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Healthy Ageing By Prof. Dr Asmaa Abdel Aziz Hassan AlaaDr. is the branch of medicine Geriatrics dealing with health care of the aged population. (growing old) refers to the Ageing natural progressive decline in body systems, that starts in adulthood, but it becomes obvious several decades later Several internal and external influences can accelerate the process of ageing, and increase vulnerability to the diseases of old age. These include: genetic factors, lifestyle and adverse environmental factors. Population Ageing It is increase in the proportion of older people in both developed and developing countries. It is one of the main features of the world population in the 20th century Figure 1. Population aged 60 & over: World and development regions, 1950-2050 Factors behind Population Ageing The main reasons for the population ageing of society are socio-economic development, and better healthcare which has improved survival rate. From the demographic point of view: population ageing is a result of both mortality and fertility: fewer children are born and more people reach old age. Over the last fifty years mortality rates in developing countries have declined dramatically raising the average life expectancy at birth from around q 41 years in the 1950s q to 62 years in 1990. q By 2025, it is projected to reach 70 years. Health trends and social impact qMany developing countries are facing a double burden: the health problems of an ageing population, and Still a high rates of communicable diseases. qIn the majority of these countries, poverty , continuing urbanization and the growing participation of women in the work - all contribute to the erosion of care for older people. qThe elderly are growing in number, and life expectancy is increasing, but we are still far from fulfilling their needs , a clear policy on elderly care is lacking, Health Problems of the Aged IMPAIRMENTS AND LOSSES(1) decreased immune response, (Infections) reduced visual, auditory, and olfactory acuity, osteoporosis and fractures, slowing of mental response, (2)LONG-TERM ILLNESS Cardiovascular diseases (a) e.g. hypertensive diseases, atherosclerosis, ischemic heart diseases, cerebrovascular disease, and peripheral vascular disease. Diet, heredity, overweight, smoking, diabetes, Hyperlipidemia & stress all are cumulative risk factors. (b) Injuries: Falls occur frequently among elderly . The three most common fracture sites among the elderly are: neck of femur, vertebrae, and distal forearm The contributing factor is osteoporosis. : The danger of cancer increases after the Cancer(b) age of 40 e.g. Lung, breast, prostate, skin, uterine , and colorectal cancer. It is the leading cause of death as the :Diabetes(d) population grows older. Myositis, :Diseases of locomotor system(e) neuritis, gout, rheumatoid arthritis, osteoarthritis, etc. These conditions cause more discomfort and disability than any other chronic disease in the elderly. Chronic :Respiratory diseases and infections(f) bronchitis, emphysema, asthma, pneumonia, tuberculosis are of major importance. Enlargement of the :Genitourinary system(g) prostate, dysuria, nocturia, frequent and urgency of micturition are the common complaints. The elderly often have special :Malnutrition(h) nutritional requirements due to: qreduced intake (poor dentition, loneliness, poverty, ignorance), qphysical or mental diseases, (depression) qmedication use, or qfunctional status (dependence and immobility). :PSYCHOLOGICAL PROBLEMS(3) Mental changes as q impaired memory, q dislike of change. q Irritability, q jealousy and q hopelessness are very frequent. q withdrawal, depression and even suicide can occur from failure to adapt. IATROGENIC COMPLICATIONS(4) Risk factors for iatrogenic complications include : (a)Multiple chronic diseases: The greater the number of chronic diseases, the greater the risk that treatment of one disease will exacerbate others. For example, treatment of arthritis with a nonsteroidal anti- inflammatory drug may exacerbate chronic gastritis. Having several physicians :Multiple physicians (b) can result in frequent change in patients therapy that increases the risk of uncoordinated care. increases the risk Multiple or inappropriate drugs (c) of drug-drug or drug-disease interactions. Risks of nosocomial infection, and :Hospitalization(d) transfusion reactions. Causes of death among elderly (65+ years) In 2000, according to WHO the main causes of death among elderly aged 65 years and above were: Cardiovascular diseases ( hypertension, atherosclerosis, ischaemic ). Diseases of pulmonary circulation Senility and other ill-defined conditions. Cerebrovascular accidents. Chronic liver diseases and cirrhosis. Peripheral vascular diseases (embolism, thrombosis ) Neoplasm Respiratory diseases ( chronic bronchitis, emphysema & asthma). Renal diseases ( nephritis, nephrotic syndrome& nephrosis). Diseases of digestive system. Infectious and parasitic diseases. Diabetes mellitus. KSA Preventive health care for the elderly The goal of preventive medicine in the elderly is the reduction of morbidity and premature mortality, and the preservation of quality of life. Primary Prevention Secondary Prevention Tertiary Prevention Primary Prevention Promoting healthy lifestyles to reduce the risk of chronic diseases Use of medications to reduce the onset of illness Immunization ( Influenza Vaccine) Safety measures to prevent Injuries Prevention of Iatrogenic Complications. A) Promoting healthy lifestyles to reduce the risk of chronic diseases Exercise, Smoking, Diet Regular physical activity reduces the risk of coronary heart disease and decreases the risk of colon cancer, diabetes, and high blood pressure Avoiding tobacco use Intake a healthy diet B) Use of medications to reduce the onset of illness 1- Postmenopausal Hormone Replacement Therapy (HRT) HRT has many: Positive effects, It reduces osteoporosis and fracture Negative effects, It increases the risk of breast cancer &causes irregular bleeding. 2- Aspirin to Prevent Cardiovascular Disease C) Immunization An annual influenza vaccination and a Pneumococcal vaccine are recommended for all elderly over age of sixty-five with normal immune systems. A primary series of tetanus vaccine followed by booster every 10 years are also recommended D) Reducing Injuries Reduce Falls and fractures: Safety measures inside & outside homes Prevention of osteoporosis by : Post-menopausal estrogen therapy Regular exercise Calcium intake. E) Prevention of Iatrogenic Complications Elderly care requires a coordinated teamwork to prevent duplication of services and compli