Medical Biotechnology Master’s Programmes
at the University of Pécs and at the University of Debrecen
Identification number: TÁMOP-4.1.2-08/1/A-2009-0011
GERIATRIC CARE
MANAGEMENT FOR SUCCESSFUL AGING
Gyula Bakó and Márta Balaskó
Molecular and Clinical Basics of Gerontology – Lecture 21
Medical Biotechnology Master’s Programmes
at the University of Pécs and at the University of Debrecen
Identification number: TÁMOP-4.1.2-08/1/A-2009-0011
Characteristics of old age
Multimorbidity affects the majority of this population
disturbance of mobility, self-reliance,
communication and social activity
inactivity Increased tendency to develop pain syndromes
inactivity Psychological features
rigidity; disorders of memory, judgement, emotions and orientation, decrease
in cognitive performance
inactivity
Isolation (loneliness) inactivity
Rapid immobilization, loss of self-reliance
General health-related problems
• pressure ulcers (decubitus)
• incontinence
• feeding disorders
• falls
• altered mental activity
• sleep disorders
• mood disorders and pain
Limitations of everyday activities caused by diseases
age-groups
(years) men women
60-69 40 % 50 %
70< 60 % 72 %
Living conditions of the elderly over 65 years of age living in community
Age-groups
Living alone Living with spouse Living with other relatives (not spouse) Living with non-relatives
males females
75-84 85+ 65-74 75-84 85+
65-74 13,0 78,2 6,6 2,2
19,3 71,2 7,4 2,0
28,1 47,0 21,1 3,8
33,2 51,1 14,1 1,7
53,3 27,7 16,8 2,2
56,8 10,2 27,5 5,5
Circumstances of seniors
In Hungary 73% of elderly people live in a household where all members are above 60 years of age. Thus, in need more and more people must depend on other persons, relatives, on the social system or on civil
organizations.
Eldercare systems
Nursing home
Senior day-care facilities
In-home care (home care services) Hospitalization
Adaptive mechanisms in people getting
older get reduced in any change of the
environment!
Housing of people over 65 years of age, living in community
Care in a nursing home or in other facility providing long-term care.
Considering the type of facility:
• It must be assessed whether the person is in need to become a resident in a geriatric
facility.
• It should be decided about whether the patient
is at the appropriate place.
For housing options the followings should be assessed
• health needs,
• social support – mistreatment,
• cognitive functions – dementia,
• physical abilities – degree of self-reliance,
• in-home care – continuous supervision
Housing of people
over 65 years of age
The most important needs in facilities for elderlies:
• certified chief nurse,
• registered nurses,
• nurses,
• full-time social workers,
• therapeutic health professionals,
• pharmacists,
• rehabilitation therapeutists,
• dentists,
• nutrition specialists,
• cleric services,
• medical services.
Ethical approaches
• If a patient suffers from dementia – he lacks
decision-making capacity – his wishes are often overruled by his family or the staff.
• Will to live is important.
• Right to be informed.
• Medication of such patients who refuse taking pills is a problem.
• Physical abuse – neglect – unprofessional care
.Senior day-care facilities
The patients who are no longer able to conduct their lifestyle, but their functions are still relatively
maintained. Thus, there is no need for them to be monitored continuously.
Housing, meal, and limited assistance with hygiene
and drug administration are provided.
In-home care (home care services)
It is advantageous for those who would like to stay at home, but they need some kind of
assistance temporarily or permanently
because of their medical conditions or
disability.
Hospitalization
More than half of the hospital beds are occupied by patients over 65 years of age!
Prevention:
• Their activity should be maintained during hospitalization.
• Beds with adjustable height (for sitting or lying down)– more comfortable.
• Infusion, oxygen administration as required.
• Glasses, hearing aids, reading….. and communication!
• Appropriate medication.
Aims of therapy in the elderly
• Transition from hospital to (nursing) home
• Relief of e.g. pain
• Improvement in self-care, independence
• Improvement of physical activity and fitness
• Improvement in functional abilities, better quality of life (QOL)
• Complete recovery (?)
Primary goal: maintenance or recovery of independence
In elderlies the possibilities are limited, BUT the expectations are more modest.
Moving Feeding
Clothing
Hygiene
Improvement of physical activity and independence
• Physiotherapy and occupational therapy for the improvement of daily activity.
• Improvement of muscle strength, stability of joints and mobility.
1 Evaluation of opportunities at home (e.g. warm environment before and during exercise).
2 Teaching and coaching exercises:
- for maintenance and improvement of joint mobility,
- for strengthening and training muscles around the joints, carrying out aerobic exercises
Since atrophy and weakness of the m. quadriceps femoris is not a consequence but rather a cause of the arthrosis of the knee!
Exercises also improve proprioception of the joint.
3 Teaching the appropriate use of orthesis and that of the optimal technique of getting up from the ground.
• Eliminating fall-promoting intrinsic (diseases, medications) and
extrinsic factors (remove slippers, thresholds, install shower, hand rail).
Physiotherapy
Effects:
- Increases aerobic capacity - Alleviates pain
- Improves muscle strength - Improves coordination
- Improves gait
- Improves quality of life
Forms:
- Isometric and isotonic exercise
- Exercise improving the efficacy of locomotion - Exercise improving
coordination
- Therapeutic underwater exercise
• Others: thermotherapy, cryotherapy, mechanotherapy, low- frequency electrotherapy, interference, pulse magnetic
therapy
• Therapeutic exercise is the most important element
Geriatric care and management
• It is a really complicated task.
• There is a need for multidisciplinary approach performed by a team.
• In Hungary the conditions are not optimal.
• The demand is huge. The resources do not meet the demands.
• There is a shortage in the number of health care
providers and the lack of a financial background is
also obvious.
Patient
Pastoral carePhysician
Personalized geriatric teamwork
Successful aging
Selection (evaluation, analysis, acceptance of the situation) Ranking of aims, choice of priorities.
Optimization (recruitment)
Recruitment of resources necessary for achieving the
objectives (e.g. establishment of new routes, learning, trainig, practicing, honing new skills).
Compensation (planning, execution)
New strategies (e.g. lists, using ortheses , special tools).
Results:
More limited, irrevocably changed, but independent and useful life.
Factors influencing aging 1
Aging well
Life Activity
Social Resources
Material Security
Physical Health and Functional
Status Cognitive
Efficacy
Factors influencing aging 2
1 Caloric restriction
A 30% reduction in caloric intake
increases life expectancy by 40-50 percent (in rodents).
Okinawa island – traditionally low caloric intake.
40 times as many people live there above the age of 100 years.
Rats:
• 40% reduced diets – 60 months survival (normal 30 months).
• 30% caloric restriction decreases core temperature by 1°C.
Low metabolic rate increases life-span. Fruit flies
(Drosophila melanogaster) live twice as long in an 18 °C than in a 30 °C environment.
A persistently cold environment reduces life-span because of sustained increase in metabolic rate.
2 Physical fitness (Heat tolerance also becomes enhanced.)
Advantages of physical fitness:
a Active muscles are able to take up glucose without insulin.
b Trained muscles are able to burn fats upon exercise (longer than 15 min).
With training, on their surface the number of lipoprotein lipase enzyme copies increases.
c In active muscles local metabolites and epinephrine induce vasodilation decreasing total peripheral resistance.
d Physical training stimulates bone formation. A high peak bone mass developed by the age of 25-30 and increased bone formation later on delays the onset of aging-associated osteoporosis.
e Exercise induces elevations in HDL (“good” cholesterol) and suppresses LDL level (atherogenic “bad” cholesterol).
f Exercise helps maintain a healthy BMI and muscle mass.
g Physical activity reduces stress without the side-effects of alcohol or those of tranquillisers.
h Exercise ameliorates aging sarcopenia and cognitive decline.
i Exercise reduces the risk of thrombosis and that of cancer.
Factors influencing aging 3
3 Stress, glucocorticoid levels (Frequent and high glucocorticoid levels lead to hyperstimulation of the hippocampus and consequent loss of memory – it may contribute to Alzheimer’s disease)
4 Growth hormone and/or sex steroids
5 Antioxidant vitamins, dietary polyphenols
6 Melatonin (antioxidant and has a role in sleep regulation)
7 Glutamate levels. Glutamate is an excitatory neurotransmitter, high levels of which (e.g. induced by cerebral ischemia) damage and finally kill
neurons (excitotoxin).
8 Cognitive training /psychological balance (life-long learning, positive thinking, religion, etc.)
9 Hormesis Ideal portions of manageable stress (heat shock – 41°C, exercise, caloric restriction, alcohol, acetaldehyde, irradiation, heavy
metals, pro-oxidants, hypergravity) stimulate Heat Shock Proteins – HSP, prolong life in animal experiments and in humans. (Measuring and
grading, determining the “ideal” dose, age-related modification of doses is a challenge.)
Factors influencing aging 4
The myth of the “Fountain of Youth”–
strange trials
Throughout history, people have been attempting to prolong life, to maintaine or to regain youth at any price.
• In 1889 Charles Edouard Brown-Séquard advocated
hypodermic injection of a fluid prepared from the testicles of guinea pigs and dogs, as a means of prolonging human life.
• In 1920 Szergej Voronov experimented with transplantation of monkey testicle as a means to prevent age-related decline in males.
• Placenta products/mother’s milk are believed in and used as means of rejuvenation of the skin and that of the body.
• Stem cells (e.g. ependymal stem cells in the brain) are used at attempts to help the recovery of irreversible organ damage,
but even in case of success, anti-aging use is debatable
• RNA-containing creams are sold in order to rejuvenate skin.