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Physical Therapy for Geriatrics

Ageing: Definitions and WHO Recommendations

Saad Al-Nassan

PT, PhD

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Gerontology

The study of all aspects of the aging process, including the clinical psychological, economic and sociologic problems encountered by the elderly and their consequences for both the individual and society.

factors impacting the normal aging process
It’s more sociological base.

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Geriatrics

Is the branch of medicine dealing with the physiology of aging and the diagnosis and treatment of diseases affecting the aged.
It’s more scientific base.

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Aging

Is the process of growing old; describes a wide array of physiological changes in the body systems; complex and variable.

Common to all members of a given species.
Progressive with time.
Evidenced by a:

Decline in homeostatic efficiency.
Increasing probability that reaction to injury will not be successful.

Varies among and within individuals

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Life span and life expectancy:

Life span:

the length of time for which a person or animal lives or a thing functions; in humans 110-120 years.

Senescence:

last stages of adulthood through death.

Life expectancy:

Is the number of years of life expectation from year of birth.

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Ageism

AGEISM is discrimination and prejudice based on chronological age.
It’s an attitude that people lose value as a person because of their age or define a person’s capabilities by their age.
Ageism determines how people interact with the elderly and when manifested in the clinic, it determines how health professionals treat the elderly.
https://youtu.be/7sQTgLgFVaE

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�Categories of elderly�

The government’s definition of “senior” begins at age 65
The senior client may start at 50 for some, 60 or 65 for others.

The people report they are only as old as the “feel”.

Some notable changes in physical capacity (exercise tolerance) occur at age 50
Gerontologists divide the senior population into the “
Young elderly: ages 65-74.
Old elderly: ages 75-84.
Old, old elderly or old & frail elderly: ages >85

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WHO ACT AND RECOMMENDATIONS TOWARD HEALTHY AGEING �

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Populations are getting older

2015

2050

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What is healthy ageing?

WHO defines healthy ageing as “the process of developing and maintaining the functional ability that enables wellbeing in older age”
Functional ability is about having the capabilities that enable all people to be and do what they have reason to value:
Meet their basic needs
Lear, grow, and make decisions
To be mobile
Build and maintain relationships
Contribute to society.

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There is no “typical” older person

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Barriers to Healthy Ageing

Outdated and ageist stereotypes
Inadequate policies
Lack of accessibility
Inadequate or absent services
Lack of consultation and involvement

Although there is no typical older person, society often views older people in stereotypical ways that can lead to discrimination against individuals or groups simply on the basis of their age. This has been labelled ageism, and this may now be an even more pervasive form of discrimination than sexism or racism. One widespread ageist stereotype of older people is that they are dependent or a burden. This can lead to an assumptions during policy making that spending on older people is simply a drain on economies and to emphasize costs containment.

Lack of accessibility to housing, transportation, social facilities all limit older people's ability to participate.

Inadequate or absent service are widespread barriers. For example health systems are often designed to cure acute conditions or systems and manage health issues in disconnected and fragmented ways, that lack coordination across care providers, settings etc. Long-term care systems in many countries do not existing placing an unsustainable burden on families – most women -.

Lack of consultation and involvement of older people in the decisions that affect their lives.

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Align health systems

Place older people at the centre of health care
Shift the care focus from managing diseases to optimizing what people can do
Develop the health workforce

Health systems need to be realigned to the needs of the older populations they now serve. Most health systems around the world are ill-prepared to address the needs of older people, who often have multiple chronic conditions or geriatric syndromes. Systems must be capable of providing older person-centred and integrated care, and focus on maintaining capacities as people age.

1) The starting point will need to be to put older people at the centre of health care. This will require focusing on their unique needs and preferences, and including them as active participants in care planning and in managing their health states. But changes are needed to systems, too. Health services have to be better integrated between levels and across specialist groupings. Much better coordination is needed with long-term care systems, and possibly formal integration as well. Case management, support for self-management, and support for ageing in place need to be woven into the fabric of health care for older people.

2) Second, evidence suggests that focusing primarily on older people’s physical and mental capacities, and maximizing their ability to do the things that are most important to them, is more effective than prioritizing the management of specific chronic diseases. This is not to reject the worth of disease management, but rather to underscore that it is an older person’s physical and mental capacities that should be the targets of, and entry points for, health interventions. Approaching older people through the lens of intrinsic capacity and the environments in which they live helps ensure that services are oriented towards the outcomes that are most relevant to their daily lives.

3) Third, the health workforce needs to be better prepared to deliver older person-centred and integrated care. They need basic knowledge and skills in geriatrics, and they need to know how to work in integrated systems of care.

These changes appear to be both affordable and sustainable. Although much of the debate on population ageing assumes it will be associated with an unmanageable increase in the demand for services, the evidence suggests it will be a much less significant driver of inflation in health-care costs than factors such as new technologies and changes in clinical practice. The integrated and person-centred approaches outlined in report have been shown to not only have better outcomes for older people but also to be no more expensive than traditional services.

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Develop long-term care systems

Establish the foundation for a functioning system
Develop the long-term care workforce
Ensure the quality of long-term care

In the 21^st century, all countries need an integrated system of long-term care. In low- and middle-income countries, the challenge may be to build a system where one does not already exist. In these settings, the responsibility for long-term care has often been left entirely to families. Socioeconomic development, population ageing and the changing roles of women mean that this practice is no longer sustainable or equitable.

Regardless of the setting, comprehensive systems of long-term care will be essential to meet the needs of older people, reduce inappropriate dependence on acute health services, help families avoid catastrophic care expenditures, and free women to play broader social roles.

1) Only governments can establish and steward long-term care systems as a whole. But this does not mean that they need to do everything. Each country will need to take stock of its unique situation to identify the best system for its context.

2) As with health systems, it will be crucial to develop a sustainable and appropriately trained workforce to provide long-term care. A crucial strategy for ensuring a sustainable workforce in the future will be to provide paid caregivers with the status and recognition that their contributions deserve.

3) The quality of long-term care can be improved by moving away from notions of long-term care as a minimal and basic safety net that provides rudimentary support to older people who can no longer look after themselves, towards a more positive and proactive agenda. Systems and caregivers need to look at how they can optimize both the older person’s capacity, and compensate for losses of capacity, in a way that maximizes dignity and choice.

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Create age-friendly environments

Combat ageism
Enable autonomy
Support Healthy Ageing in all policies

We need to ensure everyone can grow old in age-friendly environments.

Creating environments that are truly age-friendly requires action in many sectors – health, long-term care, transport, housing, labour, social protection, information and communication – by many actors – government, service providers, civil society, older people and their organizations, families and friends. It also requires action at multiple levels of government.

1) Addressing ageism must lie at the core of any public health response to population ageing. Although this will be challenging, experiences combating other widespread forms of discrimination, such as sexism and racism, show that attitudes and norms can be changed.

2) Autonomy has been shown to have a powerful influence on older people’s dignity, integrity, freedom and independence, and has been repeatedly identified as a core component of their general well-being. Fundamentally, older people have a right to make choices and take control over a range of issues including where they live, the relationships they have, what they wear, how they spend their time and whether they undergo a treatment.

3) Finally, if the goals of Healthy Ageing are to be achieved, all government sectors need to consider their contribution to and impact on Healthy Ageing. National, regional, state or municipal ageing strategies and action plans can help to guide this intersectoral response, and ensure a coordinated approach that spans multiple sectors and levels of government.

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Improve measurement, monitoring, and understanding

Agree on metrics, measures and analytical approaches
Improve understanding of the health status and needs of older populations
Increase understanding of ageing trajectories and what can be done to improve them

Making progress on Healthy Ageing will require a far better understanding of age-related issues and trends. Many basic questions remain to be answered.

As a first step towards answering these, older people must be included in vital statistics and general population surveys, and analyses of these information resources should be disaggregated by age and sex. Appropriate measures of Healthy Ageing and its determinants and distributions will also need to be included in these studies. But research will also need to be encouraged in a range of specific fields related to ageing and health, and this will require agreement on key concepts and how they can be measured.

1) The current metrics and methods used in the field of ageing are limited, preventing a sound understanding of key aspects of Healthy Ageing. Often, appropriate methods do not yet exist. Sometimes, comprehensive approaches are used in other fields but not adapted to older populations. Consensus is needed on which approaches are most appropriate.

2) And, although general population-based research and surveillance need to place a greater emphasis on older people, specific population-based research about older people is also required.

3) Finally, fostering Healthy Ageing will require a much better understanding of common trajectories of ageing, including changes in capacity and ability over time.

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Investing in Healthy Ageing means creating a future that gives older people the freedom to live lives that previous generations could never have imagined.

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