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Manifestation of Novel Social Challenges of the
European Union
in the Teaching Material of
Medical Biotechnology Master’s Programmes
at the University of Pécs and at the University
of Debrecen
Identification number: TÁMOP-4.1.2-08/1/A-2009-0011
Manifestation of Novel Social Challenges of the
European Union
in the Teaching Material of
Medical Biotechnology Master’s Programmes
at the University of Pécs and at the University
of Debrecen
Identification number: TÁMOP-4.1.2-08/1/A-2009-0011
Gyula Bakó and Márta Balaskó
Molecular and Clinical Basics of Gerontology – Lecture
21
GERIATRIC CARE
MANAGEMENT FOR
SUCCESSFUL AGING
TÁMOP-4.1.2-08/1/A-2009-0011
Characteristics of old age
Multimorbidity affects the majority of
this population
disturbance of mobility, self-reliance,
communication and social activity 
inactivity
Increased tendency to develop pain
syndromes

inactivity
Psychological features
rigidity; disorders of memory, judgement,
emotions and orientation, decrease
in cognitive
performance
Rapid
immobilization,
loss of self-
TÁMOP-4.1.2-08/1/A-2009-0011
General health-related
problems
• pressure ulcers (decubitus)
• incontinence
• feeding disorders
• falls
• altered mental activity
• sleep disorders
• mood disorders and pain
Limitations of everyday
activities caused by
diseases
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age-groups
(years)
60-69
70<
men
women
40 %
60 %
50 %
72 %
Living conditions of the
elderly over
65 years of age living in
community
2,2
2,0
1,7
2,2
3,8
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6,6
7,4
14,1
21,1
16,8
27,5
27,7
51,1
78,2
71,2
13,0
19,3
65-74
75-84
males
5,5
10,2
47,0
28,1
33,2
85+
65-74
Age-groups
53,3
56,8
75-84
85+
females
Living alone
Living with spouse
Living with other relatives (not spouse)
Living with non-relatives
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Circumstances
of seniors
In Hungary 73% of elderly people live
in a household where all members are
above 60 years of age. Thus, in need
more and more people must depend on
other persons, relatives, on the
social system or on civil
organizations.
TÁMOP-4.1.2-08/1/A-2009-0011
Eldercare systems
Nursing home
Senior day-care facilities
In-home care (home care
services)
Hospitalization
Adaptive mechanisms in people
getting older get reduced in
any change of the environment!
Housing of people over 65
years of age, living in
community
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Care in a nursing home or in other
facility providing long-term care.
Considering the type of facility:
• It must be assessed whether the
person is in need to become a
resident in a geriatric facility.
• It should be decided about
whether the patient is at the
appropriate place.
For housing options the
followings should be
assessed
TÁMOP-4.1.2-08/1/A-2009-0011
•
•
•
•
health needs,
social support – mistreatment,
cognitive functions – dementia,
physical abilities – degree of
self-reliance,
• in-home care – continuous
supervision
Housing of people
over 65 years of age
TÁMOP-4.1.2-08/1/A-2009-0011
The most important needs in facilities for
elderlies:
• certified chief nurse,
• registered nurses,
• nurses,
• full-time social workers,
• therapeutic health professionals,
• pharmacists,
• rehabilitation therapeutists,
• dentists,
• nutrition specialists,
• cleric services,
TÁMOP-4.1.2-08/1/A-2009-0011
Ethical approaches
• If a patient suffers from dementia –
he lacks decision-making capacity –
his wishes are often overruled by his
family or the staff.
• Will to live is important.
• Right to be informed.
• Medication of such patients who refuse
taking pills is a problem.
• Physical abuse – neglect –
unprofessional care.
TÁMOP-4.1.2-08/1/A-2009-0011
Senior day-care facilities
The patients who are no longer able to
conduct their lifestyle, but their
functions are still relatively
maintained. Thus, there is no need for
them to be monitored continuously.
Housing, meal, and limited assistance
with hygiene and drug administration
are provided.
TÁMOP-4.1.2-08/1/A-2009-0011
In-home care (home care
services)
It is advantageous for those who
would like to stay at home, but
they need some kind of assistance
temporarily or permanently because
of their medical conditions or
disability.
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Hospitalization
More than half of the hospital beds are
occupied by patients over 65 years of
age!
Prevention:
• Their activity should be maintained
during hospitalization.
• Beds with adjustable height (for
sitting or lying down)– more
comfortable.
• Infusion, oxygen administration as
required.
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Aims of therapy in the
elderly
• Transition from hospital to
(nursing) home
• Relief of e.g. pain
• Improvement in self-care,
independence
• Improvement of physical
activity and fitness
• Improvement in functional
abilities,
better quality of life (QOL)
TÁMOP-4.1.2-08/1/A-2009-0011
Primary goal: maintenance or
recovery of independence
In elderlies the possibilities are
limited, BUT the expectations are more
modest.
Moving
Feeding
Hygiene
Clothing
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Improvement of physical
activity and independence
• Physiotherapy and occupational therapy for the
improvement of daily activity.
• Improvement of muscle strength, stability of
joints and mobility.
1 Evaluation of opportunities at home (e.g. warm
environment before and during exercise).
2 Teaching and coaching exercises:
- for maintenance and improvement of joint
mobility,
- for strengthening and training muscles around
the joints, carrying out aerobic exercises
Since atrophy and weakness of the m. quadriceps
femoris is not a consequence but rather a cause of
the arthrosis of the knee!
Exercises also improve proprioception of the
joint.
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Physiotherapy
• Therapeutic exercise is the most important
element
Effects:
- Increases aerobic
Forms:
capacity
- Isometric and
- Alleviates pain
isotonic exercise
- Improves muscle
- Exercise improving
strength
the efficacy of
- Improves coordination locomotion
- Exercise improving
- Improves gait
coordination
- Improves quality of
- Therapeutic
life
• Others:
thermotherapy, cryotherapy,
underwater exercise
mechanotherapy, low-frequency
Geriatric care and
management
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• It is a really complicated task.
• There is a need for multidisciplinary
approach performed by a team.
• In Hungary the conditions are not
optimal.
• The demand is huge. The resources do
not meet the demands.
• There is a shortage in the number of
health care providers and the lack of
a financial background is also
obvious.
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Physician
Personalized geriatric
teamwork
Pastoral
care
Patient
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Successful aging
Selection (evaluation, analysis, acceptance of
the situation)
Ranking of aims, choice of priorities.
Optimization (recruitment)
Recruitment of resources necessary for
achieving the objectives (e.g. establishment
of new routes, learning, trainig, practicing,
honing new skills).
Compensation (planning, execution)
New strategies (e.g. lists, using ortheses ,
special tools).
Results:
TÁMOP-4.1.2-08/1/A-2009-0011
Factors influencing aging
1
Life
Activity
Social
Resources
Cognitive
Efficacy
Aging
well
Material
Security
Physical
Health and
Functional
Status
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Factors influencing aging
2
1 Caloric restriction
A 30% reduction in caloric intake
increases life expectancy by 40-50 percent
(in rodents).
Okinawa island – traditionally low caloric
intake.
40 times as many people live there above the
age of 100 years.
Rats:
• 40% reduced diets – 60 months survival
(normal 30 months).
• 30% caloric restriction decreases core
temperature by 1°C.
Low metabolic rate increases life-span.
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Factors influencing aging
3
Advantages of physical fitness:
a Active muscles are able to take up glucose without
insulin.
b Trained muscles are able to burn fats upon exercise
(longer than 15 min). With training, on their surface
the number of lipoprotein lipase enzyme copies
increases.
c In active muscles local metabolites and epinephrine
induce vasodilation decreasing total peripheral
resistance.
d Physical training stimulates bone formation. A high
peak bone mass developed by the age of 25-30 and
increased bone formation later on delays the onset of
aging-associated osteoporosis.
e Exercise induces elevations in HDL (“good”
cholesterol) and suppresses LDL level (atherogenic
“bad” cholesterol).
f Exercise helps maintain a healthy BMI and muscle mass.
g Physical activity reduces stress without the sideeffects of alcohol or those of tranquillisers.
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Factors influencing aging
4
3 Stress, glucocorticoid levels (Frequent and high
glucocorticoid levels lead to hyperstimulation of the
hippocampus and consequent loss of memory – it may
contribute to Alzheimer’s disease)
4 Growth hormone and/or sex steroids
5 Antioxidant vitamins, dietary polyphenols
6 Melatonin (antioxidant and has a role in sleep
regulation)
7 Glutamate levels. Glutamate is an excitatory
neurotransmitter, high levels of which (e.g. induced
by cerebral ischemia) damage and finally kill neurons
(excitotoxin).
8 Cognitive training /psychological balance (life-long
learning, positive thinking, religion, etc.)
9 Hormesis Ideal portions of manageable stress (heat
shock – 41°C, exercise, caloric restriction, alcohol,
acetaldehyde, irradiation, heavy metals, pro-oxidants,
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The myth of the “Fountain of
Youth”– strange trials
Throughout history, people have been attempting
to prolong life, to maintaine or to regain
youth at any price.
• In 1889 Charles Edouard Brown-Séquard
advocated hypodermic injection of a fluid
prepared from the testicles of guinea pigs
and dogs, as a means of prolonging human
life.
• In 1920 Szergej Voronov experimented with
transplantation of monkey testicle as a means
to prevent age-related decline in males.
• Placenta products/mother’s milk are believed
in and used as means of rejuvenation of the
skin and that of the body.
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Evolutionary and
philosophical considerations
•
Antagonistic pleiotropy
(breeding and life span, GnRH, human
menopause)
Prolonged fertility and breeding would
shorten life, because of lethal
complications at giving birth and
proliferative/carcinogenic side-effects of
gonadal hormones.
• Is this a disease or is it a programmed
phase of life (programmed obsolescence)?
• Benefit for the community or for
individuals (apoptosis and senescence).