Elderly Care

Introduction
• Ageing is characterized as:
– Decrease in metabolic mass
– Reduction in functional capacity of organs
– Reduced capacity to adapt to stress
– Increased vulnerability to disease
– Increased probability to death
 Ageing and disease
Age
40 Obesity
50 Diabetes
55 Ischaemic Heart Disease
65 Myocardial Infarction
70 Cardiac Arrythmias
75 Heart Failure
80 Cerebrovascular accidents
Degenerative cardiovascular disease emerging with age*
• Deterioration in health and the ‘masquerades’
– Unexpected illness can be caused commonly by any of the
so-called masquerades:
• Depression, Drugs, DM, Anemia, Thyroid disease, UTI
and so on.

• The ‘classic’ triad

– Confusion, Incontinence, and Falls
– Can represent non-specific signs of acute illness.
Significant problems
affecting the elderly**
 Changes in sensory threshold and
homeostasis
• A clinically significant feature in elderly patients is the raising
of the pain threshold and changes in homeostatic
mechanisms.

• Consequently, patients may have an abnormal response to

disease.
 Establishing Rapport with the elderly
patient
• The elderly patient especially requires support,
understanding, caring, and attention from GP – instill
confidence and security in a patient who is likely to be lonely,
insecure and fragile.

• Taking time, showing a genuine interest and a modicum of

humor, and always leaving a detailed instruction.

• Best way to generate a good relationship- home visits

– Assessment
– Continuing care
• Home visits can be considered in 3 categories:
– Unexpected visit
– Patient-initiated but routine request for a ‘checkup and tablets’
– Regular call- 2-4weeks
 Loneliness in the elderly
• 1 in 3 elderly feel lonely. – Forbes
• More likely to affect ‘old-old’, widows & widowers, and thosde
affected by disability
• Possible signs of loneliness:
– Verbal outpouring
– Drab clothing
– Dependence on television
– Body language with a ‘defeated’ demeanor
– Prolongation of visit including holding on to one’s hand
 Doctor behaviour that can irritate
patients
• Having a consulting room with slippery steps, poor lighting & inadequate
handrails
• Non-attention to simple courtesies by reception staff
• Keeping them waiting
• Having low soft chairs in the waiting room and surgery
• Being overfamiliar, with addresses
• Shouting at them on the assumption that they are deaf
• Appearing rushed and keen to get the consultation over with quickly
• Forgetting their psychosocial problems and only concentrate on physical
problems
• Forgetting they have several things wrong with them
• Being unaware that they may have seen other practitioners or may be
taking additional meds
• Failing to ask patients to give their understanding of what is wrong
• Omitting to give printed patient education hand-outs about their
problems and meds
• Omitting to explain how the meds will work
• Treating them as though they have little comprehension of their health
and treatment
• Failing to respect their privacy
• Failing to provide appropriate advice on various social services
• Failing to re-evaluate their he3alth and medication
• Failing to take steps to reverse any deterioration in their health