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