Common diseases of old age by Dr Shazia Iqbal

1. Common Disease of Old Age
Dr Shazia Iqbal FCPS, M.Sc
Medical Education (UK)
Assistant Professor (Obstetrics & Gynaecology)

2. Learning Objectives
• Understand the physiological changes of
aging
• Gain awareness of chronic diseases and
their impact on older adults
• Understand the importance of health
promotion activities

3. Program Overview
• Aging and Health
• Chronic Disease in Later Life
• Health Promotion
~ Lifestyle changes
~ Screening and prevention

4. Aging and Health

5. The Aging Process
• Generally involves slowing down of
systems
• Varies greatly among individuals
• Influenced by genetics, environment,
lifestyle factors

6. Physical Changes of Aging
Heart
Muscles
Brain
Skin
Kidney
Vision
Hearing
Bones
Taste
~ Pumping effectiveness decreases
~ Muscle mass decreases
~ Some loss of cell structure and function
~ Dryness, slower healing
~ Less efficient
~ Decreases in depth perception, color
perception, and peripheral vision
~ Decreased acuity, esp. higher pitch
~ Mineral loss faster than replacement
~ Decreased taste buds, saliva production

7. What’s Normal, What’s Not?
• Aging vs. disease process vs. external factors
• “Normal changes” of aging may actually be
part of a disease process
• Don’t assume symptoms are due to normal
aging

8. Chronic Disease in Later Life

9. Definition
Chronic disease:
• Prolonged health condition
• Can last for many years
• Rarely cured completely
• Care is aimed at managing symptoms,
preserving function, and minimizing
further damage

10. Examples
• Diabetes
• Heart Disease
• Arthritis
• High blood
pressure
• Cancer
• Low Vision
• Depression
• Kidney Disease

11. Why is it Important?
• Chronic diseases are the most prevalent and
disabling conditions facing the elderly
• Four of every five elders have at least one
chronic disease
• Chronic disease can dramatically reduce
quality of life
• Chronic diseases account for over 75% of U.S.
medical care costs (CDC, 2005)

12. Consequences/Impact
• Loss of function
• Loss of mobility
• Loss of
independence
• Disability
• Pain
• Death

13. Risk Profiles
Combination of Causes
• Aging
• Lifestyle
• Environment
• Heredity
• Stress
• Unknown

14. Common Chronic Conditions
Condition Prevalence Results in…
Arthritis
Inflammation or wearing
down of joints
Over 40 million Americans Stiffness, chronic pain,
deformity, loss of
independence
Hypertension
High blood pressure
30 million Americans
One in four adults
Cardiovascular disease,
blindness, kidney disease,
stroke
Coronary Artery
Disease
Hardened or narrowed
arteries going to the heart
Number one killer of adults
Most common form of heart
disease in older adults
Heart Attack
Chest pains
Congestive Heart
Failure
The heart is unable to
pump effectively
5 million Americans Shortness of breath
Chronic disability and
dependence
Diabetes
Inadequate insulin
function
20% of older adults affected Heart disease, blindness,
Kidney damage, neuropathy,
amputations
Cancer 50% of cancers occur in the
elderly population
Illness, disability, death

15. Discussion
Common Chronic Conditions
• What does this condition mean to you?
• What are the causes?
• What is the treatment?
• Who are the providers of care?
• Discuss any underlying attitudes or
beliefs that may affect care?

16. Health Promotion

17. Definition
Health promotion involves making lifestyle and
behavior changes in order to move toward
optimal health. Health promotion efforts
include:
• Increasing awareness of health issues
• Promoting healthier behaviors
• Creating supportive environments
• Developing preventive strategies
• Encouraging early detection and treatment
(Am J Health Promot. 1989;3:3–5)

18. Why is it important?
Improve quantity and quality of life
• Reduce risk of developing chronic conditions
• Reduce the damage or limitations that result
from an already existing chronic condition
• It’s never too early and it’s never too late to
start healthy habits

19. What can we do to promote health?
• Stop smoking
• Get active
• Eat a healthy diet
• See a doctor regularly
• Get immunized
• Get screened

20. Why Stop Smoking?
• Smoking is the leading cause of premature
death in the United States
• Cigarette smoking is known to contribute to
many chronic illnesses including: several types
of cancer, heart disease, stroke, pulmonary
disease and others
• Stopping smoking, even at an older age, can
significantly prolong life

21. Where to Get Help
• Your healthcare provider
• 1-800-NOBUTTS
• http://www.smokefree.gov/
• Clinics/Medical Libraries/Health Resource
Centers

22. Get Active
• Lack of activity and poor diet are second only to
smoking in contributing to cause of premature
death
• A sedentary lifestyle contributes to many chronic
diseases including:
•Heart disease
•Cancer
•Hypertension
•Obesity
•Lipid Abnormalities
•Diabetes
•Depression
•Osteoporosis
•Stroke
(National Institute on Aging, 2004)

23. Benefits of Physical Activity
Increased energy
Increased muscle
strength and flexibility
Better insulin
response
Improved mood
Increased
cardiovascular fitness
Increased bone mass
Better immune
function
Increased
independence
•
(National Institute on Aging, 2004)

24. What Can I Do to Be
More Active?
• Work toward 30 minutes of aerobic activity
most days of the week
• Do things that use your muscles
• Do things that make you use your balance
• Stretch to maintain flexibility
• Do things you enjoy or try something new:
walk, bike, garden, yoga, tai chi, dance
• Mix it up!
Always talk to your doctor before starting an exercise program

25. Eat a Healthy Diet

26. Why is it Important?
• It has been estimated that 10 to 25 percent of
elderly people suffer from poor nutrition
• Poor nutrition can contribute to:
•Heart disease
•Cancer
•Diabetes
•Depression
•Difficulty thinking
•Anemia
•Frailty
•Obesity
•Osteoporosis
•Isolation

27. Quick Tips for Healthier Eating
• Eat more fruits and vegetables
• Eat whole grains, nuts, beans
• Choose foods low in saturated fat,
trans fat, and cholesterol
• Get enough calcium
• Get enough protein from
low fat sources
• Cook with less fat
• Minimize foods high in sugar
• Drink enough water

28. Barriers to Good Nutrition
• Disability
• Changes in appetite
• Nausea
• Medication side
effects
• Dental problems
• Difficulty shopping
• Difficulty cooking
• Swallowing problems
• Poor vision
• Financial problems
• Depression or anxiety
• Social isolation
• Transportation
problems
• Other medical
conditions

29. Overcoming Barriers to Good Nutrition
• Chewing problems – Try juices, canned fruits,
creamed or mashed vegetables, ground meats,
eggs, cooked cereals
• Difficulty shopping – Look into grocery delivery
or shopping services, ask friends, family, church
members for help
• Difficulty cooking – Try microwaveable meals,
group dining programs

30. Overcoming Barriers to Good Nutrition
• Poor appetite – Eat with others, ask your doctor
if medicine side effects could be causing
problems, try different spices
• Financial concerns – Use coupons, buy in bulk
and share with someone, try low-cost options
such as beans, bean soups, whole grain
cereals, look into food bank programs or other
community assistance
• For expert help – Talk to your doctor about a
referral to a registered dietician

31. For More Nutrition Information
• US Food and Drug Administration
“Eating Well as we Age”
http://www.fda.gov/opacom/lowlit/eatage.html
• American Academy of Family Physicians
“The Nutrition Screening Initiative”
http://www.aafp.org/PreBuilt/NSI_DETERMINE.pdf
• National Institute on Aging “Age Pages”
http://www.nia.nih.gov/HealthInformation/Publications/
• American Geriatrics Society “Aging in the Know”
http://www.healthinaging.org/AGINGINTHEKNOW/chapters

32. Local Resources
• Meals on Wheels
(510) 574-2092
• Senior Center Daily Meal Program
(510) 675-5495
• Alameda County Food Bank
(510) 834-3663
• Mercy Brown Bag Program
(510) 742-4840

33. See Your Doctor Regularly

34. See Your Doctor Regularly
• Early detection usually means a better
outcome and less invasive treatment
• Regular check-ups should include dental, vision
and hearing checks
• Get recommended screening tests done
• Get recommended immunizations

35. General Screening Recommendations
*check with your doctor for specific recommendations
• Pap test – every 1-3 years up to age 65
• Lipid Screen – every 5 years, starting mid-thirties (male) or mid-forties
(female) up to age 70
• Mammogram – every 1-2 years, age 40-74, then optional
• Fecal Occult Blood – every year, age 50-80+
• Lower GI Endoscopy – depending on individual factors, every 5-10
years, starting at age 50
• PSA – optionally, every year up to age 70 (men)
• Bone density – mid-sixties (women)

36. Immunization Recommendations
for older adults
• Influenza – every year age 65-80
(optional age 50-64)
• Pneumonia – once at age 65
• Td/Tdap – every 10 years
• Zoster (Shingles) – once at age 60

37. Discussion
Health Promotion
• What unhealthy habits are common in your community?
• Is there an increasing awareness of healthy lifestyle
changes?
• What barriers to better health habits exist in your
community?
• What are some nutritional issues affecting older people
in your community?
• What resources are available in your community to help
seniors get adequate nutrition?

38. Local Resources for Health Information
• PAMF Community Health Resource Center
Fremont 510-623-2231
• Washington Hospital Health Library
510-494-7030 http://www.healthlibrary.org
• Kaiser Fremont Health Education Center
510-248-3455
• Fremont Main Library 510-745-1400
http://www.aclibrary.org/branches/frm/
• The Health Library at Stanford
1-800-295-5177 http://healthlibrary.stanford.edu/

39. Internet Resources
• American Diabetes Association
http://www.diabetes.org/home.jsp
• American Dietetic Association
http://www.eatright.org
• National Cancer Institute
http://www.cancer.gov/
• National Cholesterol Education
Program
http://www.nhlbi.nih.gov/about/ncep/
• Healthfinder
http://www.healthfinder.gov
• National Institute of Mental Health
http://www.nimh.nih.gov/
• American Association of Retired
Persons Health Page
http://www.aarp.org/health/
• National Center for
Complementary and Alternative
Medicine
http://nccam.nih.gov/
• National Women’s Health
Information Center
http://www.womenshealth.gov/
• Familydoctor.org
http://familydoctor.org/online/famdo
cen/home.html
• MedlinePlus
http://medlineplus.gov/
• Family Caregiver Alliance
http://www.caregiver.org/caregi
ver/jsp/home.jsp
• National Institute on Aging
http://www.nia.nih.gov/

40. References
Agency for Healthcare Research and Quality (2000). 20 tips to help prevent
medical errors. Patient fact sheet. Retrieved September 8, 2007 from
http://www.ahrq.gov/consumer/20tips.htm
Agency for Healthcare Research and Quality (2002). Quick tips – When
talking with your doctor. Retrieved September 8, 2007 from
http://www.ahrq.gov/consumer/quicktips/doctalk.htm
American Academy of Family Physicians (2005). Determine Your Nutritional
Health. Retrieved September 17, 2007 from
www.aafp.org/PreBuilt/NSI_DETERMINE.pdf.
American College of Sports Medicine’s Strategic Health Initiative on Aging.
Five steps to eating better. Retrieved September 1, 2007 from
http://www.agingblueprint.org/PDFs/Eat_Better.pdf
American Journal of Health Promotion website (para.2). Retrieved
September 15, 2007 from
http://www.healthpromotionjournal.com/resource/instruct.htm
Cassel, C. (1999). The practical guide to aging. New York, NY.: New York
University.
Centers for Disease Control and Prevention. (2005). Chronic Disease
Overview. Accessed from the World Wide Web on January 11, 2008, at:
http://www.cdc.gov/nccdphp/overview.htm

41. References
Institute of Medicine (1999). To Err Is Human: Building A Safer Health System. Kohn, L.,
Corrigan, J., & Donaldson, N. (Eds.) National Academy Press, Washington, D.C.
National Institute of Drug Abuse (2006) Trends In Prescription Drug Abuse. Retrieved
September 20, 2006 from
http://www.nida.nih.gov/ResearchReports/Prescription/prescription5.html