The main health problems of elders. Frailty and its prophylaxis. The modern strategy of health support and increasing of independence of seniors Brno, October-November 2017 Cardiovascular diseases •hypertension •ischemic heart disease – acute coronary syndrome • - cardiac failure • - arrythmias •valvular disorders • Vascular changes development •1. decade • • • •3. decade • • • •4. decade •1. decade • •3. decade •4. decade • •6. decade • •8. decade Hypertension •isolated systolic hypertension •unstable hypertension •compliance problems •ischemic brain attack •haemorrhagic brain attack •cardiac failure BPs BPd optimal below 120 below 80 normal below 130 below 85 normal for seniors 130-150 75-85 borderline 130-139 85-89 hypertension I 140-159 90-99 hypertension II 160-179 100-109 hypertension III above 180 above 110 Risks •unstable blood pressure values – collapsing •orthostatic hypotension •interaction with prostatic medications – uncontrolled BP decrease – dizziness, falls •bradycardia – beta blockers •serum mineral dysbalancies – arrythmias •…….. Ischaemic heart disease •stable angina pectoris – atypical symptomatology – dyspnea, confusion, falls, overal weakness •acute coronary syndrome – unstable angina pectoris, myocardial infarction – decrease of cardiac output – possibility of confusion or collapse, danger of malignant arrythmia •PTCA – coronary angioplasty – all ages!! • Cardiac failure – left ventricle •causes – hypertension, ischemic heart disease, valvular disorders •symptoms - dyspnoea, orthopnoea, night cough, confusion, sleeping disorders, pulmonary oedema • Cardiac failure – right ventricle •causes – chronic obstructive pulmonary disease •right ventricle – swellings of legs, peripheral cyanosis, ascites, anasarca, hydrothorax • Arrythmias Øtachyarrythmias, bradyarrythmias Øunstability, falls, confusion, cognitive decline, consciousness disturbances – palpitations less frequent Øthe most frequent diagnosis during checking blood pressure Øatrial fibrillation – risk of ischemic brain attacks, antiaggregation, anticoagulation – warfarin, oral antikoagulants Øpacemaker, cardioverter implantation – all ages!! • • Valvular disorders •aortic stenosis – short unconsciousness, vertigo •mitral insufficiency – dyspnea, tendency to pulmonary oedema • senile_aortic_stenosis Gastrointestinal diseases •loss of teeth, xerostomia •swollowing difficulties •gastroesophageal rephlux •senile gastric ulcers •maldigestion, malabsorption •ischaemic colitis, vascular ileus •diverticulosis Diseases of locomotor system – osteochondrosis, spondylarthrosis •limited reparation of cartilago •osteochondrosis – Alzheimer dementia of cartilago •coxarthrosis, gonarthrosis – long life body overweight, burden •spondylosis, spondylathrosis •up to 70% of seniors – NSAIDs OTC •pain, immobility, falls, depression Bone remodelation qpeak bone mass – up to 30 years of age only qpermanent controlled bone osteoclasts resorption followed by creation of new bone by osteoblasts – cycle duration 3-4 months qbone remodelation units q30% of remodelation runs in compact bone, 70% in spongious bone Peak bone mass – up to 30 years of age Diseases of locomotor system - osteoporosis vpostmenopausal osteoporosis – vertebral fracture v½ women with physiological menopause v2/3 women with arteficial menopause vsenile osteoporosis – hip fracture v½ of women v1/3 of men Urogenital diseases in elderly •UTI – urogenital tractus infections with atypical symptoms •repeated – permanent subclinical dehydration • - decreased defence of urinary mucosa • - slower flow of urine • - microbial colonization of bladder and urethra • - permanent catheterization • - high concentration of urine, lithiasis Incontinentia Østress incontinentia – in women, cough, lough • - weak muscles of pelvic bottom • - shorter urethra • - less effective constriction Øurgent incontinentia – in men • - prostatic hyperplasia • - permanently higher tonus of detrusor Ømixed incontinentia – in 40% of elderly • Female_anatomy Male_anatomy Respiratory diseases •chronic obstructive pulmonary disease, cor pulmonale •lung stifness, decrease of vital capacity •worse function of ciliary epitel – mucus retention – pneumoni •aspiration risk lobární pneumonie Metabolic diseases Ømetabolic syndrome qhypertension qdiabetes mellitus qhyperlipidaemia qtruncal obesity qhyperuricaemia •cardiac failure •atherosclerosis acceleration •increase ofinsulin resistence •cognitive decline acceleration •loss of independency •worsening of locomotor problems Interdisciplinary syndromes – geriatric giants instability cognitive decline imobilisation incontinency, skin integrity loss • Interdisciplinary syndromes Øsomatic §eating, drinking disorders §termoregulation disturbances Øpsychical §depression §behavior disturbance , maladaptation Øsocial §loss of independency §social isolation §family dysfunction, elderly abuse Instability and falls vbackbone disorders vvascular origine vheart diseases vbrain damage vexternal influences • SKATE PÁN Immobility •caused by trauma •serious osteoporosis with fractures •caused by brain attacks •ancle diseases •chronic internal diseases imobilisation syndrome – unfavourable cascade leading to death Incontinency •allways to solve - urology, gynecology Þnursing issue Þsocial issue Þeconomical issue Skin integrity disorders •sore ulcers, leg ulcers •slower skin renovation •decreased skin barriere function •slower wound healing •decreased immunological reaction •less effective termoregulation •lower mechanical resistence • Frailty – aging biomarker •common geriatric syndrome that embodies an elevated risk of catastrophic declines in health and function •increases incrementally with advancing age •connected with weakness, slowing, decreased energy, lower activity, and unintended weight loss – if 3 or more are present,the risk of death is high •increased vulnerability to stressors (e.g. extremes of heat and cold, infection, injury, or even changes in medication) •components – sarcopenia, osteoporosis, muscle weakness •not only fragility of bones Risk factors for frailty •chronic diseases •cardiovascular disease •diabetes mellitus •chronic kidney disease •depression •cognitive impairment • environment-related factors such as life space and neighborhood characteristics • •physiologic impairments •activation of inflammation and coagulation systems, •anemia •atherosclerosis •autonomic dysfunction •hormonal abnormalities •obesity •hypovitaminosis D in men • Prevention of frailty •treatment and close follow up of chronic diseases •vitamin D serum levels above 50-75 nmol/l maintenance •management of chronic inflammation •management of coagulation disorders •stable compensation of diabetes mellitus •metabolic syndrome management •promotion of physical activity as a prevention of sarcopenia, osteoporosis and muscle weakness • • • • Thank you for your attention