Older Adults

• A human's capacity is set at about 90 years old
• Aging


  • Intrinsic processes and interactions with the environment (i.e. sunlight, toxins, and diet) cause changes in the structure and function of the body's molecules and cells
  • These changes drive the body's decline and subsequently the failure of the whole mechanism
• 9 hallmarks of aging

  • Altered intercellular communication
  • Telomere attrition
  • Cellular senescence
  • Mitochondrial dysfunction
  • Deregulated nutrient sensing
  • Epigenetic alterations
  • Stem cell exhaustion
  • Loss of proteostasis
  • Genomic instability
• As the years pass, the body accumulates damage through DNA lesions
• How the body ages - mental functions

  • Difficulty remembering or coming up with the right word
  • Difficulty concentrating
  • Difficulty learning new material
• How the body ages - physical activity

  • Unsteadiness or loss of balance
  • Dizziness or light-headedness when standing
  • Loss of muscle strength
  • Difficulty moving; Less flexibility
  • Difficulty exercising strenuously
• How the body ages - the senses

  • Need for reading glasses
  • Difficulty seeing in dim light
  • Difficulty adjusting to changes in light levels
  • Dry eyes
  • Difficulty understanding words
  • Loss of hearing
  • Loss of taste
  • Dry mouth
• How the body ages - eating problems

  • Difficulty swallowing
  • Disinterest in eating
• How the body ages - skin and hair

  • Wrinkles and More tears in the skin
  • Dry skin
  • Bruises and broken blood vessels
  • Slow healing of wounds
  • Difficulty adjusting to changes in temperature
  • Decreased sensitivity to pain
  • Gray or white hair
  • Thinning or loss of hair
• How the body ages - sexual functions

  • Dryness of the vagina
  • Erections that do not last as long, are less rigid, or take more time
• Selected physiologic age-related changes

  • Changes in body composition
  • Changes in cells
  • Changes in the central nervous system
  • Changes in the ears
  • Changes in the endocrine system
  • Changes in the eyes
  • Changes in the gastrointestinal tract
  • Changes in the heart
  • Changes in the immune system
  • Changes in the joints
  • Changes in the kidneys
  • Changes in the liver
  • Changes in the nose
  • Changes in the peripheral nervous system
  • Changes in the pulmonary system
  • Changes in the vasculature
• Factors affecting health

  • Genetic factors
  • Physical and social environments
  • Personal characteristics
  • Demographics
• Maintaining healthy behaviors throughout life contribute to reducing the risk of non-communicable diseases, improving physical and mental capacity and delaying care dependency
• Supportive physical and social environments also enable people to do what is important to them, despite losses in capacity
• Age as a risk factor

  • Age is a primary risk factor for cardiovascular disease, type 2 diabetes, cancer, and neurodegeneration
• Healthy aging


  • The process of developing and maintaining the functional ability that enables the wellbeing in older age
• UN Decade of Healthy Aging (2021 - 2030) - a global collaboration, aligned with the last ten years of the Sustainable Development Goals, to improve the lives of older people, their families, and the communities in which they live
• Decade Action Areas


  • Age-friendly environments
  • Combating Ageism
  • Integrated care
  • Long-term Care
• Age-friendly environments


  Address the social determinants of healthy aging and enabling all people to continue doing things they value and live dignified lives
• Ageism


  Stereotyping, prejudice, and discrimination toward people on the basis of their age
• Ageism affects people of all ages but has particularly negative effects on the health and well-being of older people
• Integrated care


  Older people require a comprehensive set of services to prevent, slow, or reverse declines in their physical and mental capacities. These services need to be delivered to meet the person's needs, coordinated between different health and social care providers, and avoid causing the user financial hardship
• Long-term Care


  Access to good-quality long-term care is essential for these people to maintain their functional ability, enjoy basic human rights, and live with dignity
• WHO's works on cross-cutting issues

  • Abuse of older people
  • Dementia
  • Falls
  • Palliative care
  • Social isolation and loneliness
  • Assistive tech
  • Disability
  • Physical activity
  • Rehabilitation
• Geriatric syndromes share the following risk factors: older age, baseline cognitive impairment, baseline functional impairment, impaired mobility
• Cognitive decline


  It is very common for various geriatric syndromes, so it is imperative that we screen this to inform our prevention strategies
• Screening Tools for Cognitive Decline


  • Mini-Mental Status Evaluation (MMSE)
  • Montreal Cognitive Assessment (MOCA)
  • Mini-Cog
• Mini-Cog


  Takes about 3 minutes to perform, has good sensitivity and specificity for identifying dementia compared with tools that take longer. It consists of a 3-item recall test for memory and a simply scored clock drawing test
• We can't probably directly address cognitive decline in terms of treatment, but we have compelling evidence to suggest that physical activity positively impacts mental functions such as memory, alertness, and mood
• The knowledge of existing cognitive impairments also allows the clinician to make appropriate adjustments in the plan of care to optimize patient outcomes
• Frailty


  A state of increased vulnerability due to age-associated decline in reserve and function resulting in reduced ability to cope with stressors
• Frailty criteria


  • Slowed walking speed
  • Low physical activity
  • Unintentional weight loss
  • Low energy
  • Low grip strength (weakness)
• The dual-trait measure of gait speed with grip strength is accurate, precise, specific, and more sensitive than individual traits and other possible dual-factor combinations; the measurement of gait speed and grip strength is feasible in primary care settings
• With the rapidly aging population, primary care physicians will be increasingly required to identify and manage frail seniors and their associated complex chronic conditions with judicious use of the limited available geriatric specialist resources
• Falls prevention


  1. Establishing injury incidence/severity

  2. Establishing injury causes

  3. Introducing preventive measures

  4. Assessing the effectiveness
• Main variables that may lead to falls

  • Predisposition of internal factors
  • Extrinsic factors
  • Injury mechanism (i.e. a fall)
• The US CDC developed a fall prevention initiative called Stopping Elderly Accidents, Deaths, and Injuries (STEADI) that encourages clinical fall prevention

  
• The STEADI Initiative is a coordinated approach to implementing the AGS/BGS clinical practice guidelines for fall prevention that consists of 3 core elements: Screen, Assess, and Intervene

  
• STEADI screening tools


  • 12-item Stay Independent Brochure
  • Three key questions: Have you fallen in the past year? Do you feel unsteady when standing or walking? Are you worried about falling?
• STEADI risk factors and assessment tools

  • History of Falling
  • Gait, Strength, and Balance
  • Medications that Increase Fall Risk
  • Home Hazards
  • Orthostatic Hypotension