Introduction of Geriatrics

Geriatrics -

Adel Gassab Mohammed
MD, CABMS, MSc of Medicine Specialist Endocrinologist, Thi-Qar Specialized Diabetes, Endocrine and Metabolism Center, Lecturer Diabetes, Endocrine and Metabolism Division, Department of Medicine, College of Medicine, University of Thi-Qar,

Ageing – the most inevitable stage of human life

Geriatrics-Definition:

The care of aged people
Sub-specialty of internal medicine
Prevention and treatment of age related disabilities
Performed by Geriatricians

I will never be an old man.

To me, old age is always 15 years older than I am


Geriatric age
Age group is not defined precisely

WHO defines old age as

≥60 years ( developing countries) or ≥65 years (developed countries)

Demography

The rate of population ageing is much faster in developing country

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© 2005 Elsevier

GIANTS OF GERIATRICS (Isaacs 1970)

Presenting problems in geriatric medicine

Characteristics of presenting problems in old age

Many people (of all ages) accept ill health as a consequence of ageing and may tolerate symptoms for lengthy periods before seeking medical advice.
1. Late presentation


Infection may present with delirium and without clinical pointers to the organ system affected.
Stroke may present with falls rather than symptoms of focal weakness.
Myocardial infarction may present as weakness and fatigue, without the chest pain or dyspnoea.
Cognitive impairment may limit the patient’s ability to give a history of classical symptoms
2. Atypical presentation

Atypical presentations in frail elderly patients include:

‘failure to cope
‘found on floor
confusion’ and
off feet.

3. Acute illness and changes in function

Presentations in older patients have a more diverse differential diagnosis because multiple pathology is so common. There are frequently a number of causes for any single problem, and adverse effects from medication often contribute
• 4.Multiple pathology

Approach to presenting problems in old age

The approach to most presenting problems in old age can be summarised as follows:
Obtain a collateral history. Find out the patient’s usual status (e.g. mobility, cognitive state) from a relative or carer.


Check all medication. Have there been any recent changes?
Search for and treat any acute illness.

Identify and reverse predisposing risk factors. These depend on the presenting problem.

History
Slow down the pace.
Ensure the patient can hear.
Establish the speed of onset of the illness.
If the presentation is vague, carry out a systematic enquiry.
Obtain full details of:
-all drugs, especially any recent prescription changes
-past medical history, even from many years previously
usual function
-Can the patient walk normally?
-Has the patient noticed memory problems?
-Can the patient perform all household tasks?
Obtain a collateral history: confirm information with a relative or carer and the general practitioner, particularly if the patient is confused or communication is limited by deafness or speech disturbance.

Examinations

Thorough to identify all comorbidities.
Tailored to the patient’s stamina and ability to cooperate.
Include functional status:
-cognitive function
-gait and balance
-nutrition
-hearing and vision

Social assessment(Functional )

Home circumstances
Living alone, with another or in a care home.
Activities of daily living (ADL)
Activity of daily living:
domestic ADL(DADL): shopping, cooking, housework
personal ADL(PADL): bathing, dressing, walking.

Informal help: relatives, friends, neighbours.

Formal social services: home help, meals on wheels.

Frailty-Loss of an individuals ability to withstand minor stresses

Unintentional weight loss
Muscle weakness
Exhaustion
Low physical activity
Slowed walking speed
A healthy person scores 0; a very frail person scores 5
Frailty scale:

Falls

Around 30% of those over 65 years of age fall each year, this figure rising to more than 40% in those aged over 80. Although only 10–15% of falls result in serious injury, they are the cause of more than 90% of hip fractures in this age group, compounded by the rising prevalence of osteoporosis










Dizziness
Dizziness is very common, affecting at least 30% of those aged over 65 years in community surveys. Dizziness can be disabling in its own right and is also a risk factor for falls. Acute dizziness is relatively straightforward and common causes inclu
hypotension due to arrhythmia, myocardial infarction, gastrointestinal bleed or pulmonary embolism
onset of posterior fossa stroke
vestibular neuronitis.

Delirium

Delirium is a syndrome of transient, reversible cognitive dysfunction. It is very common, affecting up to 30% of older hospital inpatients, either at admission or during their hospital stay.

Common cause and investigations

Urinary incontinence

It occurs in all age groups but becomes more prevalent in old age, affecting about 15% of women and 10% of men aged over 65

Drugs related Problems in geriatrics

Adverse drug reactions

Comprehensive Geriatric Assessment

• Multidisciplinary diagnostic and treatment process

• Medical, psychological and functional limitations
• Coordinated plan to maximize health
• It differs from a standard medical evaluation by:
• Focus on elderly individual
• Emphasize on functional status & quality of life
• Multidisciplinary approach
CGA is defined as :


Patient selection criteria for CGA:
High risk elderly patient-frail or chronically ill
Medical co-morbidities, heart failure or cancer
Specific geriatric condition such as
dementia,
falls
functional disabilities
Psychosocial disorders such as
depression or
isolation

Major component of CGA

DOMAINS OF Comprehensive Geriatric Assessment

Additional components :

Nutrition/weight change
Urinary continence
Sexual function
Vision/hearing
Dentition
Living situation
Spirituality

Subspecialties

Cardiogeriatrics
geriatric psychiatry
geriatric rehabilitation
geriatric rheumatology, etc.

• Orthogeriatric

• Geriatric Cardiothoracic Surgery
• Geriatric urology, etc.
• Surgical
• Other
• Geriatric intensive-care unit
• Geriatric nursing
• Geriatric nutrition, etc.
Medicine

Rehabilitation

Rehabilitation aims to improve the ability of people of all ages to perform day-to-day activities, and to restore their physical, mental and social capabilities as far as possible.


The rehabilitation process
Assessment.
Goal-setting.
Intervention.
Re-assessment.

Multidisciplinary team working

Research

The Hospital Elder Life Program(HELP)
Designed to prevent delirium and functional decline in the hospitalized patient setting
40% incidence of delirium can be prevented
Replicated in over 63 hospitals across the world

Acute Geriatrics-based Ward (AGW)

AGW shortened the length of hospital stay and
May have cut down need for long-term institutional living
Geriatric-based versus general wards for older acute medical patients: a randomized comparison of outcomes and use of resources

Biology and genetics of ageing

Ageing can be defined as a progressive accumulation through life of random molecular defects that build up within tissues and cells.

(Are) we (Are) able to slow or even stop the body's clock—at least for a little while ?

Please stand by him……………….

This frail elderly person needs your hands along with the stick

Thankyou all