Geriatric Physiotherapy in India.pptx
What is Geriatrics Geriatrics is the branch of medicine that focuses on health care of the elderly. It aims to promote health and to prevent and treat diseases and disabilities in older adults. Geriatrics was separated from internal medicine as a distinct entity in the same way that pediatrics is separated from adult internal medicine and neonatology is separated from pediatrics Gerontology Gerontology is the branch of biomedical sciences that studies aging. The term “geriatrics” is used to refer specifically to the medical study of diseases and problems of the elderly. Changes with ageing Skin Epidermis thinner and fragile Dermis less elastin and flexible Hypodermis thinner and less padding UV light accelerates skin ageing Senile purpura Eye Ptosis Dry eye Tearing Flatten & uneven cornea with light scattering Hyperopia (farsightedness) Smaller pupil requiring brighter light to read Slower dark adaptation Reduced contrast sensitivity Ear Reduced sweat glands with increased ear wax affecting hearing Cochlea degeneration causing high tone loss Kidneys Reduced ability to excrete water, waste products and drugs Less tolerate water depletion Loss of circulation rhythm with nocturia Smaller and less expansible bladder with frequency of urine Less contractable bladder with hesitancy Bigger prostate with fair urine stream Bone Continual loss of bone mass from the 4th decade Hormonal change with more bone resorption than formation Less Ca absorption Shorter and stoop Brittle with easy fracture New bone formation at the verge of joints Cartilage thinner Nervous system 30,000-50,000 neurons die each day with diminishing reserve IQ slowly decline after the age of 25 Reduced short term memory Decreases retrieval ability Interrupted and less deep sleep Reduced pain, touch, temperature, and vibration sensations Reduced postural control and balance heart Heart becomes more rigid with decreased output Heartbeat less responsive to stress Heartbeat less variable with each breathing Irregular heart beat more common with ageing Systolic blood pressure increases with age Pulse pressure widened with hardened vessels Less efficient venous return prone to postural hypotension Lungs Lungs become more rigid with early closure of small airways Less efficient blood gas exchange Chest wall becomes more rigid too Reduced lung volume and vital capacity Bronchial villi thinner and cough reflex less effective Reduced ability to cope with challenges like climbing stairs, running Reduced immunity prone to chest infection GIT Saliva glands secret less with dry mouth Taste and smell senses decline Less healthy teeth affecting chewing/nutrition Stomach muscle weakened and less hungry Small intestine villi absorb less calcium, vitamin B12, folic acid Large intestine muscle weakened and secrets less mucus prone to constipation Less liver blood flow and function with fall in toxic substance/drug clearance Bile thicker with cholesterol prone gallstone Diseases in old age Geriatri
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Geriatric Physiotherapy in India.pptx
- 1. Resource Person - Prof. Satyen Bhattacharyya Associate Professor : BIMLS, Bardhaman 8348050005 www.fitofine.in Geriatric Physiotherapy
- 2. What is Geriatrics • Geriatrics is the branch of medicine that focuses on health care of the elderly. It aims to promote health and to prevent and treat diseases and disabilities in older adults. • Geriatrics was separated from internal medicine as a distinct entity in the same way that pediatrics is separated from adult internal medicine and neonatology is separated from pediatrics
- 3. Gerontology • Gerontology is the branch of biomedical sciences that studies aging. The term “geriatrics” is used to refer specifically to the medical study of diseases and problems of the elderly.
- 5. Skin • Epidermis thinner and fragile • Dermis less elastin and flexible • Hypodermis thinner and less padding • UV light accelerates skin ageing • Senile purpura
- 6. Eye • Ptosis • Dry eye • Tearing • Flatten & uneven cornea with light scattering • Hyperopia (farsightedness) • Smaller pupil requiring brighter light to read • Slower dark adaptation • Reduced contrast sensitivity
- 7. Ear • Reduced sweat glands with increased ear wax affecting hearing • Cochlea degeneration causing high tone loss
- 8. Kidneys • Reduced ability to excrete water, waste products and drugs • Less tolerate water depletion • Loss of circulation rhythm with nocturia • Smaller and less expansible bladder with frequency of urine • Less contractable bladder with hesitancy • Bigger prostate with fair urine stream
- 9. Bone • Continual loss of bone mass from the 4th decade • Hormonal change with more bone resorption than formation • Less Ca absorption • Shorter and stoop • Brittle with easy fracture • New bone formation at the verge of joints • Cartilage thinner
- 10. Nervous system • 30,000-50,000 neurons die each day with diminishing reserve • IQ slowly decline after the age of 25 • Reduced short term memory • Decreases retrieval ability • Interrupted and less deep sleep • Reduced pain, touch, temperature, and vibration sensations • Reduced postural control and balance
- 11. heart • Heart becomes more rigid with decreased output • Heartbeat less responsive to stress • Heartbeat less variable with each breathing • Irregular heart beat more common with ageing • Systolic blood pressure increases with age • Pulse pressure widened with hardened vessels • Less efficient venous return prone to postural hypotension
- 12. Lungs • Lungs become more rigid with early closure of small airways • Less efficient blood gas exchange • Chest wall becomes more rigid too • Reduced lung volume and vital capacity • Bronchial villi thinner and cough reflex less effective • Reduced ability to cope with challenges like climbing stairs, running • Reduced immunity prone to chest infection
- 13. GIT • Saliva glands secret less with dry mouth • Taste and smell senses decline • Less healthy teeth affecting chewing/nutrition • Stomach muscle weakened and less hungry • Small intestine villi absorb less calcium, vitamin B12, folic acid • Large intestine muscle weakened and secrets less mucus prone to constipation • Less liver blood flow and function with fall in toxic substance/drug clearance • Bile thicker with cholesterol prone gallstone
- 16. Geriatric Physiotherapy • Geriatric physiotherapy became a specialty of physical therapy study in 1989. since then, physiotherapists have worked to understand the problems of the aging. • There is a long list of problems dealt with in geriatric physiotherapy
- 17. AGED PEOPLE PROBLEMS • HEALTH PROBLEMS • Joint problems • Impairment of special senses • Cardiovascular disease • Hypothermia • Cancer • Prostate enlargement • Diabetes • Accidental falls • Alzheimer’s • Arthritis • Balance disorder • Incontinence • Joint replacement • Pulmonary disease • Stroke • Psychological problems Emotional problems Suicidal tendency Senile dementi Alzheimer’disease • Social problems Poverty Loneliness Dependency Isolation Elder abuse Generation Gap
- 19. Deconditioning • Problems that happen because the patient simply does not use their limbs. These problems can be addressed by reconditioning through range of motion and other exercises
- 20. Cardiovascular disease • Exercise • Aqua therapy • Electrical stimulation etc
- 21. Musculoskeletal problems • Such as osteoporosis and osteoarthritis • These problems require special attention as osteoporosis makes patients frailer, and osteoarthritis is very painfull
- 22. fall • Very common • Physio increase the balances and muscle power
- 23. Risk factor of AGED PRONE FOR INFECTIONS PRONE FOR INJURIES NEED SPECIAL ASSISTANCE PRONE FOR PSYCHOLOGICAL PROBLEMS PRONE FOR DEGENERATIVE DISORDERS INCREASED RISK FOR DISEASE INCREASED RISK OF DISABILITY INCRASED RISK OF DEATH
- 24. AIM OF GERIATRIC MEDICINE • Maintenance of health in old age by high levels of engagement and avoidance of disease • Early detection and appropriate treatment of disease • Maintenance of maximum independence consistent with irreversible disease and disability • Sympathetic care and support during terminal illness
- 26. PREVENTION • Primordial prevention • Pre geriatric care • Primary prevention • Health education • Exercise • Secondary prevention • Annual medical check-up • Early detection ( Universal approach, Selective approach) • Treatment • Tertiary prevention • Counseling and Rehabilitation • Welfare activities (Sanjay Niradhar Yojana, Vridhashrama) • Chiropody services • Improving quality of life • Cultural programme • Old age club • Meals-on wheel service • Home help • Old age home
- 27. What exercise do after age of 50 • Improves oxygen utilization • Nutrients to muscles • Transfer of oxygen from the red blood cells to muscle cells • Number of mitochondria increases, enhancing aerobic metabolism • Improved coronary blood flow • Stroke volume increases
- 28. • Raising levels of high-density lipoprotein cholesterol, the 'cardioprotective' lipid, and lowering levels of low density lipoprotein cholesterol • Exercise lowers blood pressure and reduces obesity • A combination of these two factors, in addition to the reduction in cholesterol, decreases the risk of ischemic heart disease. • Improve exercise tolerance in older people with COPD • Aerobic fitness
- 29. • Help in diabetes by decreasing insulin resistance • Increase bone mass in high impact activities • Joint mobility & muscle strength for osteoarthritis • Sleep • Mood
- 30. Risk • Sedentary • Co-morbidity • Chronic disease
- 31. How to judge • myocardial infarction within six months • angina or physical signs and symptoms of congestive heart failure • resting systolic blood pressure of 200 mmHg or higher • A functional test of cardiac capacity is to ask the patient to walk 15 m (50 ft) or climb a flight of stairs • ECG
- 33. Inactive older people • Goal is to reduce time spent of sitting • Use stairs instead of elevators • Brisk walk for shorter time & distance but with several times in a day • Functional exercises
- 34. Generally active older people • Aerobic exercises or resistance training • Aerobic exercises like cycling (stationary), brisk walking, swimming & water aquatics • Add 5 to 10 minutes of warm up & 15 minutes of cool down • Stretching • Weight exercises, with less intensity • Resistance exercises if permits
- 36. Drugs for Hypertension (treated with ACE inhibitors, angiotensin 2 receptor blockers) Lower peripheral resistance Exercise related dehydration Hypotension Dizziness
- 37. Angina, tremor, migrain (treated with beta-blockers) • Prescribed generally after MI • Decrease the cardiac rate • Older athletes who are taking, beta-blockers will have a restricted exercise capacity, particularly in endurance events. Side effects • postural hypotension • Asthma • excessive tiredness • Impotence • hyperkalemia • lethargy
- 38. Diuretics Used in Hypertension & heart failure May have dehydration in hot climate as there is more urine output Side-effects postural hypotension, light- headedness or fainting.
- 39. Prevention Prevention includes maintaining adequate hydration and avoiding standing still immediately after exertion Take diuretics after exercise session, not before that
- 40. NSAIDs • Serious side-effects of these medications include hypertension, fluid retention and the development of peptic ulceration • Can disturb renal function & cardiac function • Prevention • Don’t exert after taking NSAIDs
- 41. CNS drug • Benzodiazepines • nitrazepam and diazepam • Oxazepam • temazepam and lorazepam Effects: fine motor skills coordination and reaction time Thermoregulation This may lead to an increased risk of injury, especially in contact sports. Prevention Often, people who commence exercise can reduce their need for these medications.
- 42. Insulin and oral hypoglycemic drugs • The dosages of insulin and the oral hypoglycemic drugs may need to be reduced prior to exercise to avoid hypoglycemia
- 68. Strengthening Exercise, using own body weight
- 87. Refrence: • Clinical Sports Medicine by Karim Khan and Peter Brukner • Applied Exercise and Sport Physiology, With Labs • Geriatric Physiotherapy Photo credit: • Souvik Samanta • Dr. Argha Sadhu
- 88. www.fitofine.in