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Geriatrics for the public health centre:
introduction
Sukanya Jongsiriyanyong Department of Health, Bangkok Metropolitan Administration
22.Aug.2014
Aging Society
www.thelancet.com. Published online February 8, 2013 Population ageing
accelerating rapidly worldwide
Geriatrics for the public health centre: Introduction
9% 14% 20%
พ.ศ.2553 พ.ศ.2564 พ.ศ.2574
Epidemiology
Geriatrics for the public health centre: Introduction
Geriatrics for the public health centre: Introduction
RAMPS
• Reduced body reserve
• Atypical presentation
• Multiple pathology
• Polypharmacy
• Social adversity
5 Geriatrics for the public health centre: Introduction
Reduced body reserve
RAMPS
Geriatrics for the public health centre: Introduction
Nutr Clin Pract 2009; 24(3): 395–413.
Age-related change in lingual pressure
More pooling/pocketing in the pharyngeal recesses
Increasing the risk of adverse
consequences due to ineffective deglutition
!
Dysphagia
Atypical presentation
• Hyperthyroidism
• Hypoglycemia
• Infection
• Acute coronary syndrome
• Depression
RAMPSGeriatrics for the public health centre: Introduction
Multiple pathology
RAMPSIatrogenesis Instability Immobility Inanition
Incontinence Dementia Depression Delirium
Geriatrics for the public health centre: Introduction
Comprehensive geriatric assessment (CGA)
• Physical assessment
• Mental assessment
• Social assessment
• Functional assessment
10 Geriatrics for the public health centre: Introduction
Multiple pathology
Impression: 81-year-old-female; 14-year-education; engineer; married 1. Abrasion wound both knees due to fall 2. Hypertension with drug-induced postural hypotension 3. Paroxysmal atrial fiﾞbrillation (on anticoagulant therapy) 4. Diabetes mellitus with diabetic retinopathy 5. Osteoarthritis of both knee joints with instability 6. Established osteoporosis with spinal stenosis 7. Moderate dementia, probable Alzheimer’s disease with CVD 8. Vascular parkinsonism 9. Major depressive disorder in remission 10. Malnutrition with oropharyngeal dysphagia 11. Urge urinary incontinence
RAMPS
Geriatrics for the public health centre: Introduction
Polypharmacy
Drug-drug interaction
RAMPS
Medical reconciliation
Warfarin
AllopurinolMetformin
DigoxinOmeprazole
Chlorpheniramine Diazepam Insulin
“Start low, go slow”
Geriatrics for the public health centre: Introduction
Social adversity
RAMPS
depression in the elderly
adherence in the elderly
Geriatrics for the public health centre: Introduction
HAZZARD’S GERIATRIC MEDICINE AND GERONTOLOGY 6th Ed.Lancet 2013; 381: 752-62.
Health and Quality of Life Outcomes 2009, 7:70.Open Heart 2014;1:e000033.
Frailty
Frailty prevention
Healthy diet
Resistance exercise
Aerobic exercise
Tai-chi
Optimized management of medical conditions
Frailty assessment
Promising intervention
Geriatrics for the public health centre: Introduction
Open Heart 2014;1:e000033.
กลุ่มติดสังคม
กลุ่มติดบ้าน
กลุ่มติดเตียง
Primary prevention!Secondary prevention!
Tertiary prevention
Primary prevention for the public health centre
RAMPS
Frailty assessment
Promising interventionGeriatrics for the public health centre: Introduction
Influenza vaccine annually
dT vaccine q 10 years
Primary prevention for the public health centre
Secondary prevention for the public health centre
“ใน1ปีที่ผ่านมา เคยหกล้มไหมคะ” “รับประทานได้ไหมคะ”
RAMPS
Frailty assessment
Promising intervention
Geriatrics for the public health centre: Introduction
Am Fam Physician 2008;78(12):1369-1374, 1376.
Secondary prevention for the public health centre
Advanced Mechanical-altered Pureed
Nectar-like Spoon-thickhoney-like
Tertiary prevention for the public health centre
Swallowing technique for stroke patient with dysphagia
• Eat slowly, not rushed • Small amounts of food/liquid • Concentrate on swallowing • Avoid mixing food & liquid in the same mouthful • Use stronger side of the mouth (unilateral weakness)
HAZZARD’S GERIATRIC MEDICINE AND GERONTOLOGY 6th Ed
Modernized medicine
PALLIATION OF SYMPTOMS
Malignancy Dementia
CHF COPD ESRD
Cirrhosis
Geriatrics for the public health centre: Introduction
Doing nothing
Humanized medicine การดูแลรักษาอย่างมีมนุษยธรรม
PALLIATION OF SYMPTOMS
Palliative care
Geriatrics for the public health centre: Introduction
Humanized medicine การดูแลรักษาอย่างมีมนุษยธรรม
PreventionFrailtyRAMPSAging society
Geriatrics for !the public health centre: introduction
Geriatrics for the public health centre: Introduction
