THERMAL BATH AND WELL AGEING

MONTECATINI TERME 08/06/2013

Calsolaro Valeria Geriatric Section, Pisa

The Aging World

Green and its nuances: > 70 aa Ocher: 50-69 aa Red and its nuances: < 50 aa Brown: < 35 aa

Data updated to 2006

European aging

Map of Europe showing the percentage of the population over 65 in 2010 for each country
Data from the CIA World Factbook

Italythe oldest country in Europe

One out of five people is >65 years old

Dati ISTAT 2005 ultimo anno per il quale si dispone dei dati per tutti i paesi dellunione Europea

indice di vecchiaia

The upset pyramis attended for the second half of the XXIth century

Dati ISTAT 2005

Dynamic of ageing
50 40

% >65 aa.

30

20 10 0
Italia 1950 1975 2000 2025 2050

12,2
16,2

17,4
18,3

24,3
20,5

35,6
29,6

46,2
36,4

Francia
Cina

7,5
5,6

6,9
6,2

10,1
7,6

19,5
12,6

29,7
21,2

India
Nigeria

4,0

4,2

4,9

5,7

11,6

The Ageing Society

Every 8 Seconds.... ...a Baby Boomer turns 60. By 2015, nearly 15% of our population will be over 65 years of age The U.S. population aged 65 and older is estimated to grow from 35 Million in 2000 to 78 million in 2050 and the number of those aged 85 and older will increase from 4 mill to 31.2 million

The American Geriatrics Society

Aging is a multidisciplinary field;

the study of aging combines or integrates information from several separate areas of study Biology, sociology, and psychology are the "core" or basic areas, along with content from many other areas of study such as public policy, humanities, and economics

Ageing entail an amount of phisiological changes toward a functional decline that involve any organ and apparate

Cardiovascular
Neurological Osteo-articular

Chronic (degenerative) diseases

Risk factors Effect

Increased risk

Cardiovascular diseases Respiratory diseases Tumors Dementia Parkinson disease osteoarthritis

Slow onset (months) Slow progression (years/decades) Progressive deterioration

Journal of Gerontology 2007

The two extremes of aging

normal aging (active aging)
Functional capacity

Frailty (15% of elderly) Disability in Activity Daily Living

Performance Difference

accelerated aging (frail elderly)

Accelerated ageing: frailty

Frailty = loss of ability to react to negative stimuli

The most effective measure to counteract this is rehabilitation

Active aging

Social factors: Education, social support, communication Individual factors: Biology, genetics Public policy: Health promotion, disease prevention, continuous assistance Determinants of active aging

Environmental factors: City/rural area, model of residance Economic factors: Income, job Life style: Physical activity, diet, smoking status, alcohol

The myth of longevity

Appropriate methods to achieve and maintain health in aging

- diet - physical activity
- mobility, sociality, information, culture, communication

Fonte: Presidents Council on Physical Fitness and Sport, Washington, 1992

Thermal Bath & Health

Thermal bath can be considered a therapeutic setting extremely effective in ensuring psychophysical recovery.

During stay thermal guests can learn to live with their tensions also improving the tolerance threshold.

WELLNESS

Environment Diagnostic activity Aesthetics

Thermal stay

Traditional thermal care

Primary prevention

Secondary prevention

Healthy guest (wellness medicine)

Patient (ill guest)

WELLNESS MEDICINE
There is a great difference between being healty and feeling good

Absence of organic or pshycologic disease

Psyco-physic status of wellness that consent to the subjet to express and improve al personal potentiality

Thermalism and WELLNESS MEDICINE

Wellness is the result of a lifestyle, under various points of view: Psycological (cognition and relationship) Physical (exercice) Nutritional Self-care

The impact of Musculoskeletal diseases on the new millennium

"There are effective ways to prevent and treat these disabling disorders, but we must act now. Joint diseases, back complaints, osteoporosis and arthropathies have an enormous impact on individuals and societies, and on healthcare services and economies."
Kofi Annan, UN Secretary General 1999

Subjects older than 60 years affected by chronic diseases in UK from 1996 to 2066

BMJ VOLUME 319 20 NOVEMBER 1999

Prevalence of chronic disease in elderly population in Italy (Studio ILSA)

65-69 70-74 75-79 80-84 Total

Angina Pectoris
Myocardical infarction Arrhythmia Systemic hypertension

6,1
5,9 18,4 60,0 11,7 0,3 10,9 61,7 19,1 4,8

8,3
8,7 22,1 67,4 15,5 0,3 15,1 59,8 19,9 7,0

8,0
8,2 26,5 66,6 14,1 0,2 13,4 61,1 24,0 7,9

7,6
7,4 26,7 64,7 11,9 0,3 11,4 60,2 22,5 8,7

7,3
7,3 22,4 64,0 13,2 0,3 12,6 60,9 20,9 6,5

Heart failure
Diabetes - Type I - Type II

Age represent the most important risk factor for 3,7 6,5 7,7 11,8 6,5 the developing of osteoarthritis

Osteoarthritis COPD Peripheral vascular disease

Consiglio Nazionale delle Ricerche

OA epidemiology
Muscoloskeletal diseases are the major cause of severe pain
and long-term disability1

About 1/4 european subject is affected by some kind of

arthropathies; 1/5 assume chronic therapy 1,2 most important cause of disability1 about 11 billions/year.

OA is the most common joint disease in elderly and it is the

The cost of OA for healthcare services and economies is

1. European Bone and Joint Health Strategies Project. European Action Toward Better Musculoskeletal Health, 2005. 2. European Opinion Research Group. EEIG. Health, food and alcohol and safety. Special Eurobarometer 186, 2003.s

Arthropathies as the first cause of disability (USA)1,2

About 39 milions of medical examination/year2 > 500.000 hospitalization/year2
Arthropathies Spinal disorders Cardiac diseases Pulmonary diseases Hearing impairment Leg and harm stiffness Mental disorders Diabetes Visual impairment Ictus
0 2 4 6 8 10 Disabilit (%) 12 16 18

1. McNeil JM, Binette J.MMWR. 2001;50:120-125 2. CDC. National Arthritis Action Plan. A Public Health Strategy. 1999.

Therapy
joint supplements : Chondroitin, Glucosamine Nonsteroidal Anti-inflammatory Drugs e COX-1 inhibitor Analgesic drugs: paracetamol, tramadol

Physiotherapy Thermal medicine

NSAID adverse events

GI Tract: Ulcers, perforations, bleeding, obstruction strictures, enteropathy Kidney: NSAIDs tend to promote Sodium and water retention and edema. PGs have minimal impact on normal renal blood flow, but become important in the compromised kidney. Patients (particularly elderly and volume depleted) are at risk of renal ischemia with NSAIDs. Liver: NSAID can cause an hepatocellular demage, including an acute liver failure, through an immunological idiosyncrasy. The epidemiological risk of clinically apparent liver injury is low (18 cases per 100000 patient years of NSAID use). Myelopoiesis: platelet Dysfunction. Occasionally, NSAIDs have been associated with myelotoxicity, thereby creating a toxic neutropenia.

Thermal treatments (hydropinic therapy, mud treatments, mud-bath treatments, inhalations and thermal rehabilitation treatments) can be considered as a true and natural answer to prevention, rehabilitation and treatment of serious pathologies.
Moreover, thermal environment can promote a correct life style and balanced diet

MAL. ARTROREUMOPATICHE
Osteoartrosi e altre forme degener. Reumatismi extra articolari

MAL. ORL
Rinopatia vasomotoria Faringolaringiti croniche Sinusiti croniche Sordit rinogena (ototubarite e otitie catarrale cronica) Otiti croniche purul. non colesteatomatose

MAL. VIE RESPIRATORIE

Sindr. rino-sinuso-bronchiali cron. Broncopneumopatie croniche semplici ostruttive (escluso asma o enfisema avanzato complicato o no da insuff. resp. grave o cuore polmonare cronico)

AFFEZIONI ACCREDITABILI S.S.N.

MAL. APPARATO URINARIO

Urolitiasi e sue recidive

MAL. DERMATOLOGICHE
Psoriasi Eczema e dermatite atopica Dermatite seborroica ricorrente

MAL. GASTROENTERICHE
Dispepsia di origine gastroenterica e biliare Sindrome del colon iirritabile nella variet con stipsi

MAL. VASCOLARI
Postumi di flebopatie di tipo cronico

MAL. GINECOLOGICHE
Sclerosi dolorosa connettivo pelvico Leucorrea persistente da vaginiti Croniche aspecifiche o distrofiche

Decreto ministeriale 15 dic 1994

Balneotherapy in patients with chronic inflammatory musculoskeletal diseases

Environmental Health and Preventive Medicine 10, 171179, July 2005]

Balneotherapy in patients with chronic non-inflammatory musculoskeletal diseases

Environmental Health and Preventive Medicine 10, 171179, July 2005]

In conclusion, thermal therapy could represent an important step in the therapeutic approach to elderly patients affected by OA. Thermal therapy could not only act on joint disease, reducing pain and disability, but also could improve heart failure and depressive symptoms as well as quality of life. Moreover a decrease of pain could reduce the assumption of anti-inflammatory drugs and their adverse effects

Lucas Cranach il vecchio: "La fontana della giovinezza"