View source for 10. Health concerns of elderly. Aging societies

* The society is aging – elderly health is becoming more and more important
* Ageing (= ''greying'') of Europe
** Refers to the increase in elderly population relative to the workforce
** Due to decreased fertility, decreased mortality, and higher life expectancy
* Most deaths in developed countries are due to diseases closely related to ageing, like cancer, stroke, heart disease
* There is no evidenced-based proof that dietary supplements delay or stop ageing
** The fact that free radical scavengers doesn’t slow ageing is a counterargument to the free radical theory of ageing
* Theories of ageing
** Researching ageing is difficult, because it is very variable in people, and it occurs over such a long time
** Biological theories
*** Programmed theories = ageing occurs due to a programmed change, a biological clock
**** Programmed senescence theory
***** = senescence (cellular ageing) occurs after a set number of cell divisions (“Hayflick’s limit”)
***** Perhaps due to telomeres, which shorten with each cell division
**** Endocrine theory
***** = hormones control the biological clock
***** Especially seen during menopause
**** Immunology theory
***** = the immune system is programmed to decline over time, increasing the vulnerability to infectious disease, ageing and death
*** Damage or error theories = ageing occurs due to environmental assaults, which cause cumulative damage
**** Wear and tear theory = wear and tear of the body wears out cells
**** Free radical theory = accumulating free radicals accumulate damage on cells
**** Somatic mutation theory = unrepairable DNA damage accumulates
**** Catastrophe theory = enzyme systems are damaged, causing faulty proteins to be synthesized and accumulate
**** Cross-linking theory = cross-linked proteins accumulate and cause dysfunction of proteins
** Psychosocial theories – focus on the psychosocial aspect of ageing
*** Disengagement theory = with age decreased engagement of the person in the society is inevitable
*** Activity theory = satisfaction of life depends on maintaining interests, hobbies, relationships
* Caloric restriction
** Restriction of calories, as long as malnutrition doesn’t occur, delays ageing and extends lifespan in many species
** A type of protein called ''sirtuins'' may be involved in this mechanism
* Hutchinson-Gilford Progeria syndrome
** Progeria means “early ageing” in Greek
** Rare genetic disorder that causes rapid ageing of children
** Death due to age-related diseases occurs at young age
** Due to unstable <abbr>nuclear envelope</abbr>
* Werner syndrome (= adult progeria)
** Rare genetic disorder which causes earlier ageing
** Death occurs at around 40 – 50
** Somatic mutation in WRN gene, which encodes for a DNA repair protein
* Physiological changes in ageing
** Decreased height, increased/decreased weight
** Changed posture
** Skin changes
** Dental changes
** Decreased muscle mass
** Decreased brain mass
** Slower neural conduction
** Decreased kidney function
** Decreased lung function
** Presbyopia
** Presbycusis
** Sense of thirst and hunger decreases
* Health problems of elderly
** Often have multiple conditions at the same time
** These conditions may affect each other, and affect the possibilities of treatment
** Symptoms may be different than in younger adults or completely absent
*** Silent myocardial infarction
*** Pneumonia without fever
*** Thyroid dysfunction without typical symptoms
** The pharmacodynamics and pharmacokinetics change, changing how drugs affect the patient
* 5 “I”s of geriatric care – Immobility, incontinence, instability, intellectual decline, iatrogeny
* Hospice care – care of terminally ill patients
** Complex treatment; physical, psychosocial, and spiritual
** Goal: to improve quality of life, relieve physical and mental suffering
** Involves palliative medicine, which focuses on reducing pain and other symptoms
* Main causes of morbidity in elderly
** Cardiovascular disease
** Cancer
** Musculoskeletal disease
** Metabolic disorders
** CNS disorders
** Depression
** Falls
*** The most common cause of injury
*** Due to physical, sensory, and cognitive changes like slow reflexes, hypotension, etc.
* Main causes of death in elderly
** Heart disease
** Cancer
** Chronic lower respiratory disease
** Stroke
** Alzheimer disease
* Prevention of elderly morbidity and mortality
** Aim: increase number of health life years, reduce damage
** Primary prevention
*** Proper nutrition
*** Encourage and enable physical activity
**** 3x a week
*** Avoid risk factors (alcohol, smoking, etc.)
*** Prevent falls (by adapting the environment, etc.)
*** Ensure social support
** Secondary prevention
*** Screen for hypertension, diabetes, hearing and vision loss, osteoporosis, cancer, depression, etc.
** Tertiary prevention
*** Reduce relapse and complications of diseases
*** Early rehabilitation

[[Category:Public health 1 - Basics of disease prevention]]