Prepared by
Navaid us Saba

Gerontology
– The scientific study of old age, the process of ageing, and the particular
problems of old people.

INTERNET
– The scientific approach to all aspects of aging (health, sociological, economic,
behavioral and environmental)

Myths
– Elderly people are incompetent and incapable of making decisions or handling
their own affairs.
– Most elderly live in nursing homes
– All elderly people live in poverty
– Older people are lonely and unhappy
– Elderly do not want to work
– “Old Age” begins a 65
– Retirement ends your active life

Myths
– it’s ok to treat an older adult as if they were a young child
– A person becomes “old” the day they turn 65
– All older adults are sick, disabled or both
– Old age is accompanied by memory loss and dementia
– Olde adults are all alike
– Personality changes with age which is why there are so many cranky old people
– I am not going to be a gerontologist or a geriatrician, so I know about ageing

Demographic trends of an aging
– Demography is the scientific study of the population.
– Demography of aging as a subfield of general demography.

– The study of demography of aging is currently focused on determining: the state of
the older population;
– Change in the no
– Proportionate size
– Composition of this subpopulation ;
– The component force of fertility
– Mortality
– Morbidity
– Migration
– Immigration

– Distinct subgroups within the older population, appears to reflect societal
concerns about the policy challenges of meeting the welfare and health needs
of all components of an aging society.

– Oldest – old (also called the “frail elderly” or the “extremely old”)
– The special concerns regarding the relatively high rates of illness and disability.
And the concomitant implications for health care and social services provisions
in this age group, the oldest - old have been presents by demographers as a
geriatric imperative for future research.

An historical perspective of the
study of population aging
– Attention to population aging emerged in France at the close of the nineteenth
century
– Sundbarg was the first to place emphasis on the relative proportions of aged
individuals in a society, and the first demographer to note systemic difference
in age composition among countries.
– By implication, he hypothesized that there would be a demographic shift over
time towards an aging population structure in all countries.

– For most western countries, the aging of the population has been a distinctly
twentieth – century phenomenon.
– In U.S.A concerted demographic attention to the aging process can be found in
early 1920s, and increasing concern was expressed in the 1930s when the
declining fertility of the depression led demographers to project rapid changes
in the age structure of the united states

– Today, there is an increasing awareness that population aging will be an
important issue in developing countries currently experiencing social and
economic growth.

– Population aging is now recognized as a worldwide phenomenon that
commands immediate attention if effective societal responses are to be made
to changing demographic realities

Demographic processes and
population age structure
– Change in the size of a population over time depends on the rate persons join
the population through birth or immigration and the rate they leave the
population through death or immigration

– Traditionally, demographers have used the age of 65 for delineating old age.
– This facilitates standardized analyses and grounded in social practices.(eg
retirement, social security provision).

– As there is slightly more males than females are born in human populations
and the mortality experiences of men and women differ, demographers
typically distinguish the sex of persons in constructing models of population
change.

Social gerontology(internet)
– Refers to a specialized field of gerontology that examines the social and
sociological aspects of aging.
– Researchers focus on developing a broad understanding of the experiences of
people at specific ages, such as mental and physical wellbeing. Plus age –
specific concerns such as the process of dying
– Social gerontologist work as social researchers, counselors, community
organizers, and services providers for older adults.
– Because of their specialization, social gerontologist are in a strong position to
advocate

Theories of aging
– Developmental - genetic theories of aging
Name Author Theory
Hayflick limit theory Hayflick and Moorehead There is a limited amount of cell
population doublings, the average
being fifty per life cycle of the cell
Evolutionary theory of aging Darwin An expansion of natural selection
and states that each successive
generation is more resistant to
mutations and when mutation
occurs, they occur at later age.
Stress theory Parsons Survival into old age is enhance by
high vitality and resilience due to an
underlying resistance to stress by
the genes

– Developmental - genetic theories of aging
Author Theory
Neuroendocrine theory Denckla functional decrements in neurons
and their associated hormones are
central to the aging process
Theory of intrinsic mutagenesis Burnett Each species has specific
characteristic of its genes that
regulate the rate of errors, thereby
affecting the life span.

– Stochastic theories of aging
Name Author Theory
Error theory Orgel Any accident or error in either the
machinery or the process of making
proteins would cascade in multiple
effects that would be incompatible
with proper function
Cross linkage theory Bjorksten The large reactive proteins such as
collagen cross link and are responsible
for aging.

– New theories of aging
Name Auhtor Theory
Sleep and aging Leproult Prolong sleep loss effects
hemostasis and the species’ ability
to repair tissue
Werner syndrome Barzilai Normal people carry variants of the
gene that influence their life spines
or predispose them to an early
death

Projected trends in the world’s
aging population
– In approximately thirty years, there will be 850million elderly worldwide. Here
are some pertinent facts
– In most countries of the world there are declining fertility rates and people are living
longer. This means that a country’s population age structure will shift towards the
older age population
– Most of the growth in the no of elderly is taking place in developing countries.

– In developing countries the speed with which the elderly population is growing is
very fast compared with the speed of the same changes in developed/industrialized
countries. this contrast is particularly evident if you compared east Asia with Western
Europe
– Europe is the “oldest” world region, with the highest proportion of population aged
65 and the older, and Africa is the youngest.
– Sweden is consider to be the oldest country with 18% of its population aged 65 and
older.

– Life expectancy
– The dependency / support ratio
– Health and disability

Geriatrics
– A branch of gerontology and medicine which deals with the clinical,
rehabilitative (remedial), psycho – social and preventive aspects of illness in
elderly people.

Living options
– Assisted living
– Activities of daily living
– Preventive healthcare
– Rehabilitation
– Skilled nursing
– Memory care service
– Community involvement
– Continuity education
– Home modification

Legal and financial issues
related to health care for
older people

– Legal ramifications are extremely important for therapists in both
administrative and practicing capacities. Therapists must be certain that they
have taken adequate measures to provide an optimal and legally safe
environment for their patients

Mal practice scenarios
– The john who is the person suing, tries to provide evidence that, through a
failure to meet accepted standards, a patient has been injured. The defendant,
or the person being sued tries to show that quality care was given. Therefore it
is imperative that the therapist constantly complies with regulations and safety
practices. The safety practices of the clinic should be outline in the policy and
procedure manual, and the therapist must constantly document that safety
measures are in place. Legal documentation, separate from the documentation
used for the purpose of reimbursement, is therefore essential.

– If a patient receives minimal or no specific harm because of treatment, a suit
would be improper. Therapists can be sued only because actual harm resulted
from treatment. For example, if a patient states that the therapist did not
diagnosed a particular problem, but the therapist did not prevent the patient
from obtaining an adequate diagnosis, there is no fault. However, if because of
an inadequately maintained piece of equipment, a patient is injured, the
therapist is at fault

Dos and don’ts for legal
documentation
– Do put in patient’s behavior
– Don’t get personal
– Do use quotes
– Don’t advertise incident reports
– Don’t use charts to settle disputes
– Do be neat and legible
– Don’t try to keep secrets.

Red flags for possible litigation
– Patient refuses or leaves treatment
– Patient has cardiac arrest during treatment
– Patient sees doctor at completion of treatment
– Patient goes to hospital within 72 hours
– Patient burned during treatment
– Patient is not properly prepared or equipment fails
– Patient fall during visit
– Patient not informed of his or her condition or complications

Cont…
– Postoperative pain is greater than expected
– Patient not encourage to call doctor if he or she has a problem
– Patient wait is longer than 15 minutes
– Patient is uncomfortable about sexual questions
– Patient feels therapist didn’t spend enough time with him or her.

Financing
– Old age pension
– EOBI

– Thank you

Physiology and pathology of
aging
– The digestive system maintains normal functioning in elderly people.
– Most of the GI complaints in otherwise health older people are due to disease
(environmental agents, chronic non GI disease) rather than to aging .
– Aging is not associated with difference in either the desire to eat or the hunger
response before meal intake , but post prandial hunger and the desire to eat are
reduce.
–

– Up to 40% of healthy elderly people subjectively complain of dry mouth.
– Chewing power is diminished (decrease bulk of the muscles of mastication)
– Gustatory and olfactory sensation tend to decrease with aging
– Thresholds for salt and bitter taste show age – related elevations, whereas that
for sweet taste appears stable.

– Increase stiffness and reduce primary and secondary peristalsis in the human
esophagus that is associated with a deterioration of esophageal function
beginning after the age of 40.
– Most studies on gastric histology have found evidence of an increased
prevalence of atrophic gastritis.

Physiology and pathology of
aging
– Classic example of problems attributed to normal aging include
– Forgetfulness
– Insomnia
– Musculoskeletal pain.
– Some condition become apparent only when a system is stressed
– Eg, renal insufficiency
– Diastolic cardiomyopathy
– Condition involve multiple interacting organ systems are largely recognized as geriatric syndrome
– Eg
– Delirium
– Frailty
– Failure to thrive
– Falls
– Uninary incontinence

– Conditions are not routinely acknowledged in usual medical care and may
simply be overlooked
– Eg
– Vision and hearing deficits
– Mood disorders
– Mobility disorders