GERIATRICS

Dr. RAHIM IQBAL MBBS (Pb). MPH(H.S.A) Senior Demonstrator Rawalpindi Medical College Rawalpindi

GERIATRICS
Geriatrics

is the branch of internal medicine that focuses on health care of the elderly. It aims to promote health and to prevent and treat diseases and disabilities in older adults.
3

AGE STRUCTURE OF WORLD'S POPULATION1

1.8 billion people under age 15 years (26%) 4.4 billion people age 15-64 years (66%) 516 million people are 65 years and over (8%)

GERIATRICS

There is no set age at which patients may be under the care of a geriatrician. Rather, this is determined by a profile of the typical problems that geriatrics focuses on. This includes the so called geriatric giants of immobility, instability, incontinence and impaired intellect/memory. Health issues in older adults may also include elderly care, delirium, use of multiple medications, impaired vision

GERIATRICS
The

branch of medicine that is concerned with clinical study and treatment of old age and its manifestation.
9

GERONTOLOGY
This

is the study of the aging process itself. The term comes from the Greek geron meaning old man and iatros meaning healer. The study of physical and psychological changes which are incident to the old age is call gerontology.
10

GERIATRICS
(FACTS ABOUT OLD AGE)

Old

age is an incurable disease. We cannot cure old age.

11

GERIATRICS
THEN WHAT CAN BE DONE FOR OLD AGE PEOPLE You can protect their life. You can promote their health. You can extend their life.

12

GERIATRICS (HISTORY) The term geriatrics was proposed in 1909 by Dr. Ignaz Leo Nascher, former Chief of Clini in the Mount Sinai Hospital Outpatient Department (New York City) and a Father of geriatrics in the United States.
13

DR. IGNAZ LEO NASCHER

GERIATRICS (HISTORY)

The famous Arabic physician, Ibn AlJazzar Al-Qayrawani (Algizar, Circa 898980), also wrote a special book on the medicine and health of the elderly, entitled Kitab Tibb-al-Machayikh (6) or Teb al-Mashaikh wa hefz sehatahom.{7} He also wrote a book on sleep disorders and another one on forgetfulness and how to stregthen memory, entitled Kitab alNissian wa Toroq Taqwiati Adhakira, (8)(9)(10) and treatise on causes of mortality entitled Rissala Fi Asbab al-

15

AL-JAZZAR AL-QAYRAWANI

GERIATRICS (HISTORY)
Another

Arabic physician in the 9th Century, Ishaq ibn Hunayn (died 910), the son of Hunayn Ibn Ishaq, wrote a Treatise on Drugs for Forgetfulness (Risalah al-fi adwiyat al-nisyan) (12)

17

ISHAQ IBN HUNAYN

GERIATRICS (HISTORY)

The canon of Medicine, (2) written by Abu Ali Ibn sina Avicenna, in 1025, was the first to offer instruction for the care of the aged, foreshadowing modern gerontology and geriatrics. In a Chapter entitled Regimen of Old Age, Avicenna was concerned with how old folk need plenty of sleep, how their bodies should be anointed with oil, and recommended exercises such as walking or horse-riding. Thesis III of the Canon discussed the diet suitable for old people, and dedicated several sections to elderly patients who become constipated. (3)(4)(5)
19

ABU ALI IBN SINA AVICENNA

GERIATRICS (HISTORY)

Modern geriatrics in the United Kingdom really began with the Mother of Geriatrics, Dr. Marjorie Warren. Warren exphasized that rehabilitation was essential to the care of older people. She took her experiences as a physician in a London Workhouse infirmary and developed the concept that merely keeping older people fed until they died was not enough they needed diagnosis, treatment, care and support. She found that patients, some of whom had previously been bedridden, were able to gain some degree of independence with the correct assessment and treatment.
21

DR. MARJORIE WARREN

GERIATRICS IMPORTANT SUBJECTS INVOLVED Pharmacology Psychology Polypharmacy Orthogeriatrics Cardio-geriatrics Psychogeriatrics

23

GERIATRICS (IMPORTANT SUBJECTS INVOLVED)

Pharmacology Changes in physiology with aging may alter the absorption, the effectiveness and the side effect profile of many drugs. These changes may occur in oral protective reflexes (dryness of the mouth caused by diminished salivary glands), in the gastrointestinal system (such as with delayed emptying of solids and liquids possibly restricting speed of absorption), and in the distribution of drugs with changes in body fat and muscle and drug elimination.

24

Geriatrics (Important Subjects Involved)

Psychology Pyschological consideration is that of elderly persons (particularly those experiencing substantial problems of memory loss or other types of cognitive impairment) being able to adequately monitor and adhere to their own scheduled pharmacological administration. One study (Hutchinson et al, 2006) found that 25% of partcipants studied admitted to skipping doses or cutting them in half. Self-reported noncompliance with adherence to medication schedule was reported by a striking one-third of the participants. Further development of methods which might possibly help monitor and regulate dosage administration and scheduling is an area that deserves further attention. 25

Geriatrics (Important Subjects Involved)

Polypharmacy It is often a predictive factor (Cannon et al, 2006). Research done on home/community health care found that nearly 1 of 3 medical regimens contain a potential medication error (Choi et al, 2006).

26

GERIATRICS HEALTH PROBLEMS OF THE AGED

Due to ageing process Senile cataract Glaucoma Bony changes affecting mobility Nerve deafness Emphysema Failure of special senses Changes in mental out look

27

GERIATRICS HEALTH PROBLEMS OF THE AGED

Problems

associated with long term

illness
Genitourinary system Respiratory illness Diabetes Cancer Accidents

28

GERIATRICS HEALTH PROBLEMS OF THE AGED

Psychological

Problems

Irritability Jealousy Bitterness Depression Dementia Suicide

29

PRIMARY PREVENTION

Health habitats
Smoking Alcohol abuse Obesity Nutrition Sleep Coronary heart disease Immunization Influenza Pneumovax Tetanus

Injury prevention Osteoporosis prevention

30

SECONDARY PREVENTION

(A) Searching for Hypertension Diabetes Dental diseases Colorectal cancer Breast cancer Prostatic cancer Anemia Depression Incontinence Fall risk TB Syphilis (B) Stroke prevention (c) Myocardial infarction
31

TERTIARY PREVENTION
Rehabilitation

Physical

deficits Cognitive defects Functional defects Care taker support

32

ISLAM AND GERIATRICS

Holy Quran Hadees shreef Great people sayings

33

34

Chinese Lok dastan

Man Donkey Dog Monkey
35

GERIATRICS
References

Barton A, Mulley G. History of the development of geriatric medicine in the UK. Postgrad Med J 2003; 79:229-34. Fultext. PMID 12743345. Cannon, K.T., Choi, M.M., Zuniga, M.M.(2006). Potentially inappropriate medication use in elderly receiving home health care: a retrospective data analysis. The American Journal of Geriatric Pharmacotherapy, 4, 134-143. Gidal, B.E. (2006). Drug Absorption in the Elderly: Biopharmaceutical Medication Management by Community-Living Elderly Persons with two Standardized Assessment Tools: A Crosssectional Study. The American Journal of Geriatric Pharmacotherapy, 4, 144-153. Issacs B. An introduction to geriatrics. London: Balliere, Tindall and Cassell, 1965.
36

Thank You Very Much

37