General care of the elderly
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General care of the elderly
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General care of the elderly
- 1. General Care of the Elderly MARC EVANS M. ABAT, MD, FPCP, FPCGM Internal Medicine-Geriatric Medicine
- 3. …. accumulation of changes responsible for the sequential alterations that accompany advancing age and the associated progressive increases in the chance of disease and death. Harman D, Proc National Academy of Science USA, 1991 Aging…
- 6. Frailty Refers to a loss of physiologic reserve that makes a person susceptible to disability from minor stresses. An inherent vulnerability to challenge from the environment. Not dependent on age, diagnosis or functional ability
- 7. TIME PHYSIOLOGIC CAPACITY Ideal setting Usual trajectory Sudden illness or stressor Full recovery Less optimal recovery
- 9. dementia inappropriate prescribing of medications osteoporosis depression incontinence sensory alterations including hearing and visual impairment delirium iatrogenic problems immobility and gait disturbances falls frailty and failure to thrive pressure ulcers sleep disorders
- 16. Optimal control of all comorbid conditions
- 18. Vaccination
- 19. Vaccine Schedule Influenza vaccine 1 dose yearly Tetanus, diphteria, acelluar pertussis 1 dose Tdap, then Td or Tdap booster every 10 years Zoster vaccine (recombinant) 2 doses. 2-6 months apart Pneumococcal (stand alone recommendation) PPSV23 x 1 dose (shared decision making) PCV13 then PPSV23 after 1 year https://www.cdc.gov/vaccines/schedules/downloads/adult/adult-combined-schedule.pdf
- 20. Be wary of shams and quackery!
- 21. Consider other forms of medical care access like doctor’s house calls.
- 23. •Nutritional management • Caloric intake and macronutrient regulation • Vitamin and micronutrient supplementation • Nutraceuticals
- 26. Mental Health and Stress Management
- 28. Social support Family in- house Phone call Email SMS Video- conferencing Social media
Notas do Editor
- Aging is what happens when accumulation of changes (which can happen on multiple levels of complexity from the genome, epigenetic levels, biochemical processes, macromolecules and tissues, organ systems) responsible for sequential alterations with advancing age Associated with increased chance of disease and death
- Now we obviously see that not all older people are the same. We know of people in their 70s or 80s who are still very active and functional for their age. There are stories of what we call SUPER SENIORS who are master athletes in their respective fields (the Indian marathoner, bodybuilders like Schwarzenegger, etc.) On the other hand there are other persons who are in their 50s or 60s yet are already functionally limited, or even disabled due to the accumulated effects and complications of diseases This is the concept of chronological age vs biological age. The former is the numerical count of time of a person’s existence. The other is the actual manifestations of changes in the function of the entire body that may be phenotypically discordant with time
- As one ages, and due to numerous factors like baseline health, presence of vices, or disease, the amount of physiologic reserve (the amount of bodily resources that are used to overcome stress) decreases. This is because the body starts to use more of these resources to maintain equilibrium. This is the concept of homeostenosis-the ability to maintain equilibrium becomes narrower. At some point, if the physiologic reserve remaining is overcome, adverse outcomes happen like what we call geriatric syndromes, hospitalization and death As was discussed earlier on biological age, the physiologic reserve may vary from person to person depending on inherent and modifiable factors like genetics, lifestyle, presence of comorbidities, vices, environment, education, etc.