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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 TÁMOP-4.1.2-08/1/A-2009-0011 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 TÁMOP-4.1.2-08/1/A-2009-0011 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 TÁMOP-4.1.2-08/1/A-2009-0011 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 TÁMOP-4.1.2-08/1/A-2009-0011 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. TÁMOP-4.1.2-08/1/A-2009-0011 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. TÁMOP-4.1.2-08/1/A-2009-0011 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 TÁMOP-4.1.2-08/1/A-2009-0011 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. TÁMOP-4.1.2-08/1/A-2009-0011 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 TÁMOP-4.1.2-08/1/A-2009-0011 • 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. TÁMOP-4.1.2-08/1/A-2009-0011 Physician Personalized geriatric teamwork Pastoral care Patient TÁMOP-4.1.2-08/1/A-2009-0011 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 TÁMOP-4.1.2-08/1/A-2009-0011 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. TÁMOP-4.1.2-08/1/A-2009-0011 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. TÁMOP-4.1.2-08/1/A-2009-0011 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, TÁMOP-4.1.2-08/1/A-2009-0011 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. TÁMOP-4.1.2-08/1/A-2009-0011 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).