Geriatric Problems

 

Geriatrics is the branch of medicine that focuses on healthcare of the elderly. It aims to promote health and to prevent and treat diseases and disabilities in older adults.

Geriatrics was separated from internal medicine as a separate entity as pediatrics separated from adult internal medicine and neonatology separated from pediatrics.

Elderly female in residential care home

There is no set age at which patients may be under the care of a geriatrician. Rather, this is determined by a profile of the typical problems that geriatrics focuses on.

The term geriatrics differs from gerontology. This is the study of the ageingprocess itself. The term comes from the Greek geron meaning “old man” andiatros meaning “healer”. However “Geriatrics” is considered by some as “Medical Gerontology”.

Scope
Differences between adult and geriatric medicine
Geriatrics differs from adult medicine in many respects. The body of an elderly person is substantially different physiologically from that of an adult. Old age is the period of manifestation of decline of the various organ systems in the body. This varies according to various reserves in the organs (e.g. Smokers consume their respiratory system reserve early and rapidly).

Many people cannot differentiate between disease and ageing effects (e.g. renal impairment may be a part of ageing but renal failure is not and urinary incontinence is not a part of normal ageing). Geriatricians aim at treating the disease and decreasing the effect of ageing on the elderly. Years of training and experience (above and beyond basic medical training) go into recognizing the difference between normal ageing and what is actually pathological.

The decline in physiological reserve in organs make the elderly vulnerable disease (as dehydration from a mild gastroenteritis) and liable to have complications from mild problems (Fever in elderly may cause confusion leading to a fall and fracture of neck of femur).

Functional ability, dependence and quality of life issues are of greater concern to geriatricians perhaps than to adult physicians. Treating an elderly person is not like treating an adult. A major difference between geriatrics and adult medicine is that the elderly sometimes cannot make decisions for themselves. The issues of power of attorney, privacy, legal responsibility,advance directives and informed consent must always be considered. Elder’s abuse is also a major concern in this age group. In a sense, geriatricians often have to “treat” the caregivers and sometimes, the family, rather than just the elder.

The elderly have specific issues as regard medications. They are particularly subjected to polypharmacy due to many causes. Some it is because they have multiple medical disorders, or use many herb & OTCs, and some adult physicians just prescribe medications to their specific specialty not reviewing other medications used by the elder. The polypharmacy may result in drug interactions including adverse reactions. Also, drugs are excreted mostly by the kidneys or liver, which may be impaired in the elderly and therefore medication might need to be adjusted.

Presentations of diseases in the elderly may be vague and non-specific or present with delirium. Pneumonia may present with low grade fever,dehydration, confusion. Some elderly may find difficulty expressing their symptoms especially if the disease is active and causing confusion or if they have cognitive impairment. Delirium in the elderly may be caused by anything from constipation to a serious problem like myocardial infarction.

Geriatrics giants and elderly diseases
‘Geriatric giants’ are immobility, instability, incontinence and impaired intellect/memory. Health issues in older adults may also include elderly care,delirium, use of multiple medications, impaired vision and hearing.