’s, nursesgeriatrics, PT’s & OT’s, nurses psychologists, social workers…psychologists, social workers… families, friends, neighbors, etc.families, friends, neighbors, etc.
  12. PT - Elderly InteractionPT - Elderly Interaction GERIATRIC REHABILITATIONGERIATRIC REHABILITATION
  13. What does geriatric rehabilitation do ???What does geriatric rehabilitation do ??? ……. Focuses on restoring functional independence to older adults, in terms of. Focuses on restoring functional independence to older adults, in terms of mobility,mobility, activity of daily livingactivity of daily living (ADL’s), and quality of life (QoL).(ADL’s), and quality of life (QoL). J of Gerontological Nur.J of Gerontological Nur. Vol.27, Iss.10, pp.7,Oct 2001Vol.27, Iss.10, pp.7,Oct 2001
  14. What are the expectations ???What are the expectations ??? Small gains in function can mean large gainsSmall gains in function can mean large gains in elder patient’s QoL.in elder patient’s QoL. Disease Management and Health OutcomesDisease Management and Health Outcomes 11(6): 363-374, 200311(6): 363-374, 2003
  15. The Seneca study dietary, QoL, lifestyle, and healthydietary, QoL, lifestyle, and healthy ageing in Europe ???ageing in Europe ??? 1,091men / 1,109 women1,091men / 1,109 women aged 70 – 75 yrsaged 70 – 75 yrs Be., Fr., It., NL, Port., Sp., Switz., Pl.Be., Fr., It., NL, Port., Sp., Switz., Pl. 1988 - 19991988 - 1999
  16. Mortality riskMortality risk smokingsmoking having a low-quality diethaving a low-quality diet being physically inactivebeing physically inactive The net effect of a healthy lifestyle on the process ofThe net effect of a healthy lifestyle on the process of healthyhealthy ageingageing is likely to go together withis likely to go together with decreaseddecreased morbidity.morbidity.
  17. Healthy ageingHealthy ageing ……is provided by “health promotion”is provided by “health promotion” Age & AgeingAge & Ageing 32(4): 427 - 434, July.200332(4): 427 - 434, July.2003
  18. Public health policies are designed to create anPublic health policies are designed to create an infrastructure toinfrastructure to promote healthy ageingpromote healthy ageing andand offer support to the growing elderlyoffer support to the growing elderly population.population. Disease and Management & Health OutcomesDisease and Management & Health Outcomes 11( 5 ): 299 – 309, 200311( 5 ): 299 – 309, 2003
  19. DEFINITION OFDEFINITION OF HEALTHY / SUCCESSFULHEALTHY / SUCCESSFUL AGEINGAGEING
  20. Definition of healthy / successful ageingDefinition of healthy / successful ageing …… includes the maintenance of physical andincludes the maintenance of physical and mental function, as well as continued socialmental function, as well as continued social engagement.engagement. Health Screening and Health Promotion for ElderlyHealth Screening and Health Promotion for Elderly
  21. Succesful ageing factorsSuccesful ageing factors racerace ethnicityethnicity educationeducation economic & social resourceseconomic & social resources Disease and Management & Health OutcomesDisease and Management & Health Outcomes 11 ( 5 ) : 299 – 309, 200311 ( 5 ) : 299 – 309, 2003
  22. AGEING PROCESSAGEING PROCESS
  23. Begins before birth but the effects onlyBegins before birth but the effects only become apparent around the age of 30.become apparent around the age of 30.
  24. With ageing there is aWith ageing there is a lossloss in size andin size and functionalfunctional unitsunits within every bodily system and awithin every bodily system and a decrease in the proficiency of the remainingdecrease in the proficiency of the remaining functionsfunctions
  25. Ageing is characterized by aAgeing is characterized by a decreased abilitydecreased ability to adapt to and recover from physiologicalto adapt to and recover from physiological displacingdisplacing stimuli.stimuli.
  26. ExerciseExercise is a form of physiologicalis a form of physiological stimulationstimulation requiring complexrequiring complex interactioninteraction amongamong systemssystems..
  27. PT’sPT’s who test and prescribe exercise for middle-who test and prescribe exercise for middle- aged and older persons should be aware of theaged and older persons should be aware of the affects of aging on the various systems and onaffects of aging on the various systems and on thethe abilityability to exercise and train, as well as theto exercise and train, as well as the generalgeneral characteristicscharacteristics and specificand specific needs ofneeds of olderolder people.people.
  28. Effects of ageing on systemsEffects of ageing on systems cardiovascular systemcardiovascular system left ventricular hypertrophyleft ventricular hypertrophy limited left ventricular fillinglimited left ventricular filling decreased beta-adrenoceptor med. CV responsesdecreased beta-adrenoceptor med. CV responses cardiac dysrhytmias with exercisecardiac dysrhytmias with exercise
  29. Pulmonary systemPulmonary system decreased & impaired pulmonary functionsdecreased & impaired pulmonary functions effects of smoking , chronic illnesseseffects of smoking , chronic illnesses
  30. Musculoskeletal system/ bone massMusculoskeletal system/ bone mass gradual loss of bone massgradual loss of bone mass begins at age 30 to 35begins at age 30 to 35 -In women, it accelerates after menopause-In women, it accelerates after menopause -In men, it accelerates at age 50 to 55-In men, it accelerates at age 50 to 55 spontaneous fractures & fractures after mild traumaspontaneous fractures & fractures after mild trauma
  31. OsteoporosisOsteoporosis -Genetic factors-Genetic factors -Nutrition-Nutrition and life style factorsand life style factors -Hormonal and reproductive factors-Hormonal and reproductive factors -Medications-Medications -Comorbid factors-Comorbid factors MJA Vol.180, pp.18-22, March.2004
  32. Musculoskeletal system / muscle massMusculoskeletal system / muscle mass reduces in the number and size of fast-twitchreduces in the number and size of fast-twitch glycolglycolyytic muscle fiberstic muscle fibers diminishes muscle massdiminishes muscle mass stiffening of cartilage, tendons, and ligamentsstiffening of cartilage, tendons, and ligaments
  33. Musculoskeletal systemMusculoskeletal system Distribution of body fatDistribution of body fat More fat is deposited internally and on the torsoMore fat is deposited internally and on the torso
  34. Relation between muscle mass & bodyRelation between muscle mass & body fatfat Diminished muscle mass is masked by anDiminished muscle mass is masked by an increased amount of body fat.increased amount of body fat. LIFESTYLE !!!LIFESTYLE !!!
  35. Neurological systemNeurological system decreases in the number and size of neuronsdecreases in the number and size of neurons decreases nerve conduction velocitydecreases nerve conduction velocity decreased righting reflexesdecreased righting reflexes increased reaction timeincreased reaction time loss of ankle jerks and vibratory senseloss of ankle jerks and vibratory sense
  36. Neurological systemNeurological system increased postural swayincreased postural sway Due to changes of posture, older people’s center ofDue to changes of posture, older people’s center of gravity shifts to behind the hips.gravity shifts to behind the hips. ASSISTIVE DEVICES!!!ASSISTIVE DEVICES!!!
  37. Neurological systemNeurological system Control of the movement is:Control of the movement is: --less coordinationless coordination --more hesitantmore hesitant --require more attentionrequire more attention
  38. Elderly’s common problemsElderly’s common problems Muscle weakness, falls, fracturesMuscle weakness, falls, fractures Arthritis, foot problemsArthritis, foot problems Cardiovascular diseasesCardiovascular diseases Alzheimer, Parkinson, CVAsAlzheimer, Parkinson, CVAs PainPain CancersCancers Vision & hearing lossesVision & hearing losses Cognitive impairmentsCognitive impairments Depression disorders & dementiaDepression disorders & dementia
  39. RELEVANT RESEARCH ON THERELEVANT RESEARCH ON THE ELDERLYELDERLY
  40. Medline / Cinahl 1985 - 2002Medline / Cinahl 1985 - 2002 Muscle strengthMuscle strength should be one of the factors that isshould be one of the factors that is assessed and treated in elderly at risk for falls.assessed and treated in elderly at risk for falls. More clinical trials are needed to determine ifMore clinical trials are needed to determine if muscle strengthening exercises are affective inmuscle strengthening exercises are affective in preventingpreventing falls.falls. J of American Geriatric SocietyJ of American Geriatric Society 52 ( 7 ) :1121 – 9, July. 200452 ( 7 ) :1121 – 9, July. 2004
  41. Medline, cochrane , embasseMedline, cochrane , embasse 1991-20041991-2004 Vitamin DVitamin D supplements appears to reducesupplements appears to reduce risk ofrisk of fallsfalls among ambulatory or institutionalizedamong ambulatory or institutionalized healthy older individuals byhealthy older individuals by more than 20 %.more than 20 %. JAMAJAMA 291(16):1999 – 2006, Apr. 2004291(16):1999 – 2006, Apr. 2004
  42. Strength trainingStrength training in rehabilitation isin rehabilitation is helpfulhelpful andand safe insafe in managing physical dysfunction, weightmanaging physical dysfunction, weight control, osteoporosis, and low back paincontrol, osteoporosis, and low back pain
  43. Muscle strengthMuscle strength is reliably enhanced byis reliably enhanced by resistance exercises (once a wk) and may aidresistance exercises (once a wk) and may aid in reducingin reducing hip fracturehip fracture as well as improvingas well as improving the ability to undertake daily activities andthe ability to undertake daily activities and maintain independence.maintain independence. J of Reh Research & DevelopmentJ of Reh Research & Development Vol. 37, No: 2, pp. 245 – 254 , March/April 2000Vol. 37, No: 2, pp. 245 – 254 , March/April 2000
  44. The Epidos prospective studyThe Epidos prospective study In ambulatory elderly women the effect of fracture is stronger inIn ambulatory elderly women the effect of fracture is stronger in the first 6 months and persists for several yrs thereafter.the first 6 months and persists for several yrs thereafter. Prevention of hip fracture and improved care may contribute toPrevention of hip fracture and improved care may contribute to increase life expectancy in addition to preserving QOL.increase life expectancy in addition to preserving QOL. J of The Ame Ger SocJ of The Ame Ger Soc 52 ( 5 ) : 685 – 690, May 2004.52 ( 5 ) : 685 – 690, May 2004.
  45. FallsFalls remain a major cause of morbidity &remain a major cause of morbidity & mortality for the elderly, despite considerablemortality for the elderly, despite considerable growth in fallgrowth in fall preventionprevention programs in recentprograms in recent years.years. Health promotion consist ofHealth promotion consist of group exercisegroup exercise programs through multidisciplinary,programs through multidisciplinary, multifactor interventions for high-riskmultifactor interventions for high-risk populations.populations.
  46. Participation in a weekly group exerciseParticipation in a weekly group exercise program with moderate intensity can improveprogram with moderate intensity can improve balance and reduce falls.balance and reduce falls. Age & AgeingAge & Ageing 32 ( 4 ) : 407 - 414, July 200332 ( 4 ) : 407 - 414, July 2003
  47. Gymnastics once a week didn’t provide benefitsGymnastics once a week didn’t provide benefits in HRQOL and functional status after 10 wks.in HRQOL and functional status after 10 wks. To improve the health of the general public,To improve the health of the general public, sedentary older adults should be recruited andsedentary older adults should be recruited and encouraged to combine gymnastics with healthencouraged to combine gymnastics with health enhancing physical activities.enhancing physical activities. JJ of Epidemiology & Community Healthof Epidemiology & Community Health 58 ( 2 ) : 83 – 8 , Feb 200458 ( 2 ) : 83 – 8 , Feb 2004
  48. ExerciseExercise programs significantly improveprograms significantly improve balance and mobilitybalance and mobility in patients with balancein patients with balance problems. Enhanced balance training may , inproblems. Enhanced balance training may , in addition, improveaddition, improve confidence and QOLconfidence and QOL butbut needs further research.needs further research. J of Ame Ger Soc.J of Ame Ger Soc. 51( 6 ): 847–52 , June 200251( 6 ): 847–52 , June 2002
  49. AA new methodnew method of exercise prescription isof exercise prescription is based onbased on walking velocitywalking velocity of the elderly.of the elderly. Moderate intensityModerate intensity physical activity isphysical activity is recommended for healthrecommended for health promotion,promotion, diseasedisease preventionprevention, and especially as a means of, and especially as a means of delaying functional loss in the elderly.delaying functional loss in the elderly. Aeyegi, YukitoshiAeyegi, Yukitoshi
  50. App 60 % of the max walking velocityApp 60 % of the max walking velocity representsrepresents moderate exercise.moderate exercise. SIMPLY, SAFELY, EFFECTIVELY !!!SIMPLY, SAFELY, EFFECTIVELY !!!
  51. Wearing shoes withWearing shoes with low heels and large contactlow heels and large contact areaarea may help older adultsmay help older adults reduce the risk ofreduce the risk of fallfall in everyday settings and activities.in everyday settings and activities. J of the Amer. Ger Soc.J of the Amer. Ger Soc. 52 ( 11 ): 1840 – 6, Nov 200452 ( 11 ): 1840 – 6, Nov 2004
  52. Contrary to findings from gait-laboratoryContrary to findings from gait-laboratory studies,studies, athletic shoes are not associated with relativelyathletic shoes are not associated with relatively low risk of fall in older adults during everydaylow risk of fall in older adults during everyday activities.activities. Fall risk was markedly increased whenFall risk was markedly increased when participants were not wearingparticipants were not wearing shoes.shoes. J of The Amer. Ger Soc.J of The Amer. Ger Soc. 52 ( 9 ): 1495 – 1501, Sep 200452 ( 9 ): 1495 – 1501, Sep 2004
  53. ““InIn blood pressure monitoringblood pressure monitoring as older adult’sas older adult’s perceptionsperceptions can serve as guidelines forcan serve as guidelines for gerontologists and others ingerontologists and others in hypertensionhypertension management effectivelymanagement effectively with olderwith older adults.”adults.” J of Gerontological NursingJ of Gerontological Nursing 30 ( 1 ): 44-52, Jan 200430 ( 1 ): 44-52, Jan 2004
  54. Managing smoking, obesity, sedentary lifestyle,Managing smoking, obesity, sedentary lifestyle, homocysteinemia are equally important in reducinghomocysteinemia are equally important in reducing coronary risks in the elderly.coronary risks in the elderly. By promoting and monitoring a healthy lifestyle,By promoting and monitoring a healthy lifestyle, healthcare providers can help older adults improvehealthcare providers can help older adults improve their CV health.their CV health. J of Gerontological NursingJ of Gerontological Nursing 29( 6 ): 18-23, June 200329( 6 ): 18-23, June 2003
  55. Future researchFuture research --needs to address compliance issues, and interventions for peopleneeds to address compliance issues, and interventions for people with cognitive impairment, dizziness and vision loss.with cognitive impairment, dizziness and vision loss. --is also required in residential care and hospital settings, whereis also required in residential care and hospital settings, where there is relatively little research evidence to guide us.there is relatively little research evidence to guide us. Internal Medicine JournalInternal Medicine Journal 34 ( 9-10): 557-564, Se34 ( 9-10): 557-564, Se pp/Oct 2004/Oct 2004
  56. Self-rated verbal communication is significantly relatedSelf-rated verbal communication is significantly related to age, IADLs, intellectual activity, social activity,to age, IADLs, intellectual activity, social activity, cognitive function, max phonation time, the numbercognitive function, max phonation time, the number of teeth, the wearing of dentures, self-rated generalof teeth, the wearing of dentures, self-rated general health and oral function.health and oral function. ……hearing ability and wearing of hearing aids..hearing ability and wearing of hearing aids.. Geriatrics & Gerontology Int.Geriatrics & Gerontology Int. 4 ( 2 ): 100 – 4, June 20044 ( 2 ): 100 – 4, June 2004
  57. epidemiological follow-up study over 5epidemiological follow-up study over 5 yrsyrs Depressed older people are at high risk for physicalDepressed older people are at high risk for physical disability.disability. An individualized program to maintain their ADLs andAn individualized program to maintain their ADLs and IADLs and physical exerciseIADLs and physical exercise should be included in their treatmentshould be included in their treatment.. J of the Amer. Ger Soc.J of the Amer. Ger Soc. 49( 3 ): 290-6, March 200149( 3 ): 290-6, March 2001
  58. Client and family centered care, along with the provision ofClient and family centered care, along with the provision of enhanced QOL and well-being through appropriate mobilityenhanced QOL and well-being through appropriate mobility activities and pain management are the corner stones to aactivities and pain management are the corner stones to a positive hospice approach for the elderly with terminal cancerpositive hospice approach for the elderly with terminal cancer and other life-threatening illnesses.and other life-threatening illnesses. Throughout the dying process,Throughout the dying process, it is essential forit is essential for PT’s & OT’sPT’s & OT’s to focuses on assessments andto focuses on assessments and interventions for clients to adaptation.interventions for clients to adaptation. Topics in Geriatric Reh.Topics in Geriatric Reh. Vol.20, No:2, pp.120-30, 2004Vol.20, No:2, pp.120-30, 2004
  59. There is a need to establishThere is a need to establish ethical guidelines,ethical guidelines, which take into consideration differences inwhich take into consideration differences in religion, culture, ethnicityreligion, culture, ethnicity and race in theand race in the elderlyelderly.. Clinical MedicineClinical Medicine 3(3): 232 – 4, May/June 20033(3): 232 – 4, May/June 2003
  60. Community Health Care For Older Adults “Family,and Community Based Care : The Supports For Care Plan Implementation” Comhrensive Geriatric Assessment., 2002
  61. ComplemComplemaantaryntary,,and Alternative Therapand Alternative Therapyy -Mind-Mind -body therap-body therapyy -Manual-Manual,,and body-and body- work therapwork therapyy -Ac-Acaapuncturepuncture -- AlternativeAlternative dietary therapdietary therapyy -- HerbalHerbal medicinemedicine -- AromatherapyAromatherapy -- HomeopathyHomeopathy -- MagneticMagnetic therapytherapy -- SpiritualSpiritual healinghealing Topic in Geriatric Reh. 18(2): 63 – 79, 2002
  62. ApplicationApplicationss of CAM Therapof CAM Therapyy inin GeriatricGeriatricalal RehabilitationRehabilitation StrokStrok AcAcaapuncturepuncture FallFall Tai-ChiTai-Chi ArthritArthrit Yoga,relaxation techniqueYoga,relaxation technique PaPaıınn MindMind -Body therap-Body therapyy AlzheimerAlzheimer IMIAIMIA ParkinsonParkinson AlexanderAlexander techniquetechnique
  63. Benefit of IntegratBenefit of Integratee CAM TherapCAM Therapyy intointo GeriatricGeriatric RehabilitationRehabilitation -- EnhancingEnhancing communicationcommunication -- IncreasingIncreasing therapeutictherapeutic optionsoptions -- PromotingPromoting empowermentempowerment
  64. ConsiderationConsiderationss in Prescriin Prescribebe ExerciExercisseses FForor ElderlyElderly -- Medical –Medical – physiologicalphysiological factorsfactors -- PsychologicalPsychological ffactorsactors
  65. TheThe PhysiotherapyPhysiotherapy EvaluationEvaluation FForor ElderlyElderly -- Age /Age / gendergender -- PrimaryPrimary diagnosisdiagnosis -- SecondarySecondary diagnosisdiagnosis -- VisualVisual,,andand sensorysensory impairmentsimpairments -- MedicationsMedications -- CognitiveCognitive statusstatus -..........-.......... J Geront. Nur Vol.27, Iss.10, pp.19, Octob., 2001
  66. TheThe Objectives ofObjectives of Exercise ProgramExercise Program -- ImproveImprove self-careself-care capabilitiescapabilities andand well-beingwell-being -- Improve CVImprove CV capacitycapacity andand enduranceendurance -- IncreaseIncrease muscularmuscular strengthstrength andand enduranceendurance -- ImproveImprove oror maintainmaintain flexibility,flexibility, coordinationcoordination andand balancebalance -- WeightWeight controlcontrol -- PromotePromote relaxationrelaxation -- RelieveRelieve anxiety,anxiety, insomniainsomnia andand depressiondepression -- MaximizeMaximize socialsocial contactcontact andand enjoymentenjoyment allall the lifethe life
  67. AnAn ExampleExample -- Habitual vs.Habitual vs. physicalphysical activityactivity -- Intensity:Intensity: LowLow 30 –40 VO30 –40 VO2Max2Max 50-70 VO50-70 VO2Max2Max %% 2-32-3 METs (METs ( walking on 2-3walking on 2-3 mphmph )) -- Duration:Duration: Warm-up/Warm-up/ exercise /exercise / cool-downcool-down AvoidAvoid rapidrapid oror majormajor changes inchanges in intensityintensity
  68. TheThe ResearchResearch Agenda onAgenda on GeriatricGeriatric RehabilitationRehabilitation -Structure of-Structure of carecare :: DifferentDifferent settingssettings -Process of-Process of carecare :: ExercisesExercises -Process of-Process of carecare :: Assistive technologyAssistive technology Am. J Phys. Med. Reh. Vol.83, pp.858-866, 2004
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