GERIATRIC REHABILITATION
POPULATION AGING
A CHALLENGE
in the developing world
Radical change in perspective
PROPORTION of ELDERLY >65
1950-1970: 5% 200 million
2000 : 6.8% 400 million
2025 : 10% 800 million
AGING CRISIS
> 60 year old
= 1 in 10 , 1 in 5
2050 : 25% , > 80y/o
PHILIPPINE STATISTICS
1970 1995 2030
>60 4.6 % 5.5 % 13.5 %
NSO
REAL PICTURE
580 million people in the world aged 60 years and over
This figure is expected to rise to 1000 million within 20 years
A 75% increase in that age group compared to a less than 50% increase in the worlds population as a whole
AGING AND LONGEVITY
Aging
Integral part of living
Decline in physiologic & biologic reserves
Higher risk for chronic illness and disability
AGING AND LONGEVITY
Primary Aging
Changes that occur with aging independent of disease
Secondary Aging
Aging + Disease
AGING AND LONGEVITY
Aging integral part of living associated with physiological and biological changes
Longevity adding number to years in life
GERIATRIC REHABILITATION
Classification of aging
Oldest Old : 85 and above
Old Old : 75 to 84 y/o
Young Old : 65 to 74 y/o
GERIATRIC REHABILITATION
Psychosocial Barriers
Right of dependency attitude
Dependency fostered by environment
MYTH
Progressive decline of intelligence
Perpetuation that old people becomes sick and dependent
Sexual interest and activity decline
PHYSIOLOGY OG NORMAL AGING
DEC. Reserved capacity of organ system
DEC. Internal homeostatic control
DEC. Ability to adapt in response to different environment
DEC. Capacity to respond to stress
EFFECTS OF AGE ON ORGAN SYSTEM PERFORMANCE
Difference in RATE OF AGING
Different organ age at different age
Age changes with complex performance
Age changes in adaptive response
CARDIOVASCULAR SYSYEM
DEC. Maximal Heart Rate
DEC. Ejection Fraction
DEC. Rate of early diastolic filling
DEC. Baroreceptor sensitivity
NC:RHR
INC. BP, Stroke Volume
INC. LV end systolic pressure
RESPIRATORY SYSTEM
No change
Total Lung Capacity
pCO2 & ph
INC. Residual Volume
INC. Functional residual capacity ( DEC. elasticity, loss of recoil )
RESPIRATORY SYSTEM
DEC. Vital capacity
DEC. max volume ventilation
DEC. expiratory flow rate
DEC. forced expiratory ventilation
DEC. ventilation perfusion ratio
( collapse airway, obesity, supine)
RENAL SYSTEM
DEC. renal mass & # tubules, glomeruli
DEC. blood flow & GFR
DEC. ability to concentrate & dilute urine
DEC. ability to conserve sodium
DEC. creatinine clearance, urinary creatinineexcretion
GENITOURINARY SYSTEM
DEC. bladder capacity
DEC. ability to postpone voiding
DEC. urethral & bladder compliance
DEC. urethral closure pressure
DEC. urinary flow rate
INCONTINENCE symptom of disease
GENITOURINARY SYSTEM
DEC. excitement pahse
Enjoys coitus throughout life
INC. fragility of vaginal wall
INC. BPH
INC. residual volume
No change in sexual desire & interest
DEC. force of ejaculation & psychogenic erection
HEMATOLOGIC SYSTEM
INC. ferritin values
INC. ESR
INC. C-reactive protein
N: Blood & plasma volume
DEC. drug binding w/ protein
DEC. volume distribution for H2O soluble drugs
NEUROLOGIC SYSTEM ABILITY to learn is preserved ( slower )
INC. crystal intelligence
DEC. fluid intelligence
CRYSTAL INTELLIGENCE
Knowledge that comes prior learning and past experiences
FLUID INTELLIGENCE
Involves being able to think and reason abstractly and solve problems
Independent of learning, experience and education
- solving puzzles and coming up with problems, solving strategies
NEUROLOGIC SYSTEM
DEC. short term memory
DEC. Speed of motor activity
DEC. Proprioception, Gait, Strature
SENSORY SYSTEM
DEC. Sensory Modalities Vibration Touch Deep painVISION Presbyopia Physiologic miosisHEARING Presbycusis
THERMOREGULATORY SYSTEM
DEC. Temperature regulation
(DEC. sensitivity to changes & abnormal vasomotor control)
DEC. Thermogenesis
Inefficient sweating
IMMUNOLOGIC SYSTEM
DEC. antibody production
DEC. lymphocytes & T cell activity
INC. Autoantibodies & complexes
GASTROINTESTINAL SYSTEM
DEC. Liver size, Blood flow, Hepatic transformation
DEC. Gastric motility
DEC. Perception of feces
DEC. Absorption of calcium & thiamine
ENDOCRINE SYSTEM
DEC. glucose tolerance
DEC. production of thyroid hormone
DEC. cortisol produce
DEC. serum testosterone, estrogen
No Change: diurinal rhythm, stress response
MUSCULOSKELETAL SYSTEM
DEC. motor unit
DEC. muscle mass
DEC. fiber size
DEC. myofibrils
DEC. muscle enzymes
LOSS OF STRENGTH
MUSCULOSKELETAL SYSTEM
Postural Changes
Spine
Limbs
PHYSIOLOGIC CHANGES
INC. Postural sway
DEC. Balance with 1 leg
DEC. Righting reflex
INC. Reaction time
INTEGUMENTARY SYSTEM
DEC. skin moisture
DEC. blood supply
DEC. sensitivity to pain and temperature
MEDICAL
Confusion Dementia
Falls DV
OTHER chronic illness
Visual/ Hearing/ Speech
Malnutrion
CONFUSION
CAUSES
Changes in environment
Drugs
Alcohol
TIA
Trauma
Infection
MI ( asympomatic )
Bleeding
Electrolyte imbalance
Metabolic
Brain tumor
Constipation
DEMENTIA
Cognitive Changes
TYPES:
REVERSIBLE
IRREBERSIBLE
FALLS
CAUSES
From the elderly
- PHYSIOLOGIGAL Righting reflex
Visual input
Vestibular input
Proprioception
- DISEASE
From the environment
From the MD
RISK FACTORS FOR INC.D FALLS
Reduced mobility
Impaired cognition
Cardiac disease; stroke
Vertigo
Drugs
CARDIOVASCULAR DISEASE
AGING
PHYSIOLOGICAL CHANGES: MINOR
PATHOLOGICAL CHANGES: SEVERE
SEX AND THE ELDERLY
Desires
Failure to ask sexual aspect
DISEASE AFFECTING SEX
Parkinsons disease
Diabetes Mellitus
Hypertension
Arthritis
Peyriones disease
VALUE OF TEETH
MASTICATION
COMMUNICATION
COSMETICS
NUTRITION
Physical Condition: dentures, CVA
Cognition: dementia, confusion
Impaired appetite: drugs, infection
DEC. sense of smell & taste
Isolation
Palatability
POLYPHARMACY
Organ system changes
- DEC. Metabolism
- DEC. Tissue & Protein Binding
- DEC. Excretion
Treating symptoms than the problem
Confusion
ASSESSMENT OF ELDERLY
COMPREHENSIVE
Physical
Mental
Functional
Socio-economic
GERIATRIC REHABILITATION
ROLE
Proper intervention, reverse disability
Disease prevention through health promotion via physical activity and early rehabilitation
Prevent/Minimize Disability
Restoration of function
Integration to the Society
GOAL
Positive outlook for living a longer time
Ensure active aging
Promote longevity & DEC. disability
SUCCESSFUL AGING
Healthy
Active
Productive
ACTIVE AGING
The process of optimizing opportunities for physical, social, and mental well-being throughout the life course in order to extend healthy life expectancy
SUCCESSFUL AGING
Will only occur when an older persons personal dignity, sense of belonging and self worth are maximized
ACTIVE LIFE EXPECTANCY
Functional independence in the remaining proportion of life years (compression of modility )
HEALTH AND LONGEVITY
Active ageing makes the difference (Alexander Kalanche)
Living Longer Living Stronger (Australia)
Prolonging Vitality
IMAGES
YOUNG
- Energetic, strong, mobile, health
ELDERLY
- Slow, poor, weak, chronically sick
- Burden of the future
AGING AND LONGEVITY
AGING
Imperative to maximize function
Increase quality of life, decrease in health care cost