Ageing - Health Care of the Elderly

Ageing

·        Net effect of age related of age related changes ® ­likelihood of dying

·        Age related changes affect all body systems: cardiac, respiratory, CNS, musculoskeletal, vision, hearing, skin, immune and renal

·        Demographics:

·        In absolute number of 60, and > 60s as a proportion of total population

Concepts

·        Cohort Effect: Each current age group (eg adults now aged 80 – 90) have experienced a distinctive history, leading to the following cohort effects:

o  Disease and disability with roots in environmental exposure varies from cohort to cohort (eg tobacco use, diet, peak bone mass)

o  Cross sectional studies should consider cohort effect (eg medical care available to 80 year olds when they were 30, compared with 30 year olds now). A difference may not be due solely to aging

o  Cultural and social differences between cohorts: eg response to health professionals, access to services, gender and spiritual issues

·        Diversity of physiology and function increases with age: stereotypes are unhelpful, need individual assessment

·        Multiple pathology: Not a single disease process presenting acutely, but a person presenting with disease(s) and/or disabilities. Need a model of care and assessment that considers individual disease processes, individual experience, the social context, and interactions between and within these dimensions

·        Failure to present (professionals need to initiate strategies to overcome):

o  Self stereotyping: I‟m just old, there‟s nothing they can do, etc

o  Cognitive impairment and depression

o  Disability: eg ¯mobility

·        Atypical presentation: Strange or unusual presentations are more common compared with younger people, due to multiple diseases, reduced homeostatic capability, etc. Can be non-specific (not coping, immobile, etc)

·        Threshold effect: Change in functional status can occur in the absence of a clear precipitant due to build up of subclinical dysfunction and loss of physiologic reserve

·        Disordered homeostasis and the cascade effect: Age related effects ® ¯ability to maintain homeostasis in the presence of a threat (eg medication). Disordered homeostasis in one system can trigger dysfunction in another

·        Caring for carers is important in maintaining people in the environment of their choice

Disability

·        Disability is understood by (WHO definition):

o  Pathology: abnormal structure or function of an organ or system.  Eg osteoarthritis

o  Impairment: Loss or abnormality of psychological, anatomical or physiological function. In  decreasing order of prevalence in the elderly these are (in a CHCH study): visual impairment, hypertension, symptomatic spinal osteoporosis, hearing impairment, stroke/TIA, osteoarthritis of the hip or knee, urinary incontinence, dementia, postural hypotension 

o  Disability: Any restriction or lack of ability to perform a task or activity.  Eg for elderly women in

o   Mosgiel: housekeeping, shopping, bathing, mobility 

o  Handicap: disadvantage for a particular individual resulting from impairment or disability that limits fulfilment of a role normal for someone of that age, culture, gender, etc. Eg reading a newspaper, shopping, etc 

o  However, some things don‟t fit well into this model (eg psychiatric illness). WHO currently revising. Will also include impact of environment (eg not being able to drive is not always a disability – eg if you live in the 3^rd world) 

·        Interventions should address all levels, and acknowledge the interaction between each level

·        Reported disability has a clear age associated increase