Annals of Community Health (ISSN 2347-5455, eISSN 2347-5714), Peer Reviewed, Indexed Journal focusing exclusively on Community Medicine and Public Health

Preventive Geriatrics

  • Introduction
  • Definitions
  • Problems of elderly
  • Goals of Geriatric care
  • Prevention & control of social problems
  • Prevention & control of Health problems
  • Non- governmental organisations.
  • References

Introduction

  • The phenomenon of population ageing has become a major concern for the policy makers all over the world, for both developed and developing countries, during last two decades.
  • The elderly population (aged 60 years or above) account for 7.4% of total population in India in 2001. (Males 7.1% while for females 7.8%).
  • The old-age dependency ratio climbed from 10.9% in 1961 to 13.1% in 2001.
  • Among females it was 13.8% and males 12.5%.
  • In view of the increasing need for intervention in area of old age welfare, Ministry of Social Justice & Empowerment, Government of India adopted ‘National Policy on Older Persons’, 1999.
  • Policy provides broad guidelines to State Governments for taking action for welfare of older persons by devising their own policies and plan of action.
  • To ensure well-being of senior citizens & improve quality of their lives through providing specific facilities, concessions, relief, services & helping them cope up with problems associated with old age.

Definitions

  • Geriatrics: Is a branch of medicine which deals with problems of old age.
  • Gerontology: Science which deals with processes of ageing.
  • Preventive Geriatrics: Is a branch of Geriatrics which deals with prevention & control of disability & improving the quality of life of the aged people.

The principles of Preventive Geriatrics -“You do not heal old age, you protect it, promote it and extend it”.

Problems of elderly

  • Social problems
  • Economic problems
  • Psychological problems
  • Health problems

Goals of Geriatric care

  • Provide a safe and supportive environment.
  • Restore and maintain the highest possible level of functional capacity.
  • Preserve individual autonomy.
  • Maximize quality of life.
  • Provide comfort and dignity for disabled & ill.
  • Stabilize & delay progression of chronic diseases.
  • Prevent acute medical illnesses, early detection and treatment.

Social problems

  • Social problems of aged is important because the physical wellbeing & mental health is affected.
  • Loneliness & Social isolation.
  • Rapid disintegration of joint family.
  • Change in social contacts due to retirement.
    • Bereavement -Death of spouse/ siblings ,close relatives,friends, or separation of their children after marriage.
  • Diminished participation in social & cultural activities like marriages, ceremonies, visiting temples etc.
  • Diminished role in the family & community. Even if they participate their role is not much appreciated.
  • These factors leads to STRESS which in turn contributes to ILLNESS.
  • Problems of leisure
  • Absence of job
  • Diminished social contact-
    • Chronic disability associated with ageing process
    • Due to death of close friends and relatives
    • Lowered or loss of income.
  • Change in the attitude of community towards elderly.
  • Inability to adopt with changing environment.

Economic problems

  • More common in women then men.

Causes:

  • Retirement of people employed in government services, local bodies, public sector & private organizations.
  • Self employee like agriculturists, businessmen, daily wage earners who cannot earn their livelihood due to disease and disability etc.

Prevention & control of social & economic problems among elderly

  • Promoting Joint family system
  • Involvement in leisure time activities like light house hold work, part time jobs, social services, reading books looking after agricultural lands, gardening etc.
  • Income generation activities.
  • Social welfare measures :All aged needs sympathy and assistance by their family members and community.
  • Social security measures like old age pension. It should be given to those who are not cared by their family and community.
  • Provision of institutional care - For those who have no house of their own or persons to look after them.

It should provide :

  • Medical and nursing care
  • Home help
  • Nutrition
  • Physiotherapy
  • Appliances like hearing aids, spectacles, dentures
  • Recreational facilities.

Health problems

  • Cardiovascular system: Degenerative diseases of heart & vessels
    • Hypertension
    • Atherosclerosis
    • CHD
  • Psychological problems:
    • Emotional disturbance
    • Feel lonely, neglected & unwanted
    • Anxiety, depression & suicidal tendencies
    • Impaired memory
    • Rigid outlook
  • Nutritional excess or deficiencies: Obesity, Anemia, Avitaminosis, etc.,
  • Sensory system :
  • Eyes : Senile cataract, glaucoma
  • Ears : Nerve deafness, vertigo, tinnitus
  • Skin : Loss of elasticity of skin leading to wrinkling and dryness.
  • Locomotor system
  • Articular disorders:
    • Osteoarthritis
    • Spondylosis of spine – lumbar and cervical
    • Gout
    • Rheumatoid arthritis
  •  Nonarticular disorders
    • Fibrositis
    • Myositis
  • Fractures due to falls: Fracture neck of femur and hip.
  • Fires, traffic collisions are extremely common.
  • In case of crisis and conflict displaced older people are particularly vulnerable.
  • Respiratory system: Chronic bronchitis, Emphysema, Asthma
  • Central nervous system
    • Cerebro vascular accidents
    • Peripheral neuritis
    • Alzheimer’s disease
    • Parkinson’s disease
  • Endocrine system
    • Diabetes mellitus
    • Hypothyroidism
  • Malignancies
    • Females: Ca cervix, ca ovary
    • Males: lung ca, prostate ca
  • G I System
    • Dental caries & loss of teeth.
    • Indigestion due to reduced metabolism & malabsorption.
    • Constipation.
  • Genito urinary system
    • Males : BPH
    • Females: Uterine prolapse, Nonspecific vaginitis, cervicitis

Prevention & Control of Health problems

The main objective is to protect, promote & restore the health of elderly people.

Primary prevention:

  • Health promotion:
    • Health Education
      • Explaining the biological changes in ageing.
      • Personal hygiene.
      • Regarding smoking, alcohol related diseases.
      • Information on CD & NCD specific to old age.
      • Availability & utility of health services.
      • Over the counter drugs.
      • Use of aids like visual, auditory, walking aids etc
      • Information regarding elderly abuse.
    • Environmental Modification
      • Maintenance of clean housing conditions.
      • Need for fresh air, light & ventilation.
      • Disposal of waste & human excreta.
      • Vector control.
      • Prevention of accidents both inside & outside the home.
        • Slip resistant flooring
        • Smooth pathways
        • Hand rails in bathrooms
        • Stairs- landing at short intervals
        • Adequate lighting
        • Contrasting colors
    • Nutritional intervention
      • Principles of balanced diet.
      • Food safety.
      • Food which improve bowel movement.
    • Life style & behavioral changes
      • Physical exercises like yoga and relaxation
      • Personal habits like alcohol, smoking & tobacco chewing.
  • Specific protection:
    • Immunization.
    • Avoidance of injuries and falls
    • Vitamin D, calcium supplementation.
    • Certain food rich with antioxidant property- protect against cancer and degenerative disorders.

Secondary prevention

Action which halts the progress of the disease at its incipient stage and prevents complication.

  • Early diagnosis & treatment – Early recognition of CD & NCD, proper treatment, patient compliance & self care.
  • Provision of free medical care.

Tertiary prevention

All measures available to reduce or limit impairments & disabilities,& minimize suffering caused by existing disability.

  • Rehabilitation of elderly people with chronic diseases & care for terminal illness.
  • Rehabilitation – medical, vocational , social and psychosocial.
    • Measures include-
      • Training to increase independence in self care;
      • Educational and vocational measures aimed at achieving economic independence;
      • Social measures to ensure full integration and acceptance in community.
  • Medical rehabilitation
    • Appropriate exercise therapy for maintain the range of motion of joints, improving power in weak muscles and strengthening them.
    • Restoring function of affected extremity.
    • Provision of external appliance, splint or caliper, crutches, wheel chair etc.,
    • Relief of pain by means of physical modalities like heat, cold, electricity.
    • Bowel/ bladder training to achieve continence.
  • Psychosocial rehabilitation
    • Rehabilitation is never complete unless the psychosocial aspects are duly taken care.
    • Problems– loneliness, anxiety, depression, feeling of insecurity, behavioral disorders, affective disorders, personality disorders, suicidal tendencies, dependence, irritability, malingering, hysteria etc.,
    • The clinicians duty is to–explain, reassure, remove problems of the disabled about his disabilities, their effect on work and its possible solutions.

NGO’s in Geriatric care

    • NGO’s are the first one to bring out the problems of elderly in India.
    • Help Age India
    • Action for Social Help Assistance
    • Centre for the Welfare of Aged
    • Geriatric Society of India
    • Nightingale Medical Trust
    • Cheru Resmi Centre
  • Services:
    • Provision of foodd
    • Day care centre
    • Old age homes
    • Medical and psychiatric care
    • Financial assistance-income generation & micro projects.
    • Counselling

References

  1. Situation Analysis Of The Elderly in India: Central Statistics Office; Ministry of Statistics & Programme Implementation ,Government of India: Jun 2011.
  2. Indira Gandhi National Open University School of Health sciences; MME-04; Basic Geriatrics; Vol 3,4,6.
  3. Kishore J. National Health programs of India. 9th ed. Century publications: New Delhi; 2011. p 494-98.
  4. Park K. Park’s textbook of preventive and social medicine. 21st ed. Jabalpur(India): Banarsidas Bhanot; 2010. p 547-50.
  5. Text book of public health and community medicine. 1st ed. AFMC, New Delhi; 2009.p 889-92.


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