Information regarding current status of Geriatric Patients and Health facilities availability in Bangladesh

1. Geriatric Illness & Care
Perspective of Bangladesh

2. Defining OLD
• Most developed countries accepted the
chronological age of 65 years as older person.
• There is no UN standard criteria but UN agreed cut-
off of 60+ years to refer as older person

3. Categorizing the definition of older person
• Chronology
• Change in social role
– Change in work patterns
– Adult status of children & menopause
• Change in capabilities
– Invalid status
– Senility
– Change in physical characteristic

4. World Population Aging
• In 1950, there were 335 million children in the 0-4 age
group and just 131 million people ages 65+
• Mid-2010, there were 642 million persons ages 0-4 and
523 million ages 65+
• The 65+ population is projected to exceed the 0-4
population during that same five-year period, rising from
601 million in 2015 to 714 million in 2020

5. Ageing and Life Course
• 2 billion
people will be aged 60 and older by 2050. This represents both
challenges and opportunities.
• 4-6%
of older persons in high-income countries have experienced some
form of maltreatment at home.
• 25-30%
of people aged 85 or older have some degree of cognitive decline.

6. Pictures of Bangladesh
1. The elderly population of Bangladesh will increase
from 6.8 million in 2000 to 65 million in 2100.
2. whereas the total population will be about double.
3. The ratio of people of working-age to elderly people
will decline from 11 to 2 at the end of the century.
Ref-ICDDR,B: Centre for Health and
Population Research

7. Bangladesh
Demographic Profile
• Population 163,654,860 July 2013 Est
Age structure Percentage Total number
55 to 64 years 5.7% Male- 4,775,062
Female 4,625,192
65 years and
over
4.9% Male 3,918,341
Female 4,078,723
Source: CIA World Factbook 7

8. Pattern of presentation of
geriatric illness
• Late presentation
– Many people accept illness as a consequence of aging.
• Atypical presentation
– Infection may present with delirium.
– Stroke may present with falls.
– MI may present as weakness and fatigue

9. Pattern of presentation of
geriatric illness
• Acute illness and change in function
– May present with
• Failure to cope
• Found on floor
• Confusion
• Off feet
• Multiple pathology

10. Common presenting problems
• Falls about 30% over 65 years of age
about 40% over 80 years of age
• Dizziness about 30% over 65 years of age
• Delirium about 30% of older hospital
inpatients

11. Common presenting problems
• Urinary incontinence affecting 15% women
and 10% men over 65 years of age
• Adverse drug reaction are the cause of 20% of
admission in those over 65 years of age
• Hypothermia
• Under nutrition

12. Other presenting problem
• Dementia
• Infection
• Fluid balance problem
• Heart failure
• Hypertension
• Dizziness and blackout
• Diabetes mellitus
• Anemia
• Painful joints

13. Pattern of Geriatric diseases in
Medical wards

14. AN EPIDEMIOLOGICAL STUDY OF THE
MORBIDITY
PATTERN AMONG THE ELDERLY POPULATION IN
AHMEDABAD, GUJARAT
Rajshree Bhatt1, Minal S Gadhvi1, K N Sonaliya2, Anand Solanki3, Himanshu Nayak3
The present study was conducted in urban field practice
area (UHTC) of Department of Community Medicine BJ
Medical College Ahmedabad. Random selection of one
region was done & Kalapinagar comes out as our survey
area. We haveincluded only those persons above 60 years
of age who have given informed consent.

16. Patterns of admission and discharge in an
acute geriatric medical ward
I C Taylor, J G McConnell Accepted 6 March 1995
Data was collected retrospectively on admissions to the
acute geriatric medical ward from the 1st January to
the 31st December 1993. Patients admitted to a 30
bedded acute geriatric medical ward in 1993 were
followed up to discharge.

18. At Kenyatta National Hospital
March 1990-March 1991
• Total no. of patients- 1296
• Between 60-79 years- 1008(77.8%)
• First time admission 86.4%
• Commonest diseases- Hypertension and
cardiomyopathy about 43.9% of all diseases.
• Commonest neurological disease was Stroke

19. At Kenyatta National Hospital
March 1990-March 1991
• Among 1296 patients 88 i.e. 6.8% of patient died
• Commonest cause of death Heart failure due to
cardiomyopathy and hypertensive heart disease.

20. Pattern of Geriatric diseases in
rural areas of Bangladesh

21. Health Problems of the Geriatric People:
A Community Based Study in a Rural Area in Bangladesh
Md. Jawadul Haque 1 Rafiqul Alam2
A community based cross-sectional study among the geriatric
people i.e. 60 years and above age group was carried out in the
rural villages of Rangpur district A total of 1000 geriatric people
were interviewed

22. Distribution of respondents by their current disease pattern n=1000
Current disease Respondent
NO %
Without disease 138 13.8
With disease 862 86.2
Arthritis 401 40.1
RTI 377 37.7
Cataract 229 22.9
Diarrhoeal disease 166 16.6
PU & hyperacidity 149 14.9
Dental problem 94 9.4
Asthma 70 7.0
Hypertension 67 6.7
Diabetes Mellitus 34 3.4
Hydrocele 44 4.4
Hernia 7 0.7
PID 9 0.9
Others 73 7.3

23. Distribution of the respondents by
their complaints, n = 1000
General complaints Respondents
No %
Decreased vision 636 63.6
Weakness 532 53.2
Partial memory loss 58 5.8
Hearing defect 175 17.5
Others 91 9.1

24. Geriatric Health Problems in a Rural
Community of Bangladesh
Shaila Ahmed, Sonia Shirin, Masuda Mohsena, Nargis Parvin, Niru Sultana, Samia
Sayed, Rishad Mahzabeen, Masuma Akter, Abu Sayeed
This cross sectional descriptive study was conducted in some
rural communities of Sreepur Thana during the month of April
2007. The study population included those aged 50 years or
more and residing in the study areas. A total of 226 respondents
were selected purposively

25. The prevalence of old-aged diseases or
symptoms or events (n=226)
Variables Total
n %
Men
%
Women
%
Systolic hypertension 40 (17.7) 19 (47.5) 21 (52.5)
Visual impairment 48 (21.2) 29 (60.4) 19 (39.6)
History of fall 40 (17.7) 16 (40.0) 24 (60.0)
Joint pain
(Arthralgia/arthritis
148 (65.5) 71 (48.0) 77 (52.0)
Palpitation
(unexplained)
94 (41.6) 42 (44.7) 52 (55.3)
Cough (not
categorized)
52 (23.0) 36 (69.2) 16 (30.7)
Dyspnoea
(unexplained)
42 (18.6) 22 (61.1) 20 (38.9)
Chest pain (non-
specific)
50 (22.1) 20 (40.0) 30 (60.0)
Chest pain with
sweating
32 (14.2) 11 (34.4) 21 (65.6)

26. Health Issues of an Ageing Bangladeshi
Population
Golam Mostafa and Peter Kim Streatfield
Methodology: Using data from the Matlab Health and
Demographic Surveillance System(HDSS), the living arrangements
of elderly people during 1974, 1982, and 1996, self-reported
chronic and acute morbidities, and unhealthy status were
examined through cross-tabular analysis. The method of Sullivan
was used for calculating healthy life-expectancy and active life
expectancy

27. • The prevalence of chronic morbidity was higher among
females than males.
• Arthritis was the most prevalent chronic disease among
both males and females followed by gastric problems
and anaemia.
• The most prevalent acute conditions among males and
females were cough, fever, and cold, followed by
headache and toothache.

28. • Females are more unhealthy than males.
• Inability to carry out normal daily activities
was more common among females

29. Chronic disease burden among people
over 60 years of age in rural Bangladesh
Overall, 73% of those surveyed in Mirsarai and 44% in
Abhoynagar.
Arthritis (37%) and hypertension (27%) were the most
common chronic conditions reported.
Verbal autopsy data show that at least 42% of all deaths
in these areas in this age group were due to chronic
conditions

32. Management

33. Admission to Department of
General Internal Medicine or
Department of Geriatrics
Does it really
matter?

34. Yes, It does…..

35. Findings in favour of GU
• At one year
– Lower mortality (23.8 vs 48.3%)
– Fewer had initially been discharged to a nursing home
(12.7 vs 30.0%)
– Patients were less likely having spent time in a nursing
home (26.9 vs 46.7)
– They more likely had improvement of functional status
– Lower direct costs
Ref: Rubenstein & al N Engl J Med, 1984

36. Points to remember in caring for
Elderly
• Individuals with dementia don’t know they have
dementia
• Be Respectful
• Focus on the person not the task. The relationship is
more important than getting the job done.
• Talk, touch and explain
• Know something about their life story

37. Points to remember in caring for
Elderly
• Do not argue with person
• Always tell them what you are going to do

41. Management of Patient with
Multi Morbidity

42. • Inquire about the patients primary concern (&
that of family or friend) and any additional
objectives for visit.
• Conduct a complete review of care plan with
person of Multi morbidity
• What are the current medical condition and
intervention? Is there any adherence/comfort
with care plan

43. • Consider patient’s preference.
• Is relevant evidence available regarding
important outcome
• Consider prognosis
• Consider interactions within among treatment
and conditions

44. • Weigh benefits and harms among the
components of treatment plan.
• Communicate and decide for or against
implementation or continuation for
intervention/treatment
• Reassess at selected intervals for benefit,
feasibility, adherence

45. Table showing the no. of geriatric patient
admitted/ come for consultancy in outdoor
basis in DMCH
Traits Total no. Of
patients
No. of patients above 65
years
Percentage
Indoor
Male 332 80 24.09
Female 285 36 12.63
Outdoor
Male 150 12 8
Female

46. প্রবীণ স্বাস্থ্য চিচিৎসা কিন্দ্র
ঢািা কেচিকিল িকলজ হাসপাতাল

47. Geriatric Ward in DMCH
প্রবীণ স্বাস্থ্য চিচিৎসা কিন্দ্র
Aims and objective
• To ensure health service at an acceptable level to the elderly
• Expansion of treatment facilities for chronic, terminal and
degenerative diseases.
• Starting an outdoor clinic for the elderly in all the medical
college hospitals
• To build up a group of dedicated staff for this vulnerable
population
• To provide health education to the care givers.

48. Geriatric unit will be consists of
• Outpatients department
• Inpatient department
• Health education Unit

49. outpatients department/Geriatric
clinic
• Weekly run by geriatric unit
• Conducting a routine health assessment of
elderly persons
– Simple clinical examination relating to eye, BP, blood
sugar
– Appropriate investigation, diagnosis and
management

50. outpatients department/Geriatric
clinic contd.
• One stop service at the department including
laboratory investigation and drug supply
• Health education to patient and care giver
• Maintain record of elderly using standard format
• Admission in geriatric unit for patients requiring
further evaluation, investigation and treatment.

51. Criteria for admission in geriatric ward
(Inpatient department)
• Patients aged 65 years and above.
• Elderly patients with chronic ailments requiring further
evaluation
• Elderly patients with acute illness with no organ failure
that fulfills HDU or ICU admission criteria
• Patients requiring comprehensive, multidisciplinary
approach for diagnosis and management

52. • Patients requiring special care in terms of logistics and support
• Patients with acute complications requiring surgical attention will not
be admitted
• Patients with multi organ or single organ failure requiring support will
be sent to ICU or HDU according to their criteria respectively
• Admission will be through Geriatric outpatients department or
referral from different medicine unit during office hours.

53. All admitted patients in geriatric unit will be
managed in collaboration with other specialists as
much as possible.

54. Health education unit
• To impart training to District and PHC
providers
• To arrange weekly outpatients counseling
sessions
• To arrange awareness campaigns
• Arranging field clinics and health camps

55. Team of geriatric medicine
• Professor (Geriatric Medicine)
• Associate professor
• Assistant professor
• Junior consultant
• Psychiatrist
• Assistant registrar
• Nurses
• Physiotherapist
• Nutritionist
• Lab technician
• Program assistant
• Hospital attendant
• Computer operator