MODULE 4
• Geriatrics simply refers to the medical care of the elderly people.
• Geriatric care has two distinct facets-
• first, promotion of health and longevity
• and second, management of diseases which are specifically
incident in old age for sustaining a comfortable and healthy aging
• Gerontology on the other hand refers to the “study of physical
and psychological changes which are incident to old age”.
• the distribution of respondents according to age categories of
• the young-old (60-70 years),
• middle-aged old (71 to 80 years) and
• oldest-old (81+ years)
• assessing the extent of independence versus dependence
prevalent among the elderly.
• in India accounted for 7.4% of the total population in 2001,
• 8.6% (104 million; 53 million females and 51 million males) in
2011
• and has been projected to increase to 19% by the year 2050
[1,5,6].
• Globally, demographers predict that it will take only another 25-
30 years for the 65 years and older age group to reach double the
number of children under 5 years of age.
• This means that future populations might require more
geriatricians than pediatricians.
• one out of two elderly in India suffers from at least one chronic
disease which requires life-long medication.
• impairment of special sensory functions like vision and hearing.
• A decline in immunity as well as age-related physiological changes
leads to an increased burden of communicable diseases in the
elderly.
• Check: Geriatric big care big 10 pdf
The effect of : age changes,
• impaired immunological function,
• poor nutrition,
• multiple pathology,
• sensory deficits,
• psychiatric disorders
• and inter-current drug treatment interact both to modify and
mask a disease process in the elderly.
Geriatric care issues
• The biggest hurdle to a physician attending a geriatric patient is
existence of co-morbidities which refers to presence of two or
more diseases in one individual. These multi-morbidities more
than often interact with each other to lead to non-specific
symptoms, correction of which require thorough assessment.
• Single system disease even if present might manifest atypically.
• Formulating a treatment plan also becomes painstaking
especially against the background that most drugs act more
potently in the elderly thus increasing the risk of adverse drug
reactions (ADR) and interactions.
• This is compounded by rapid deterioration, if the dominant
disease remains untreated and rapid progression to
complications. All these changes take lesser time to occur and a
much longer time to reverse.
• geriatric care has to address two-fold problems- first, basic health
promotion to retard the rate of physiological aging and second
medical management of diseases and disorders incident to old
age.
• It has been reported that a geriatric individual takes an average of
six prescription drugs concurrently and often suffers from adverse
drug reactions
• Geriatric pharmacotherapy needs to be included as a component
of undergraduate and postgraduate education in medicine as well
as in other disciplines like nursing and pharmacy.
• The most recent national policy effort is the National Programme
for the Health Care of the Elderly (NPHCE), launched by the
government of India in 2011 with the vision to provide accessible,
affordable and high quality long term dedicated services to the
elderly by creating more enabling environment for a society for all
ages to promote active and healthy ageing.
• The program however seems to have overlooked the problems of
care-givers of the beneficiaries. Although a number of dedicated
services have been set up at various levels of healthcare delivery,
these services lack specialized equipment and trained geriatric
healthcare team to bring about target oriented management of
geriatric problems.
• As life expectancy increases, so has the influence of mental illness
on older persons’ quality of life, especially at advanced ages.
• At the global level, the number of people living with dementia is
expected to nearly double every 20 years.
• Depressive disorders and symptoms also affect many older
persons, particularly the most vulnerable among them living in
long-term care facilities.
• Depression can be triggered by factors such as isolation and loss
of family members or friends, which are common in old age,
diminishing quality of life as well as negatively interacting with
physical health conditions. The need for mental health care in old
age is thus growing in scope and urgency.
• Climate change and natural hazards have significant implications
for human health, with older people often more vulnerable than
the young.
• The increased health risks associated with advancing age make
older persons particularly sensitive to extreme weather conditions
such as heatwaves, which are increasing in frequency due to
climate change.
• Older persons are also more at risk when natural hazards occur
because they are less mobile and often live alone.
• Older persons in refugee, asylum-seeker, returnee and
statelessness situations are also faced with severe health-related
challenges due to lack of appropriate healthcare services.
• Discrimination, including with regard to opportunities to earn
income; long distances to health facilities, particularly in rural
areas; as well as fees for transportation and medical treatment
are hindrances to accessing health care, especially for those with
chronic conditions.
• The breakdown of social ties—or fabric—of families and
communities caused by forced displacement poses additional risks
to older persons such as marginalization and strains on mental
health and well-being.
WATCH [Link]
search_query=laura+carstensen+ted+talk+
[Link]
• Who gets addiction?
• How is it a community problem?
• What are community solutions for addiction?
Families and substance abuse – Role & Impact
• First, it may be seen as protecting and sustaining both strong and
weak members, helping them to deal with stress and pathology
while nurturing younger and more vulnerable members.
• Secondly, the family may be a source of tension, problems and
pathology, influencing weaker members in harmful ways,
including destructive drug or alcohol use.
• Thirdly, it may be viewed as a mechanism for family members to
interact with broader social and community groups, such as peer
groups, schools, work colleagues and supervisors and persons
associated with religious institutions.
• Fourthly, the family may be seen as an important point of
intervention - a natural organizational unit for transferring and
building social and community values.
• Negativism. Any communication that occurs among family
members is negative, taking the form of complaints, criticism, and
other expressions of displeasure.
• Parental inconsistency. Rule setting is erratic, enforcement is
inconsistent, and family structure is inadequate. Children are
confused because they cannot figure out the boundaries of right
and wrong. As a result, they may behave badly in the hope of
getting their parents to set clearly defined boundaries
• Parental denial. Despite obvious warning signs, the parental
stance is: (1) “What drug/alcohol problem? We don’t see any drug
problem!” or (2) after authorities intervene: “You are wrong! My
child does not have a drug problem!”
• Miscarried expression of anger. Children or parents who resent
their emotionally deprived home and are afraid to express their
outrage use drug abuse as one way to manage their repressed
anger.
• Self-medication. Either a parent or child will use drugs or alcohol
to cope with intolerable thoughts or feelings, such as severe
anxiety or depression.
• Unrealistic parental expectations. If parental expectations are
unrealistic, children can excuse themselves from all future
expectations
• Research has found that friends are more similar in their use of
marijuana than in any other activity or attitude. In this situation,
drug use by peers may exert a greater influence than the attitudes
of parents. This researcher observed that peer and parental
influences are synergistic, with the highest rates of marijuana use
being observed among adolescents whose parents and friends
were drug users
• Parents exercising traditional family roles may be able to limit the
influence of peer groups on children's attitudes towards drug use
and therefore have a crucial influence on children's behaviour
• Family factors that may lead to or intensify drug use are thought
to include prolonged or traumatic parental absence, harsh
discipline, failure to communicate on an emotional level, chaotic
or disturbed members and parental use of drugs, which provides
a negative role model for children
• Dysfunctional drug or alcohol use may mask an underlying
emotional illness. A frequent finding from clinical assessment of
users is a "dual diagnosis", where two or more clinical conditions
exist at the same time in an individual. Multiple problems in the
family are also very common.
Portugal a case study – current status
• [Link]
• [Link]
Reasons
• Experimentation / rebelliousness / curious
• Peer pressure
• Relief from pain (psychological + physical)/ Escapism
• Lack of control / Impulsive
• Accessibility
• Lack of awareness
• Densensitization and normalization
• Media – the idea of fun / happiness/ celebration “happening” rite
of passage
• No meaningful relationships – emptiness and loneliness
• Poverty
See video in folder
See video in folder
The pleasure – pain balance – Anna Lembke – see video in folder
• You feel pleasure – automatically pain is reduced
• You don’t simply return from pleasure to neutral state , the
tendency is to go heavy on the pain side – so you tip the scale
again on happiness end – thus this can get never-ending until you
simply retract from the process
• You are less happy automatically pain sensation increases , in
other words – unhappiness or not being happy is the same as
being in pain