Health Sciences 2711A/B Lecture Notes - Lecture 4: Stereotype, Visual Impairment, Impaired Glucose Tolerance
27 Jun 2018
School
Department
Course
Professor
Giants of Geriatrics: Immobility and Instability
Geriatrics: Sub-specilty of internal medicine and family medicine that focuses on health care
of elderly people. (clinical practice; specialization in medicine)
Aims to promote health by preventing and treating diseases and disabilities in older
adults
A comprehensive approach to patient care
Involves the whole person
Medical/cognitive/psychiatric/functional/social/environmental assessment
Team Focused
Addresses functional “fall-out” of illness (bed rest decreases functional capacity a lot)
whole system falls apart if one part falls apart
Involves “family"
Takes time
Is the care of the individual with multiple handicaps - must treat multiple things at the
same time
Requires detective work
older people have harder time explaining things
patients usually (not always) 75+
looks beyond medical model due to everything involved
Geriatric Assessment
evidence based
delays nursing home admission - if things are managed better
prevents hospital readmission - knowing more means managing more at once instead
of one thing at a time
improves QOL
reduces medications used
different family doctor will give lots of medication, geriatric doctor could cut
meds in half
Who Provides Geriatric Care
Nurses
Occupational therapists
Physiotherapists
Speech language pathologists
Social workers
Dieticians
Therapeutic recreation therapists
Pharmaceutics
Pastol care
Physicians: geriatricians, geriatric psychiatrists, family Docs trained in care of elderly
Hospice
Student Interest in Geriatrics
Students in HS (medicine, nursing etc.) have neg. attitudes toward elders
Attitude lowers (neg.) with training
Instructors may lack knowledge
Instructors may not acknowledge importance of geriatrics
Students not keen on chronic illness
Students like to feel competent
Kids are “cuter”
Loss of idealism
Instructors do not often provide enough info on importance of geriatrics
Ageism
Stereotyping based merely on preconceived notions or idea about age
The belief that old age is inextricably linked with disease and disability
Implications of Ageism
Under-treatment of conditions - People are under treated due to ageism (which
life is more important to save)
Under-recognition of conditions
Inappropriate treatment recommendations
Need for Geriatric Expertise
Residents specializing in geriatrics lowered
Primary care MD’s have little training in caring for older persons
UME geriatric is limited @78 hours nationally in all of Med school
Future doctors will spend >50% of their time seeing person over 65
Background
Anticipated need for 2006: 512-607 specialists
The realty is at 210
Would need to graduate approx. 32 geriatricians/yr.
2007:7 trainees entered GM across the country
Lower student interest in geriatric medicine
Suggested ratio: 1.25 per 10 000 over 65yrs.
Medical system has no way of planning for the future.
Definition of Health
Health: is the state of complete physical, mental and social well-being and not merely
the absence of disease or infirmity (WHO)
Normal Ageing
In 1962 strehler defined normal aging as
The process of growing old defined by gradual biologic impairment satisfying 5
criteria
The effects are:
Cumulative over time
Progressive in nature - no way back
Universal - exception cancer cell
Intrinsic (would occur in a perfect environment)
Deleterious (compromise normal biological function)
Chronic Disease
85% of Canadians over 75 years have at least 1 chronic disease
The most common chronic diseases include
Arthritis (50%)
Visual impairment (30%)
Hearing impairment (30%)
Hypertension (30%)
Cancer (20%)
Measuring Function
Activities of daily Living (ADLs): mobility, transfers, eating, grooming, dressing
Instrumentals Activities of Daily Living (IADLs): managing medications, managing
finances, meal preparation, shopping, housework, travel and telephone
Functional Inapirment
Very common in later life
19% of those >age 65 are dependent on someone else for at least 1 ADL
More than 30% of those >65 experience functional impairment
15% of those over 65 have trouble walking
1/4 men and 1/3 women over age 85 have difficulty with walking
2/3 of people in hospital or nursing home unable to (walk) ambulate without assistance
A lot of people meaning a lot of caregivers
Giants of Geriatrics - Bernard Issac
Clusters of chronic diseases with diminished possibility for recovery, afflicting most
Document Summary
Geriatrics: sub-specilty of internal medicine and family medicine that focuses on health care of elderly people. (clinical practice; specialization in medicine) Aims to promote health by preventing and treating diseases and disabilities in older adults. Addresses functional fall-out of illness (bed rest decreases functional capacity a lot) whole system falls apart if one part falls apart. Is the care of the individual with multiple handicaps - must treat multiple things at the same time. Requires detective work older people have harder time explaining things patients usually (not always) 75+ looks beyond medical model due to everything involved. Physicians: geriatricians, geriatric psychiatrists, family docs trained in care of elderly. Students in hs (medicine, nursing etc. ) have neg. attitudes toward elders. Instructors do not often provide enough info on importance of geriatrics. Stereotyping based merely on preconceived notions or idea about age. The belief that old age is inextricably linked with disease and disability.
