Geriatric Health Promotion

Hildebrand Hanoch Victor Watupongoh

Departemen Ilmu Penyakit Dalam

FK UKI / RSU UKI

Jakarta 2021

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Introduction

Geriatric patients:

≥ 60 years old

+

Multiple Diseases / Complexity

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What is Aging???

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Why aging occurs??

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Multiple Mechanism of aging

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Theories of Aging

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Health promotion of the elderly

• Health promotion is the process of enabling people to increase control over & improve their health by developing their resources to maintain or enhance well being.

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• Health promoting is an action for health using knowledge, communication & understanding

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Objectives of health promotion

• Increase quality and years of healthy life
• Maintain function
• Eliminate health disparities and independency
• Improve (enhance) quality of life
• Extend life expectancy → ↓ premature mortality caused by chronic& acute diseases

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Component of health promotion

1. Exercise
2. Nutrition
3. Rest & sleep
4. Periodic medical check up
5. High risk behavior
6. Spiritual well-being
7. Psychosocial well-being

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1- Exercise

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🡪 3 - 4 kali seminggu,min. @ 30 menit)

• Jalan / Jogging (pukul 8-9 pagi, ± 1 jam)
• Usahakan ikut: Senam Lansia, Senam Jantung Sehat, Taichi, Yoga, dll
• Berjemur 🡪 sinar matahari mengubah Vitamin D di kulit menjadi aktif 🡪 membantu penyerapan kalsium dari makanan.

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OLAHRAGA / AKTIVITAS FISIK

sesuai kemampuan

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Physical benefits of exercise

1. Consumption of body fat
2. Improve cardio-vascular capacity( by↑ blood flow----- keep tissue healthy
3. Control hypertension & blood sugar
4. Improve respiratory function
5. Improve joint flexibility
6. Improve pattern of sleep & rest
7. ↑ independency
8. Improve sense of well –being & relaxation
9. Maintain mind’s function
10. Promote sense of normality
11. Peristaltic movement

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Psychological benefits of exercise

1. Improve mood state
2. Improve self-image
3. Reduce stress
4. Enhance sleep
5. Improve depressive state of elderly

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Social benefits of exercise �

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• Improve social interaction & relation with other

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Taichi, Walking, Water Aerobic, Swimming, Resistance Training

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2- Nutrition

It is neglected especially those living alone or with low income.

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Factors affecting nutritional status:

1. Age related changes
2. Psychosocial factors
3. Economic factors
4. Cultural factors

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Age related changes

• ↓ Taste & smell
• ↓ Visual acuity
• Loss of teeth & poor fitting denture
• ↓ Gastric secretion→ influence in absorption of B12, folic acid & iron.

Food remain longer time in stomach + ↓ gastric secretion will lead to indigestion & feeling of fullness.

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Psychosocial factors

• Depression is common (losses, death, retirement, change of body appearance, impaired vision &poor physical fitness) this will lead to lack of interest in eating& anorexia and ↓ food intake.

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• Living alone also will lead to lack of incentive to cook &eat.

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Economic Factors

• Low income
• Limited access to food and food choices
• Inadequate facilities to food storage and preparation

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Cultural factors

• Eating habits may miss certain food group as vegetarians.

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Nutritional requirement of elderly

1- Calories

• Caloric requirement diminished by 10% in age 51-75 years and by 20-25% in age more than 75 years.

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• N.B: Fat yield 9 cal/gram, CHO and protein yield 4 cal/gram, mineral and water yield no calories

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2- Protein requirement

• 0.8 g/kg body wt
• A balanced diet of a healthy elderly should contain 12-14% of total caloric intake.
• During infection, stress, trauma protein ↑ to 1.6 or 1.5 g/kg body wt

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3-Fat requirement

• Fat either saturated or unsaturated
• Total fat intake limited to 30 % or less of total energy intake
• Saturated fat limited to 10-15% of total energy intake
• Dietary cholesterol intake limited to 300mg/ day or less

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4- Carbohydrates requirement

• CHO is essential for maintaining normal bl. glucose level & preventing protein break down.
• 50% of total calories---- CHO
• Simple CHO as sugar, honey ( avoided)
• Complex CHO as vegetables, grains, fruits
• Complex CHO has vit, minerals, fibers which help in bowel elimination& ↓ bl. cholesterol level.

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5- Vitamins & mineral requirements

• Calcium:---for mineralization of bone &has a role in blood & cardiac function.

🡪 Daily requirement 1200 mg / day if

there is no contraindications

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• Vitamin D :------ needed for calcium absorption& metabolism.
• Exposure 15 minutes/day to sun is enough

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Dietary guideline for old persons

• Eat a variety of food
• Maintain a healthy weight
• Choose a diet low in fat, saturated & cholesterol
• Choose a diet plenty of vegetables, fruits & grain products
• Use sugar & salts in moderate

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❶ Asupan nutrisi 🡪 seimbang

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* Kecuali pasien gagal jantung, gagal ginjal

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KARBOHIDRAT

VITAMIN + MINERAL

PROTEIN + LEMAK

SERAT

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Diet:

• Kurangi asam lemak jenuh
• Sosis, masakan cepat saji, gorengan, ...
• Kolesterol tersembunyi
• Gula, Keju...
• Perbanyak konsumsi sayuran, buah ...
• Asam lemah tak jenuh (olive oil, ...)

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3- Rest & Sleep

• Person spend 1/3 of his life in sleep
• Sleep is time for cell growth& repair
• Elderly need 5-7 hrs at night

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Importance of Rest & sleep:

1. Conserve energy
2. Provide organ respite (rest)
3. Restore the mental alertness& neurological efficiency
4. Relieve tension
5. Emerge feeling of well being

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Factors affecting sleeping patterns

• Age related changes in sleep patterns
• Internal factors
• External factors

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How to promote good sleep

1. Engage in exercise program
2. Avoid exercise within 3-4 hr. of bedtime.
3. Spend time out door in the sunlight each day but avoid period between 12 Md to 3 PM sunshine exposure.
4. Engage in relaxing activities near bedtime.
5. Avoid tobacco at bedtime
6. Avoid drink any caffeinated beverages before mid afternoon.
7. Limit fluid intake after the dinner hour if nocturia is a problem.
8. Limit daytime naps to 30 minutes or less.
9. Avoid using the bed for watching TV, writing bills, and reading.

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4- Periodic medical examination

Importance of Periodic medical examination:

1. Assess elderly level of well-being
2. Detect early signs of disease
3. Educate client how to promote his health
4. Reinforce + ve promoting & protecting behaviors
5. If examination done at home, it permit evaluation of environment ( hazards caregiver…)

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Types of health screening

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Immunizations

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5- High Risk Behavior

• It is behavior that damage physical health.

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It includes:

• Over the counter medication (multiple medications )
• Smoking
• Caffeine

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Smoking

• Nicotine & toxic substances in cigarette has impact on detoxication process in the body------- cell damage& variety of diseases as cancer, respiratory, CVD, ↑ risk of osteoporosis

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• Cessation of smoking improves cerebral blood flow & ↑ pulmonary function

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Multiple medication

• Older people consume many medication--------↑adverse drug reaction

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• The most common over the counter medication: Analgesics, laxatives& antacids followed by cough products, eye wash& vitamins.

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Caffeine

• Found in coffee, tea, soft drinks, chocolate
• It is mood elevator
• It stimulates sympathetic nervous system
• ↑ motor activity
• ↑ muscle capacity & alertness
• ↑ Rapid pulse
• ↑ calcium excretion

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❻ Kendalikan Stress, �Istirahat Cukup, �Sempatkan rekreasi dan/ atau aktivitas sosial lainnya

“THE BRAIN-GUT CONNECTION”

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THANK YOU�TERIMA KASIH

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