geriatric services

7/27/2019 Geriatric Services

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Geriatric Services


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Introduction

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The population is gradually aging

In India, 5% population is above the age of 60years

In Western countries this is more than double

In 2006 World Population Prospects a reportby the Population Division of the UN Departmentof Economic and Social Affairs projects the

following:


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Introduction

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By 2050, Indias life expectancy is likely to increasefrom the current 64.7 to 75.6 years

Indians above 80 will increase more than six times

from the current 78 lakh

People over 65 will almost quadruple from 6.4 crore

in 2005 to 23.9 crore

Population aged 15-24 years will decrease from

present 19.3% to 12.7%


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Aging of Population

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By aging of population is meant the increase inthe proportion of people in the higher age group

of population

Causes

Decrease in fertility

Reduced mortality

Migration of people


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High-Risk Group Amongst

Elderly

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Very old people

Aged person living alone

Aged women, especially single and widowed

Aged people living in institutions Isolated old people

Aged people suffering from severe ailments orhandicaps

Aged couple in which one spouse is seriously ill orhandicapped

Aged people having to live on the minimum supportprovided by the state or social security, or on evenless


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Geriatrics Terminology

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Aging of the Population Denotes a physiologic process that begins at

conception and entails changes, characteristic for

the species, throughout the whole life cycle

Gerentology Defined as the scientific approach to all aspects of

aging (health, sociological, economic,environmental and others)

It is, most often a multidisciplinary field


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Geriatrics

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It is a branch of gerontology and medicine that isconcerned with the health of the elderly in all its

aspects:

Preventive

Clinical

Remedial

Rehabilitation

Continuous surveillance


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Geriatric Problems

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Health Fundamentally, it does not differ from other health problems But the special features are:

Ill health in elderly is manifested by a number of physical or mentaldefects

These were either neglected in earlier part of life or that occurred later

Morbidity Pattern is usually of degenerative nature Most prevalent are:

Cardiovascular

Cerebrovascular

Cancer

Diseases of locomotor system Mental illness

Diseases of vision and hearing

Accidents


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Geriatric Problems

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Mortality 11.9% over 60 years

Fatal illness

Cardiovascular 23%

Cerebrovascular 23.1%

Respiratory 10.8%

Renal Failure 4.1%

Others 34.5%


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Geriatric Problems

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Mortality Increases in the older age group Leading causes above 65 years are:

Cardiovascular diseases Cerebrovascular accidents Malignant diseases

Early detection There is no comprehensive programme or system

for detecting ill health that is not readily apparent Physical, mental, environmental, or social factors

causing ill health often go unreported This specially affects the health of the elderly


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Geriatric Problems

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Nutrition Elderly people are often subclinically malnourished

Oral health Good oral hygiene favours correct nutrition

Has positive psychological and social effects May prevent disease

Environment Both physical and social environment have

important bearing on the health of elderly Socioeconomic factors

H it li ti D t


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Hospitalization Data (From aNew Delhi Hospital)

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Male : Female 2:1 (N = 3142)

Types of patients Medical 47.2% Eye 19.4% Surgical 15.1%

Orthopaedics 4.5% Medical

Cardiac 33.7% Respiratory 31.6% Neurological 19.2% Gastrointestinal 5.6% Renal 3.6%

ALS 9 days for patients over 60 years


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Concepts and Principles for Geriatric Services

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Essentially a community service Doctors, Public health nurse, Social service agencies,

Hospital - all take part

Best place for elderly is their own home

Aged are at-risk population Main emphasis on prevention

A holistic approach

Geriatric service as part of general health service

Service oriented towards family and community

Spectrum of service wide Service available to all

Continuous evaluation


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Geriatric Service Concepts and Principles

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Geriatric service should be a part of the general healthservice

Service should be oriented to the family and communitywith integration and coordination

Spectrum of service should be wide with concept ofprogressive patient care with continuity of service

Service should be available to all

A continuous evaluation mechanism should be built intothe system


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The Aims

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Sustained in Independence, Comfort andContentment in home surrounding

Those in need should be provided with alternative

residential accommodation

Hospital accommodation to be provided to those in

need of full medical assessment, therapy,

rehabilitation or long term skilled medical or nursingcare


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Components

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A model geriatric programme comprises thefollowing elements:

General practitioners health centre

Domiciliary service

Hospital services and

Community services


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Health Centers (Model Proposed byWHO)

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8-12 GPs serve 20,000 to 30,000 people

Domiciliary, community services can be

integrated

Entire health team meet at the centre

Team includes physician, social worker, nursesand voluntary agencies

Screening done by nurse


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Domiciliary Service

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Service includes: (in patients own home)

Home helpers

Night sitters-in

Meals on wheels Physiotherapy

Occupational therapy

Chiropody


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Hospital Services

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A Geriatric Unit

OPD

Day Hospital

Continuing treatment

Long term beds including

Terminal care


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Bed Distribution

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ICU -2-5%

Semi-intensive and basic care 50-55%

Long stay 15%

Neuropsychiatry 10-12%

Rehabilitation 15%


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Changes Associated with Aging

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Vision Glaucoma, cataracts, macular degeneration

Sensitivity to glare

Reduced speed of accommodation tochanging light levels

Reduced vision in low light

Yellowing of the aging lens

Reduced visual acuity Reduced fields of vision


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Hearing

Reduced hearing ability

Malfunctioning hearing aids

Sensitivity to high frequency noises Difficulty filtering out background noise


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Physical Changes Loss of muscle strength (up to 40% - 60%) ,

flexibility and coordination Reduced balance

Reduced reflex /reaction time Reduced dexterity and fine motor coordination Increased response to environmental vibration Decreased thermal response

(tolerance of a lower range of roomtemperatures)


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Cognitive Function Increased prevalence of dementia with age

Reduced memory

Visual perception changes

Reduced reasoning and abstract thinking

Communication changes

Increased susceptibility to delirium


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SENIOR FRIENDLY PHYSICAL

ENVIRONMENT IN HOSPITALS

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Lighting Seniors require 30% more light for equivalent

vision, and up 5 times brighter light in areas forreading and task completion

30-70 foot-candles indoor illumination

Consider using natural fluorescents ,fullspectrum lights(T5 and T8 lamps)

Ensure no glare Cove lighting Direct illumination on vertical surfaces No highly polished surfaces


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SENIOR FRIENDLY HOSPITALS

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Lighting (contd.)Avoid pooled lighting and shadows (sconces,

table lamps) Provide night lighting in patient washrooms

Ensure focused light on signs and other wayfinding cues

Ensure consistent levels of brightness inadjacent areas

Create gradual changes of light levels whencoming in from outdoors awnings or outdoor covered entranceway skylight inside entranceway brighter interior light inside entranceway


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Noise/Sound High noise levels can lead to anxiety, confusion

and fatigue from over stimulation and difficultyhearing that which is spoken to the senior.

Background noise can create misinterpretationsof what is happening in the environment Reduce the use of the public address system as much

as possible and turn off in patient bedrooms

Combine a visual display that scrolls slowly to informpatients in a waiting area


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Reduce background ambient noise (eg.

ventilation systems, radio) Have hearing amplifiers available in all patient contact

areas

Reduce the number of hard surfaces and choes

Use quality acoustical ceiling and wall products consider heating and ventilation structure to reduce

noise when installing


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Dcoruse colours at the warm end of

the spectrum (blue tones aredifficult to see)

pastels and low contrast colours aredifficult to see and define

use colour to define functional areas

(ie yellow hallway, green rooms,amber activity room)


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use color contrast to highlight areas such as doors toassist

Way finding.

Use the same colors on exit or out of boundsdoorways as hallways to camouflage and reduceunwanted use.


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Upholstery

Avoid visual over stimulation

No strongly flecked patterns

Plain fabrics with mild patternsAvoid very dark colours and soft pastels

Avoid "vibrational " patterns

Warm colours most easily seen and appreciated


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Art Non glare finish

Well lit with focused light(3-4 times brighter)

Content with full spectrum colour especially in brighter

tones Select pictures that are clear and realistic with

definition

Colour contrast to help define the features/objects inthe picture

Avoid the use of mirrors which may cause confusionand agitation due to visual perception changes


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Orientation/Way finding Large clocks, calendars

Combine a visual display that scrolls slowly along withverbal calls

to inform patients in a large waiting area

Clear demarcation of different functional areas bycolour, sign,

physical layout, other identifying features (eg. Largedistinctive

picture, fish tank)

Ensure patients can clearly see their destination onpatient care units (ie dining room doors open,uncluttered hallways)


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Signs should be: Uncluttered with a simple message avoid

too much information on one sign

Strong contrast of: Print on sign background

Sign from environment background

White on dark brown or black or black onyellow in a busy environment with white

background Black on white or dark green on white for

general use


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Matte, non-glare finish Include simple explanatory graphic

Key locations (eg.bathroom) with signs

perpendicular to the

wall to facilitate identification

Follow CSA guidelines for signage


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Safe Mobility

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Flooring Quiet cushion flooring (eg. vinyl cushion tufted)

Matte, non-slip, finish or wax

Low pile carpeting

Even colour NO bold patterns that can createvisual perception challenges

Contrast baseboard or floor border to define flooredge and pathway


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Safe Mobility

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Doors:All doors wide enough for easy clearance of

wheelchair

Threshold no more than beveled edge

Lever handles

Max. 8 lbs pull, 14 lbs push force

Automatic door opening mechanisms for main

entrances and hall doorways


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Safe Mobility

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Seating area just inside entranceways to allowvision time to adjust to light changes

Adequate wheelchair availability at entranceways

Accessible parking (consider valet service)

Covered outside entranceway with drive-up drop-

off area


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Specific Functional Areas

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Bedrooms Visually distinctive doorways and bed area in

shared room

Direct sightline to washroom from bed

Call bells Remote voice activated is ideal

Ability to be fixed to bedside

Large, easily activated button


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Telephone Black phone with large white push buttons with

contrast numbers/letters

Located within easy reach of bed

Volume control

Suitable for use with hearing aids


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Light switches For personal areas bedside console with clear

labels and large buttons

Hallways

Clear, unimpeded pathways wide enough forwheelchair/walker and caregiver in each direction(larger than minimum wheelchair accessstandard)

Avoid shiny surface with glare


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Avoid long hallways without visual interruption Seating areas at regular intervals along long

hallway

Hand railings in hallways to assist walking

(1.5daimeter with 2 hand clearance easy griprounded style

Handrails extend beyond top and bottom landings


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Steps use conventional (7 risers; 11treads) that will

be expected

highlight step edge with contrast colour(yellow)

Rampsavoid if possible

But if required

5% - 8% slope

rest area every 30 feet

mark top and bottom with yellow strip


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Waiting Areas Quiet small waiting areas without multiple

stimuli which allow confidential conversationfor the hearing impaired

Combine visual and auditory cues in largewaiting areas (ie. large electronic number signto call next patient

Full turning radius (as per building codes) for wheelchairs/walkers plus space for caregiver

to maneuver the wheelchair in seating areasand between seats


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Washrooms Large enough for wheelchair/walker and

caregiver access in accessible stalls in publicwashrooms (larger than minimum code)

Patient room washrooms with full wheelchairturning radius

All toilets with minimum of one non-slip grab bar45 degree at side of toilet


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Accessible toilet paper dispenser (19 high, atthe side and slightly to front of toilet) with paper

not hidden within dispenser

High toilets(18) available in some public regular

stalls

Toilets in patient rooms with space for over-toilet

commode

F it


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Furniture

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Tables Sturdy 4 legged

Rounded corners,

Edges defined with contrasting colour borders Matte tabletop

Contrast table settings to assist with depth

perception

Furniture


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Furniture

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Beds

Electric adjustable height to 18 low

Controller with simple technology and large

easily identified buttons

Pressure relieving mattressAvoid side railings that fold down to the floor

Bedside tables

On glides instead of wheels Lever handles for easy glide drawers

Furniture


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Furniture

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Chairs

Seat -18-19 in. high, 18-20 in. deep with firm cushion Arms extended to front chair edge, 10 in. above seat

height

Lumbar support

Non-slip easily cleaned fabric Clearance under front of seat to allow feet under front

edge

Stable/tip-free

Minimal back recline and backwards seat tilt Chair legs able to be fit with blocks to further raise seat

height

OTHER FACTORS


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OTHER FACTORS

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Large print for all written materials

provided (minimum 14 font) withsimple non serif characters

Hearing amplifiers should be availablefor use with clients by ALL staff

Volunteer guides to accompanyseniors to their destination within afacility instead of relying on verbaldirections

Consider nutrition needs of seniors(diabetic, low salt food in vendingmachines and gift stores)


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Rehabilitation

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For Reactivation: who are passive, lethargic, and

physically and socially immobilized are encouragedto live again in his own sarrounding

Resocialization: means making contact again withfamily, neighbours, friends, and other citizen

Reintegration: Means he is again restored to thesociety


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Other Services

Long term care Follow-up and after care by GP/Nurse at home

Social and Welfare Services

Restoration of pension

Reduced rail fare

Help age

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