Quarantine and the elderly
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Quarantine and the elderly
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Quarantine and the elderly
- 1. The Elderly in Quarantine Marc Evans M. Abat, MD, FPCP, FPCGM Internal Medicine-Geriatric Medicine Head, Center for Health Aging, and Section of Geriatrics, The Medical City Clinical Associate Professor, Division of Adult Medicine, Department of Medicine, PGH
- 2. Outline Aging and Frailty Some Realities of the Filipino Elderly COVID-19 and the Elderly Physical Effects of Quarantine Mental Effects of Quarantine Management Approach
- 4. âŚ. accumulation of changes responsible for the sequential alterations that accompany advancing age and the associated progressive increases in the chance of disease and death. Harman D, Proc National Academy of Science USA, 1991 AgingâŚ
- 5. Biochemical composition changes Physiologic capacity decreases Decline in homeostasis Susceptibility to disease increases Mortality increases with age
- 8. High Vulnerability Low Vulnerability Less Noxious Insult Very Noxious Insult Predisposing Factors or Vulnerabilities Precipitating Factors or Insults
- 9. Frailty Refers to a loss of physiologic reserve that makes a person susceptible to disability from minor stresses. An inherent vulnerability to challenge from the environment.
- 10. TIME PHYSIOLOGIC CAPACITY Ideal setting Usual trajectory Sudden illness or stressor Full recovery Less optimal recovery
- 11. Some Realities of the Filipino Elderly
- 12. older individuals comprise 7.5% of the total population equivalent to 7.5 million individuals only 30% receive social pension of P500 monthly (USD$10) and 40% receive no pension at all Difficulties in healthcare access, rural higher than in urban setting Int Psychogeriatr. 2020 Apr 30 : 1â5.
- 13. Majority of older Filipinos are deeply religious and have strong views of Godâs role in health and well-being Going to church regularly and attending church activities and gatherings are part of everyday life for older Filipinos Concept of multigenerational households Int Psychogeriatr. 2020 Apr 30 : 1â5.
- 14. COVID-19 and the Elderly
- 16. High risk for hospitalization and DEATH ⢠Due to more severe COVID-19 illness ⢠Due to worsening of co-morbidities ⢠Due to possible frailty https://www.cdc.gov/coronavirus/2019-ncov/covid- data/investigations-discovery/hospitalization-death-by-age.html As of June 24, 2021
- 17. Philippine COVID-19 cases by age group as of 1st week July 2021 https://covid19trackerph.com/age
- 18. Physical Effects of Quarantine
- 19. Eur J Transl Myol 30 (2) 219-222, 2020
- 20. Consequences of unguided exercises at home Older people expressed the need to perform physical activity at home increase the risk of injury due to a lack of adapted equipment or poor knowledge of the physical exercises to perform JMIR Aging. 2020 Jan-Jun; 3(1): e19007
- 21. Non-communicable diseases (NCDs) increased morbidity from chronic disease and with higher all-cause mortality â˘Detrimental health behaviours, such as smoking and reduced physical activity may mediate over 30% of this effect https://blogs.bmj.com/bmj/2020/04/09/the-effects-of- isolation-on-the-physical-and-mental-health-of-older-adults/
- 22. Increased NCD progression â˘Reduced OPD access â˘Problems with medication supply access â˘Fears about going to a healthcare facility â˘Shifted focus of healthcare resources to COVID-19 care Aging Clin Exp Res. 2020; 32(7): 1189â1194. https://unsdg.un.org/sites/default/files/2020-05/Policy-Brief-The-Impact-of- COVID-19-on-Older-Persons.pdf
- 23. Quarantine and nutrition Change in nutritional habit ⢠Reduced availability ⢠Limited access ⢠Unhealthy food ⢠Psychological factors Weight gain and nutrition loss ⢠Oxidative stress ⢠Inflammation Increased NCD burden ⢠Cardiovascular risk European Journal of Clinical Nutrition volume 74, pages852â855(2020)
- 24. Mental Effects of Quarantine
- 25. Rev Panam Salud Publica. 2020;44:e81.
- 26. Rev Panam Salud Publica. 2020;44:e81.
- 27. Rev Panam Salud Publica. 2020;44:e81.
- 28. Stress in the old vs. the young older show less emotional distress than younger participants ⢠elderly had a greater resilience than the younger participants without gender differences economic losses and the increase in the use of anxiolytics are related to distress Am J Geriatr Psychiatry 28:10, October 2020
- 29. Loneliness and dementia 1,905 nondemented participants at baseline, drawn from the longitudinal Betula study in Sweden, with a follow-up time of up to 20 years (mean 11.1 years) âDo you often feel lonely?â increased risk of all-cause dementia ( HR 1.46, 95% CI 1.14â1.89), and Alzheimerâs disease (HR = 1.69, 95% CI 1.20â2.37) The Journals of Gerontology: Series B, Volume 75, Issue 5, June 2020, Pages 919â926
- 31. Mental health and physical activity 1,046 older adults over the age of 50 in North America 97% adhered to social distancing guidelines Participants who performed greater levels of physical activity experienced lower levels of depression-like symptoms when age, sex, and education were accounted for Greater light and strenuous activity predicted lower depression-like symptoms. Am J Geriatr Psychiatry 28:10, October 2020
- 32. need to help older adults integrate simple, safe ways to stay physically active in a limited space â˘Booklets â˘Online videos and resources â˘Volunteer groups JMIR Aging. 2020 Jan-Jun; 3(1): e19007.
- 33. Start low, go slow but keep on going (symptom-limited) Safe equipment (even if improvised) Involved the family and friends (even via teleconferencing)
- 36. Medical concerns Regular monitoring Ensure medication adherence and reconciliation Watch out for signs of deterioration Eliminate/reduce noxious habits e.g. cigarettes or alcohol
- 37. Nutritional support Availability of nutritious food Education on appropriate portions Financial support for procurement Logistic support for preparation
- 39. Social support Family in- house Phone call Email SMS Video- conferencing Social media
- 40. Not just how, but how well to communicate During phone call ⢠Watch the same show together ⢠Have grandkids tell stories or vice versa Using technology ⢠Share pictures and videos Be specific ⢠What are you eating for lunch? ⢠What are you doing now? http://ocm.auburn.edu/experts/2020/03/261525-covid19-elderly- population.php
- 41. Spirituality
- 42. Thank you!
Hinweis der Redaktion
- Aging is what happens when accumulation of changes (which can happen on multiple levels of complexity ď from the genome, epigenetic levels, biochemical processes, macromolecules and tissues, organ systems) responsible for sequential alterations with advancing age Associated with increased chance of disease and death
- Changes start at genomic and molecular levels. These eventually lead to decreases in physiologic capacity. This explains why as some people age, they start complaining of not being able to do the things they usually do despite being generally well. A decline in homeostasis happens. We will discuss this further in the next slide. This leads to an increased susceptibility to disease (even with minor insults for some persons). All of this eventually lead to increased mortality as one ages.
- Now we obviously see that not all older people are the same. We know of people in their 70s or 80s who are still very active and functional for their age. There are stories of what we call SUPER SENIORS who are master athletes in their respective fields (the Indian marathoner, bodybuilders like Schwarzenegger, etc.) On the other hand there are other persons who are in their 50s or 60s yet are already functionally limited, or even disabled due to the accumulated effects and complications of diseases This is the concept of chronological age vs biological age. The former is the numerical count of time of a personâs existence. The other is the actual manifestations of changes in the function of the entire body that may be phenotypically discordant with time
- As one ages, and due to numerous factors like baseline health, presence of vices, or disease, the amount of physiologic reserve (the amount of bodily resources that are used to overcome stress) decreases. This is because the body starts to use more of these resources to maintain equilibrium. This is the concept of homeostenosis-the ability to maintain equilibrium becomes narrower. At some point, if the physiologic reserve remaining is overcome, adverse outcomes happen like what we call geriatric syndromes, hospitalization and death As was discussed earlier on biological age, the physiologic reserve may vary from person to person depending on inherent and modifiable factors like genetics, lifestyle, presence of comorbidities, vices, environment, education, etc.
- Those who are vulnerable due to the multiplicity of their risk factors only needs a minor insult to manifest with problems. On the other hand, those with minimal risk factors or with minimal vulnerability would take either one big insult or successive moderate insults to manifest with problems In older patients, the slopes and baselines are variable, and may be challenging to document or measure. In real life, this can be estimated by a number of maneuvers.
- Thank you for listening