INTRODUCTION TO GERIATRIC MEDICINE - PowerPoint Presentation

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INTRODUCTION TO GERIATRIC MEDICINE

BY

DR ADENIKE ADENIRAN

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LEARNING OBJECTIVES

To sensitize interest in the peculiarities of the health challenges of the senior citizens and focus on how to assist them to have quality care

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OUTLINE

DEFINITIONS OF TERMS

PHYSIOLOGICAL ORGAN DECLINE WITH AGE

EFFECTS OF THESE PHYSIOLOGICAL DECLINES ON HEALTH

PRESENTATION OF DISEASES IN ELDERLY

THE GERIATRIC GIANTS

PRACTICAL CONCERNS

ETHICAL AND MEDICOLEGAL ISSUES

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DEFINITIONS

Geriatric medicine is the branch of medicine that focuses on health care of the elderly people

It aims to promote health by preventing and treating diseases and disabilities in

olderadults

Geriatrics is the care of aged people

Gerontology is the study of aging process

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PHYSIOLOGICAL ORGAN DECLINE WITH AGE

Geriatrics differs from standard adult medicine because it focuses on unique needs of the elderly person.

The body of the aged person is different physiologically from that of the young adult

During old age, the decline of various organ systems become manifest.

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Previous health issues and lifestyle choices produce different constellation of diseases and symptoms in different people

Appearance of symptoms depends on the remaining healthy reserves in the organs

Example:- a smoker consumes the respiratory system’s reserves early and rapidly.

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In geriatrics, there is distinction between diseases and the effect of normal aging.

For example, renal impairment may be a part of aging but renal failure and urinary incontinence are not.

In geriatrics the disease is treated so healthy aging can continue

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Decline in physiological reserves in organs makes the elderly develop some kinds of diseases and have more complications from mild problems like dehydration from mild gastroenteritis.

A mild fever in elderly persons may cause confusion which may lead to a fall and subsequent fracture of neck of the femur.

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ISSUE OF POLYPHARMACY

Specific attention must be placed on their medications.

Multiple organ pathology results in multiple medical disorders which make them prone to polypharmacy.

Polypharmacy increases risk of drug interactions or adverse drug reactions.

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Drug metabolites are excreted mostly by the kidneys or the liver which may be impaired in the elderly necessitating medication adjustment

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PRESENTATION OF DISEASE IN THE ELDERLY

This may be vague and non-specific.

It may include delirium or falls.

Pneumonia may present with low grade fever and confusion rather high grade fever and cough seen in younger adults

In the presence of cognitive impairment, the elderly may not able to describe their symptoms in words.

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Mild problems like constipation may cause delirium in the elderly as well as serious life threatening conditions like heart attack.

The root cause must first be identified and appropriate treatment given to resolve the problem.

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THE GERIATRIC GIANTS

Bernard Isaac the British geriatric hero, described these conditions characteristic of elderly age groups

These major categories of impairments appear in elderly people especially as they begin to become frail

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These include

Immobility

Instability

Incontinence

Impaired intellect/memory

Impaired vision

Impaired hearing

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IMPAIRED HEARING

This can lead to social isolation, depression, and dependence as the person can no longer talk to other people, receive information over the phone, or engage in simple transaction such as talking to a person in the bank or store.

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VISUAL PROBLEMS

This can lead to falls from tripping over unseen objects

Can also lead to medicines being taken incorrectly because instruction could not be read

Can also lead to mismanaged finances

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IMMOBILITY & INSTABILITY

Both can lead to falls.

They can also make incontinence more problematic

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PRACTICAL CONCERNS

Elderly people generally want to be independent for as long as possible

Functional abilities, independence and quality of life issues are of great concern to geriatricians and their patients

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ELDERS CARE OPTIONS

Information about elder care options that geriatricians must provide include:-

Referral to home care services if available e.g. skilled nursing facilities, assisted living facilities, and hospice as appropriate.

Frail elderly people may choose to decline some kinds of medical care because of risk-benefit ratio.

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Examples:

Screening mammogram: since breast cancer is typically slow growing and would cause no pain, and the elderly is likely to die from other causes

Frail people are also at significant risk of post-surgical complications and need for extended care

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ETHICAL & MEDICOLEGAL ISSUES

Elderly persons may no longer be able to make decisions for themselves.

It is the responsibility of their geriatrician to encourage them well ahead of this degree of deterioration to consider prepared ‘power of attorney’ and ‘advance directives’ that will provide guidance if they are in need

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Patient’s privacy must be respected while ensuring they receive appropriate and necessary services.

They must support informed consent and resist temptation to manipulate the patient by withholding information such as dismal prognosis for a condition or the likelihood of non-recovery from surgery

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ELDER ABUSE

This is the physical, financial, emotional, sexual or other type of abuse of an older dependent.

For elderly people who are unable to care for themselves, geriatrician may recommend legal guardianship or conservatorship to care for the person or the estate.

End of life issues and “Do Not Resuscitate (DNR) orders should also

be resolved.