Biological aging is a lifelong process that begins with fertilization, and in this process, both anatomical and physiological irreversible functional changes occur in the whole organism. In the social sense, old age appears as a definition that changes from society to society according to the cultural situation and social characteristics, and in the modern sense, it is the name of the period in which the person completes his active working period and lives with the contribution or accumulation of the social security system. According to this definition, although it does not constitute a definite limit in terms of biological aging, 65 years of age is accepted as the old age limit due to social reasons.
While the ratio of the population over 65 years of age in the United States of America (USA) is 13%, this rate reaches up to 20% in Scandinavian countries. In Western countries, the elderly population constitutes an average of 15% of the total population. However, this 15% consumes more than 50% of hospital admissions and 40% of health resources. For Turkey, this rate is estimated to be around 6%. Average life expectancy is estimated at 72.37 years from birth (70 years for men and 75 years for women) for the entire population of Turkey. Considering our population density, it is obvious that the number of elderly individuals in our society is not to be underestimated.
The aging of societies has largely been a concept that came with the twentieth century. The increasing elderly population and life expectancy, especially in developed countries, have brought socio-political problems related to the change in the age distribution of the population in many areas, from the provision of health services to social security and working environments. In these days when we are living in the 2000s, the size of the discussions has transcended the political reality and turned into an ethical reality.
Geriatrics, which simply means medicine for the elderly, is a discipline that aims to protect the health of individuals in the later years of life, to prevent their diseases and to treat them with multidimensional evaluation. In the second half of the 20th century, it was accepted as an officially recognized branch of science in England, the USA and Western European countries, and it is a higher specialization on internal medicine.
Reasons such as developments in both preventive and curative medicine, improvement of nutrition and living conditions, widespread use of family planning and birth control in societies have led to an increase in the average life expectancy in societies, thus increasing the proportion of the elderly population in the population. Although this expression means that “this change in the social structure is the result of the victory of science and technology against many diseases that shorten the life span”, unless adequate response is given to the increasing medical, psychological, social, economic and environmental needs that come with the increase in the elderly population. It is necessary to accept the fact that this is an empty victory. Here, with the philosophy of producing solutions to the problems of elderly people with a holistic approach, Geriatrics emerges as a branch of science that was born with the aim of transforming this victory into a real victory.
First of all, the elderly is an individual in whom the complex effects of many interacting factors on health and functional capacity are intensely felt. It also requires socioeconomic, environmental and familial evaluation. Although aging is not a disease state, various degrees of age-related changes occur in many organ systems. Therefore, in this age group, it is necessary to distinguish very well the changes of normal aging from the findings due to any disease. Otherwise, the findings of a treatable disease may be attributed to old age and the treatment may be delayed, and the normal age-related changes may be considered as a disease state and the person may be exposed to unnecessary treatments. On the other hand, age-related changes in the functional response of organ systems may cause diseases to manifest differently in the elderly than in young adults. In other words, diseases in the elderly may not progress with classical signs and symptoms. In addition, the existing diseases in most of the elderly are chronic, and unlike the approach in other disciplines, the primary goal is to increase the quality of life by keeping the physical, mental and spiritual functional capacity of the elderly at the highest level, in addition to the treatment of diseases.
Heart diseases, hypertension, diabetes mellitus, rheumatic diseases (such as osteoporosis, osteoarthritis, rheumatoid arthritis), cancer (such as breast, prostate, lung, colon cancers), lung diseases (such as COPD, chronic bronchitis), hyperlipidemia (such as hypercholesterolemia), cerebrovascular diseases (such as stroke) are common in the elderly. In addition to these, one of the subjects that Geriatrics is most interested in is the diseases that are more common in the elderly and are referred to as “Geriatric Syndromes”. The most important of these diseases is Dementia (also called dementia, forgetfulness disease). 60% of dementia is caused by Alzheimer’s Disease and early diagnosis is very important. Because there is no definitive treatment and the average life expectancy after diagnosis is 4-12 years. There are special diagnostic procedures (such as neuropsychiatric tests, MRI) as well as medical examinations that enable early diagnosis and determination of the type of dementia. Depression, like dementia, is a disease that is common in the elderly and can lead to bad results, up to suicide attempts if left untreated. Apart from these two important diseases, Urinary Incontinence, Use of multiple drugs, Pressure sores (bed sores), Nutritional Disorders (not well-nourished), Falls constitute other geriatric syndromes.
The method that provides the evaluation of elderly individuals from all aspects is called “Detailed Geriatric Evaluation”. With this method, besides the medical evaluation of the person, psychological, social, environmental and familial evaluations are made and the patient is examined as a whole from all aspects. All problems are revealed by using other diagnostic methods. As a result, the most appropriate treatment model is created for the patient and the changes that occur over time are determined beforehand.
Another important feature of geriatrics is that preventive medicine is at the forefront. Especially after the age of 45, in terms of the problems observed frequently in this age group, monitoring the person according to the determined protocols and diagnosing and treating the diseases that may occur in the early period are among the primary goals. “Healthy Aging” has come to a very important position in the world today, and it contributes to the preparation of a healthy and successful future with social and individual awareness. Especially after the age of 45, being under the control of a doctor regularly and having some diagnostic procedures in addition to the examination enables some diseases to be detected in advance. As a result of these evaluations, the entire health status of the person can be revealed and it can be ensured that they look to the future with confidence.
The aging population is still in a position to benefit from preventive health services. As stated, the size of health expenditures allocated to the elderly population in developed countries is many times higher than the ratio of the elderly population to the whole society. This situation brings to mind the question of the situation in our country, where the inspections on health expenditures are quite scattered. Appropriate approach to aging problems and preventive health services are important not only in terms of health but also in terms of economy.
When we look at our country in terms of geriatrics and geriatric services, it is seen that there is a big gap. There are currently only 15 geriatric specialists in Turkey actively dealing with geriatrics. The majority of these geriatricians work in medical schools like me.
Social and individual awareness and education for the target of “Healthy Aging”, providing health care arrangements that can best serve the elderly population in addition to the services offered to the entire population; It can be possible by creating resources for the necessary health, education and research investments. Education should be provided at all levels of the society, and every communication tool and opportunity should be evaluated for this. The training of medical doctors who will maintain health services and education should be by placing the geriatrics/gerontology curriculum both in clinical and preclinical periods in medical faculties, and in specialization programs, primarily internal medicine and family medicine. Geriatrics specialization after internal medicine residency seems to be a suitable structuring model for the specialization of geriatrics and for the training of teaching staff. Education is the basic approach in order for the aim of healthy aging aimed for the whole world to be real in our country as well. In order to determine the most appropriate structuring model for our country, to replace geriatrics/gerontogy education in pre- and post-graduate medical education, and to structure the researches that will form the necessary database, an increasing number of trained instructors will be needed in this field.
Healthy aging and a happy, peaceful and trouble-free old age are the right of every individual.
Assoc. Hüseyin DORUK
Internal Medicine and Geriatrics Specialist
