10. Health concerns of elderly. Aging societies

From greek.doctor
  • 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 nuclear envelope
  • 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