Geriatric Illness & Care Perspective of Bangladesh

Defining OLD

• Most developed countries accepted the

chronological age of 65 years as older person.

• There is no UN standard criteria but UN agreed cut-

off of 60+ years to refer as older person

Categorizing the definition of older person

• Chronology

• Change in social role– Change in work patterns– Adult status of children & menopause

• Change in capabilities– Invalid status– Senility– Change in physical characteristic

World Population Aging

• In 1950, there were 335 million children in the 0-4 age group

and just 131 million people ages 65+

• Mid-2010, there were 642 million persons ages 0-4 and 523

million ages 65+

• The 65+ population is projected to exceed the 0-4 population

during that same five-year period, rising from 601 million in

2015 to 714 million in 2020

Ageing and Life Course

• 2 billion people will be aged 60 and older by 2050. This represents both

challenges and opportunities.

• 4-6% of older persons in high-income countries have experienced some

form of maltreatment at home.

• 25-30%of people aged 85 or older have some degree of cognitive decline.

Ref-ICDDR,B: Centre for Health and Population Research

Pictures of Bangladesh

1. The elderly population of Bangladesh will increase

from 6.8 million in 2000 to 65 million in 2100.

2. whereas the total population will be about double.

3. The ratio of people of working-age to elderly people

will decline from 11 to 2 at the end of the century.

Source: CIA World Factbook 7

BangladeshDemographic Profile

• Population 163,654,860 July 2013 Est

Age structure Percentage Total number

55 to 64 years 5.7% Male- 4,775,062Female 4,625,192

65 years and over

4.9% Male 3,918,341Female 4,078,723

Pattern of presentation of geriatric illness

• Late presentation

– Many people accept illness as a consequence of aging.

• Atypical presentation

– Infection may present with delirium.

– Stroke may present with falls.

– MI may present as weakness and fatigue

Pattern of presentation of geriatric illness

• Acute illness and change in function

– May present with

• Failure to cope

• Found on floor

• Confusion

• Off feet

• Multiple pathology

Common presenting problems

• Falls about 30% over 65 years of age

about 40% over 80 years of age

• Dizziness about 30% over 65 years of age

• Delirium about 30% of older hospital

inpatients

Common presenting problems

• Urinary incontinence affecting 15% women and

10% men over 65 years of age

• Adverse drug reaction are the cause of 20% of

admission in those over 65 years of age

• Hypothermia

• Under nutrition

Other presenting problem

• Dementia• Infection• Fluid balance problem• Heart failure• Hypertension• Dizziness and blackout• Diabetes mellitus• Anemia• Painful joints

Pattern of Geriatric diseases in Medical wards

AN EPIDEMIOLOGICAL STUDY OF THE MORBIDITY

PATTERN AMONG THE ELDERLY POPULATION INAHMEDABAD, GUJARAT

Rajshree Bhatt1, Minal S Gadhvi1, K N Sonaliya2, Anand Solanki3, Himanshu Nayak3

The present study was conducted in urban field practice

area (UHTC) of Department of Community Medicine BJ

Medical College Ahmedabad. Random selection of one

region was done & Kalapinagar comes out as our survey

area. We haveincluded only those persons above 60

years of age who have given informed consent.

Patterns of admission and discharge in anacute geriatric medical ward

I C Taylor, J G McConnell Accepted 6 March 1995

Data was collected retrospectively on admissions to the

acute geriatric medical ward from the 1st January to

the 31st December 1993. Patients admitted to a 30

bedded acute geriatric medical ward in 1993 were

followed up to discharge.

At Kenyatta National HospitalMarch 1990-March 1991

• Total no. of patients- 1296

• Between 60-79 years- 1008(77.8%)

• First time admission 86.4%

• Commonest diseases- Hypertension and

cardiomyopathy about 43.9% of all diseases.

• Commonest neurological disease was Stroke

At Kenyatta National HospitalMarch 1990-March 1991

• Among 1296 patients 88 i.e. 6.8% of patient died

• Commonest cause of death Heart failure due to

cardiomyopathy and hypertensive heart disease.

Pattern of Geriatric diseases in rural areas of Bangladesh

Health Problems of the Geriatric People:

A Community Based Study in a Rural Area in Bangladesh

Md. Jawadul Haque 1 Rafiqul Alam2

A community based cross-sectional study among the geriatric

people i.e. 60 years and above age group was carried out in the

rural villages of Rangpur district A total of 1000 geriatric people

were interviewed

Distribution of respondents by their current disease pattern n=1000Current disease Respondent

NO %

Without disease 138 13.8

With disease 862 86.2

Arthritis 401 40.1

RTI 377 37.7

Cataract 229 22.9

Diarrhoeal disease 166 16.6

PU & hyperacidity 149 14.9

Dental problem 94 9.4

Asthma 70 7.0

Hypertension 67 6.7

Diabetes Mellitus 34 3.4

Hydrocele 44 4.4

Hernia 7 0.7

PID 9 0.9

Others 73 7.3

Distribution of the respondents bytheir complaints, n = 1000

General complaints Respondents

No %Decreased vision 636 63.6

Weakness 532 53.2Partial memory loss 58 5.8

Hearing defect 175 17.5

Others 91 9.1

Geriatric Health Problems in a Rural Community of Bangladesh

Shaila Ahmed, Sonia Shirin, Masuda Mohsena, Nargis Parvin, Niru Sultana, Samia Sayed, Rishad Mahzabeen, Masuma Akter, Abu Sayeed

This cross sectional descriptive study was conducted in some

rural communities of Sreepur Thana during the month of April

2007. The study population included those aged 50 years or

more and residing in the study areas. A total of 226 respondents

were selected purposively

The prevalence of old-aged diseases orsymptoms or events (n=226)

Variables Totaln %

Men%

Women%

Systolic hypertension 40 (17.7) 19 (47.5) 21 (52.5)

Visual impairment 48 (21.2) 29 (60.4) 19 (39.6)

History of fall 40 (17.7) 16 (40.0) 24 (60.0)

Joint pain (Arthralgia/arthritis

148 (65.5) 71 (48.0) 77 (52.0)

Palpitation (unexplained)

94 (41.6) 42 (44.7) 52 (55.3)

Cough (not categorized)

52 (23.0) 36 (69.2) 16 (30.7)

Dyspnoea (unexplained)

42 (18.6) 22 (61.1) 20 (38.9)

Chest pain (non-specific)

50 (22.1) 20 (40.0) 30 (60.0)

Chest pain with sweating

32 (14.2) 11 (34.4) 21 (65.6)

Health Issues of an Ageing Bangladeshi Population

Golam Mostafa and Peter Kim Streatfield

Methodology: Using data from the Matlab Health and

Demographic Surveillance System(HDSS), the living arrangements

of elderly people during 1974, 1982, and 1996, self-reported

chronic and acute morbidities, and unhealthy status were

examined through cross-tabular analysis. The method of Sullivan

was used for calculating healthy life-expectancy and active life

expectancy

• The prevalence of chronic morbidity was higher among

females than males.

• Arthritis was the most prevalent chronic disease among

both males and females followed by gastric problems

and anaemia.

• The most prevalent acute conditions among males and

females were cough, fever, and cold, followed by

headache and toothache.

• Females are more unhealthy than males.

• Inability to carry out normal daily activities

was more common among females

Chronic disease burden among peopleover 60 years of age in rural Bangladesh

Overall, 73% of those surveyed in Mirsarai and 44% in

Abhoynagar.

Arthritis (37%) and hypertension (27%) were the most

common chronic conditions reported.

Verbal autopsy data show that at least 42% of all deaths

in these areas in this age group were due to chronic

conditions

Management

Admission to Department of General Internal Medicine or

Department of Geriatrics

Does it really matter?

Yes, It does…..

Findings in favour of GU

• At one year– Lower mortality (23.8 vs 48.3%)– Fewer had initially been discharged to a nursing home

(12.7 vs 30.0%)– Patients were less likely having spent time in a nursing

home (26.9 vs 46.7)– They more likely had improvement of functional status– Lower direct costs

Ref: Rubenstein & al N Engl J Med, 1984

Points to remember in caring for Elderly

• Individuals with dementia don’t know they have

dementia

• Be Respectful

• Focus on the person not the task. The relationship is

more important than getting the job done.

• Talk, touch and explain

• Know something about their life story

Points to remember in caring for Elderly

• Do not argue with person

• Always tell them what you are going to do

Management of Patient with

Multi Morbidity

• Inquire about the patients primary concern (& that of family or friend) and any additional objectives for visit.

• Conduct a complete review of care plan with person of Multi morbidity

• What are the current medical condition and intervention? Is there any adherence/comfort with care plan

• Consider patient’s preference.

• Is relevant evidence available regarding important outcome

• Consider prognosis

• Consider interactions within among treatment and conditions

• Weigh benefits and harms among the components of treatment plan.

• Communicate and decide for or against implementation or continuation for intervention/treatment

• Reassess at selected intervals for benefit, feasibility, adherence

Table showing the no. of geriatric patient admitted/ come for consultancy in outdoor

basis in DMCH

Traits Total no. Of patients

No. of patients above 65 years

Percentage

Indoor

Male 332 80 24.09

Female 285 36 12.63

Outdoor

Male 150 12 8

Female

প্রবীণ স্বাস্থ্য চিচি�ৎসা কে�ন্দ্র ঢা�া কে�চি�কে�ল �কেলজ হাসপাতাল

Geriatric Ward in DMCH প্রবীণ স্বাস্থ্য চিচি�ৎসা কে�ন্দ্র

Aims and objective• To ensure health service at an acceptable level to the elderly

• Expansion of treatment facilities for chronic, terminal and

degenerative diseases.

• Starting an outdoor clinic for the elderly in all the medical college

hospitals

• To build up a group of dedicated staff for this vulnerable population

• To provide health education to the care givers.

Geriatric unit will be consists of

• Outpatients department

• Inpatient department

• Health education Unit

outpatients department/Geriatric clinic

• Weekly run by geriatric unit

• Conducting a routine health assessment of elderly

persons

– Simple clinical examination relating to eye, BP, blood

sugar

– Appropriate investigation, diagnosis and management

outpatients department/Geriatric clinic contd.

• One stop service at the department including

laboratory investigation and drug supply

• Health education to patient and care giver

• Maintain record of elderly using standard format

• Admission in geriatric unit for patients requiring

further evaluation, investigation and treatment.

Criteria for admission in geriatric ward (Inpatient department)

• Patients aged 65 years and above.

• Elderly patients with chronic ailments requiring further

evaluation

• Elderly patients with acute illness with no organ failure

that fulfills HDU or ICU admission criteria

• Patients requiring comprehensive, multidisciplinary

approach for diagnosis and management

• Patients requiring special care in terms of logistics and support

• Patients with acute complications requiring surgical attention will not

be admitted

• Patients with multi organ or single organ failure requiring support will

be sent to ICU or HDU according to their criteria respectively

• Admission will be through Geriatric outpatients department or

referral from different medicine unit during office hours.

All admitted patients in geriatric unit will be

managed in collaboration with other specialists as

much as possible.

Health education unit

• To impart training to District and PHC providers

• To arrange weekly outpatients counseling

sessions

• To arrange awareness campaigns

• Arranging field clinics and health camps

Team of geriatric medicine• Professor (Geriatric Medicine)• Associate professor• Assistant professor• Junior consultant• Psychiatrist• Assistant registrar• Nurses• Physiotherapist• Nutritionist• Lab technician• Program assistant• Hospital attendant• Computer operator

Thank you