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JOSE RONILO G. JUANGCO, MD. MPH.

UERMMMCI
DISEASE PREVENTION AND CONTROL

COURSE OUTLINE
Epidemiology of Geriatrics
Healthy aging
Preventive Geriatrics

Satchel Paige
Age
is a question of
mind over matter.
If you dont mind,
it doesnt matter.

8/9/16

REASONS FOR POPULATION AGING

FERTILITY RATE

MORTALITY RATE

LIFE SPAN

POPULATION AGING
8/9/16

Longest documented lifespan so far.

Madame Jeanne
Calment
(1875-1997)
Exact Age at
Death:
122 years and 164
days

5
8/9/16

Oldest documented Filipino

107 years and 55 days
January 6, 1812 - March
2, 1919

Oldest person alive

BESSE COOPER
114 years, 316 days as
of July 08, 2011 after
Maria Gomes Valentim
(Brazil)died just 18 days
short of her 115th
birthday.

DR. FE DEL MUNDO 99 Y/O

BORN NOVEMBER 27,1911

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DECREASE FERTILITY

8/9/16

10

Globally, people aged over 60 will outnumber children aged 0-14 by 2050

8/9/16

11

The number of older persons has more than tripled since 1950; it will almost
triple again by 2050

8/9/16

12

The number of working-age people per older person is expected to drop

globally by more than 50 per
cent over the next four decades

The potential support ratio is the number of persons aged

15 to 64 per every person aged 65 or over.
8/9/16

13

The number of persons aged 80 or over is increasing substantially

In 2009, six countries account for over 50 per cent of the population
aged 80 or over. China 18 M, US12 M India 8 M, Japan 8 M and
Germany and the Russian Federation with 4 M each

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14

Philippines

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15

Data
2007 Philippine Longitudinal Study of Aging (PLSOA)
sample size:

60+ = 3,105

1996 Philippine Elderly Survey (PES)

sample size: 50+ = 2,285
60+ = 1,264

NSO Census data (1980, 1990, 2000, 2007)

8/9/16
16

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17

DISABILITIES

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18

HEALTH STATUS AND NEEDS

LIFESTYLE RELATED DISEASES

DEPENDENCY SUPPORT RATIO

HIGHER MORBIDITY RATES THAN IN THE

YOUNGER AGE GROUPS

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19

HEALTH STATUS AND NEEDS

RATIO OF GERIATRICIANS
TO ELDERLIES
1: 186,839
LACK OF GERIATRIC
WARDS
LIMITED CAPACITY FOR
ACCESS

8/9/16

20

CENTERS FOR GERIATRIC CARE

Center for Healthy Aging
Geriatric Wellness
The Medical City
Geriatric Multidisciplinary Clinic
Manila Doctors Hospital
Philippine General Hospital
Geriatric Outpatient Clinic
St. Lukes Medical Center
Geriatric Center

The Medical City Home Care

Ortigas, Pasig
Home Health, Inc
Sikatuna Village, QC
Mano Po Nursing Home
Araneta Ave., QC
The Wellness Place
Philamlife Village, QC
Mother Ignacia Home for Women
Pansol, Laguna
La Verna
Marikina City

HEALTH STATUS AND NEEDS

MORBIDITY

INFLUENZA
TB
BRONCHITIS
DIARRHEA
HYPERTENSION
PNEUMONIA
HEART DISEASES
MALARIA
CHICKEN POX
MALIGNANCY
HEALTH INTELLIGENCE SERVICE DEPATMENT OF HEALTH

8/9/16

22

HEALTH STATUS AND NEEDS

MORTALITY

8/9/16

HEART DISEASES
CARDIOVASCULAR DISEASES
PNEUMONIA
MALIGNANCY
TB
ACCIDENTS
COPD
RESPIRATORY DISEASES
DIABETES
RENAL DISEASES

23

HEALTH STATUS AND NEEDS

LIFESTYLE
50 % SMOKING
1/3 ALCOHOL DRINKERS

8/9/16

24

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25

DEFINITIONS
CHRONOLOGICAL AGE
BIOLOGICAL AGE
SUBJECTIVE AGE

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26

DECADES
OF AGING
NEAR
OLD 45 - 59
YOUNG OLD

(60 69)

MIDDLE OLD

(70 79)

OLD OLD

(80 90)

VERY OLD OLD

8/9/16

(90 UP)
27

MORE DEFINITIONS
PROCESS OF GRADUAL
MATURATION

AGEING
SENESCENCE

LONGEVITY

DECLINE COMPONENT
DELETERIOUS
CHANGES

LIFE SPAN
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28

The best way

to find yourself
is to lose
yourself in the
service of
others.

8/9/16

29

Active ageing
is the process of optimizing
opportunities for health, participation
and security
in order to enhance
quality of life
as people age.
8/9/16

30

GOALS

healthy
healthy

Death
Death

disease
disease

Healthy
aging

Accident/
Accident/ Complcations
Complcations

Decline
Decline // Frailty
Frailty

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32

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33

Determinant:
Health and Social Service
Focus on health promotion and disease
prevention
Equitable access to quality primary and longterm health care

8/9/16

34

For many elderly in the developing world,

the most urgent nutritional issue is

HUNGER

8/9/16

35

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36

Behavioral Determinants
Lifestyle changes at any age, can delay or
deter the onset of disease, and can reduce
or delay functional declines and can
promote the quality of life.

8/9/16

37

 Never too late to change!

EX. STOP SMOKING
Prevent children from smoking
Older adults also benefit from quitting

EX. PHYSICAL ACTIVITY

Prevent heart disease, falling, diabetes

8/9/16

38

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39

Personal Factors
Biology and Genetics
30% of how we age and our predisposition to disease

Psychological factors
Learning speed declines
Wisdom, experience increase
Resilience

8/9/16

40

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41

Determinants Related to the Physical

Environment
Physical Environment
Access to health and social services
Urbanization, womens migration

Housing
Clean air and water
Safe foods

8/9/16

42

Obstacles to Immediate Consultation

BSNOH 2000

Obstacle

Total Pop
n=2690
%

No money

61.4

Too weak

No time, too busy

6.8

Too far

4.5

Transport problems

3.3

Doctor rarely comes to town

2.3

Others
8/9/16

20.0
43

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44

Determinants Related to the Social

Environment
Social Support
Social Isolation increases risk of death and dementia

Protection from Violence and Abuse

Education and Literacy
Elder participation in volunteerism, mentoring,
visiting

8/9/16

45

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46

Economic Determinants
Income
Social Protection
Decline due to migration, nuclear family
National old age pension

Work
Informal sector

8/9/16

47

Health Insurance
BSNOH 2000

Without 92.5%
With
7.5%

8/9/16

BSNOH 2000

48

Philippine Elderly Study

(UP Pop Inst 1996)
Most of those who felt that they had a poor
health status were:
Women
Rural residents
Widowed/Separated
With low educational attainment

8/9/16

49

Logan Pearsall Smith

Youth is the time for

adventures of the body,
but age for the
triumphs of the mind.

8/9/16

50

LEVEL OF EVIDENCE
A = Randomized
Controlled Trials
B = Well Conducted
Studies
C = Expert Opinion

BASIS

USPTF US Preventive Services Task Force

Canadian Task Force
American College of Physicians
American Geriatrics Society
Philippine Geriatric Society

TOOLS
Healthy Lifestyle
Immunization
Screening Processes

HEALTHY LIFESTYLE
HEALTHY EATING HABITS B

Fiber rich foods

Low Fat
Low Salt
Low Calorie
Calcium

HEALTHY LIFESTYLE
PHYSICAL ACTIVITY AND EXERCISE B
Walking
Endurance
Stretching
Flexibility
Weight Training
Strength
Dancing & Taichi
Balance

HEALTHY LIFESTYLE
SMOKING CESSATION A
It is never too late to quit

HEALTHY LIFESTYLE
LIMIT ALCOHOL INTAKE B

Risk of Injuries
Use during Driving

HEALTHY LIFESTYLE
INJURY PREVENTION A
Use of Seatbelts
Not Driving when taking
sedatives or if with poor
vision at night
Fall Prevention Programs

HEALTHY LIFESTYLE
UNDERSTANDING DRUG THERAPY
Complete Drug Information

TOOLS
Healthy Lifestyle
Immunization
Screening Processes

IMMUNIZATION
INFLUENZA A
Annually
Contraindicated with Egg Allergy

IMMUNIZATION
PNEUMOCOCCAL B

5 years
Before age 65
Every 7 10 years
When in doubt Vaccinate

IMMUNIZATION
TETANUS A
(-) Vaccination 2 doses td
(+) Vaccination booster at 65 or every 10 years

TOOLS
Healthy Lifestyle
Immunization
Screening Processes

SCREENING
HYPERTENSION A
Annually
130/85

SCREENING
BREAST CANCER A
Mammography
Every 2 3 years
Stop at 70 (USPSTF), 74
(ACP), 85 (AGS)
No evidence for Self Breast
Examination

SCREENING
COLORECTAL CANCER B
FOBT Annually
Sigmoidoscopy Every 5 years
Colonoscopy once
no role for high fiber low fat diet

SCREENING
CERVICAL CANCER B
Women who have cervix
Pap Smear every 3 years
Stop at 65 (AGS), 70 (ACS) if
adequately screened
Stop after two normal pap
smear

SCREENING
OBESITY OR MALNUTRITION B
Height and weight annually
BMI

SCREENING
ALCOHOLISM
At initial visit or when suspected

SCREENING
DYSLIPIDEMIA B

LDL - 130 mg/dl

HDL - 35 mg/dl
Triglycerides - 150 mg/dl
For high risk patients
No evidence if effective in healthy patients

SCREENING
VISION AND HEARING DEFICITS A
Annually
Include glaucoma screening
No evidence for routine audiometry

MA Perlstein
"If
"If your
your time
time hasn't
hasn't come,
come, not
not even
even aa
doctor
doctor can
can kill
kill you."
you."

FALL PREVENTION

Scope of the Issue

35% of people 65 and older fall each year1

Those who fall are 2-3 times more likely to fall again 2
10%-20% of falls cause serious injuries3

1. Hornbrook, 1994; Hausdorff, 2001; NC BRFSS, 2006

2. Tinetti, 1988; Teno, 1990
3. Sterling, 2001

WHERE DO PEOPLE FALL?

For those 65+
60% happen at home
30% occur in public places
10% in health care institutions

MORE FACTS
Tripping in the home is a cause of many falls
Falls account for 80% of all injury related admissions to the
hospital of people over 65 years of age worldwide
Fractures accounted for only 35% of non-fatal injuries but 61%
of the total costs related to falls
Lower extremity injuries > Upper extremity injuries

THE REALLY SCARY STATISTICS

* ONLY 25% of hip fracture patients will make a full
recovery
* 40% will require nursing home care
* 50% will need a cane or walker

And .

* 24% of those over age 50 will die within 12 months.

WHY DO PEOPLE FALL? SUMMARY OF 12 STUDIES

Accident/environment- 31%
Gait/balance problem 17%
Dizziness/vertigo 10%
Confusion 4%
Postural hypo-tension 3%
Vision 3%
Other and unknown 20%

Multifactorial Risk Factors

Intrinsic
Factors

Extrinsic Factors

Age related
changes
Chronic
conditions

leg
weakness
Balance
problems

Medications

FALLS

Footwear
Alcohol
Environmental
factors
Assistive device

FALLS PREVENTION STRATEGIES FOR COMMUNITY

DWELLING OLDER ADULTS

Encourage exercise for balance & strength

(most effective)2
Comprehensive clinical exam 1
Update vision exam4
Stop medications that increase fall risk 3

FALLS PREVENTION STRATEGIES FOR COMMUNITY

DWELLING OLDER ADULTS

Counsel regarding alcohol consumption

Reduce hazards in home environment 1
Modify footwear
Use assistive devices
Replace vitamin D if deficient
Treat osteoporosis if present

GET UP AND GO TEST (TUGS)

All older persons who report a single fall should be

observed as they

stand from a sitting position

walk 10 feet, turn, and return to the chair
sit back in the chair
[If not completed in 10 seconds or less or demonstrate
unsteadiness, further assessment is required!]

SUMMARY
What have you learned?

REMEMBER
We all need to prepare for the Ageing of the
Population

REFERENCES
Geriatrics Manual by Porras, Jiloca and Juangco
Philippine Plan of Action for Senior Citizens
Active Aging Policy Framework WHO

Resources
North Carolina Falls Prevention Website:

www.ncfallsprevention.org
AGS/BGS Clinical Practice Guidelines: Prevention of
Falls in Older Persons:
http://www.americangeriatrics.org/education/prevention_of
_falls.shtml
Evidence-based Programs: www.stopfalls.org
CDCs Preventing Falls: What Works:

http://www.cdc.gov/HomeandRecreationalSafety/Falls/prev
entfalls.html

outline

overview

strategies

PCPs

resources

HAVE A NIC
E DAY