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geriatrics

Geriatrics is the branch of medicine that provides health care for the elderly; it differs from gerontology, study of the aging process itself. However, geriatrics is considered by some as 'medical gerontology'. The term geriatrics comes from the Greek geron meaning'old man' & iatros meaning 'healer'. See elderly for disorders of the elderly. The I's of geriatrics [2] - Immobility - Impotence - Isolation - Incontinence - Iatrogenesis - Insomnia - Instability - Irritable colon - Impaired eyes/ears - Impecunity - Immune deficiency - Intellectual decline The 5 Ms of geriatrics [12] 1) Mind - maintaining mental health - managing dementia - prevention & treatment of delirium - evaluation & treatment of depression 2) Mobility - maintaining ambulation - maintaining balance - prevention of injury, especially due to falls 3) Medications - reducing polypharmacy - medication deprescribing - appropriate prescribing for the elderly - encourage awareness of drug adverse effects 4) Multicomplexity - older patients may have a multiplicity of health conditions - living conditions may be impacted by age, health conditions, & social concerns 5) Matters Most - advance directives - goals of care - care preferences reflected in treatment plan Why is geriatrics important? - the prevalence & disabling effects of geriatric conditions among older adults result in substantial morbidity. [3] - Internal medicine house staff are often unaware of risks for adverse outcomes in hospitalized elderly [4], including: a) delirium b) malnutrition c) pressure ulcers d) falls e) depression f) infection g) adverse drug effects h) drug interactions see elderly for demographics 'the graying of America' What distinguishes geriatrics from internal medicine & family practice? 1) Geriatrics differs from adult medicine in many respects. The elderly are physiologically different from younger adults (see age-related physiological changes). These differences include a diminished capacity to maintain homeostasis, resulting in an increased risk of complications from otherwise mild stress or pathology. 2) Geriatrics places a greater emphasis on functional ability, independence & quality of life than does adult medicine. These are the best indicators of longevity in the elderly. 3) The prevalence of dependence in the elderly is high, thus a geriatrician may often deal with caregivers. 4) The prevalence of cognitive impairment is high, thus a geriatrician may often deal with decision-making capacity, advance directives, durable power of attorney for health care... 5) a geriatrican must also be alert for signs of elder abuse. 6) one of the major problems in geriatrics is polypharmacy - this is part cultural, part situational - the cultural part stems from advertisement, the media & other factors that convince Americans there is a medication for every ailment - however, elderly are the group of patients most at risk for drug interactions & they are at increased risk of complications from such drug interactions - 72% of elderly with dementia are prescribed >= 5 medications, 43% >= 10 medications [12] - these medications often include highly sedating & anticholinergic agents [12] - what seems to be apparent is that the healthiest elderly are generally those on the fewest medications

Related

aging alcohol consumption in the elderly geriatric disorder; disease of old age; geriatric syndrome gerontology health maintenance (preventive medicine) in the elderly longevity pharmacokinetics in the elderly stem cell transplantation in the elderly; geriatric stem cell transplantation SuperAger (exceptional cognition in the elderly) trauma in the elderly; geriatric trauma

Specific

geriatric nursing

General

medical specialty

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Topics in Geriatrics

References

  1. Geriatric Medicine: An Evidence-Based Approach, 4th ed, Cassel CK et al (eds), Springer-Verlag, New York, 2003
  2. The Sepulveda VA GRECC Guide to Geriatric Assessment
  3. Cigolle CT, Langa KM, Kabeto MU, Tian Z, Blaum CS. Geriatric conditions and disability: the Health and Retirement Study. Ann Intern Med. 2007 Aug 7;147(3):156-64. PMID: 17679703
  4. Fernandez HM et al, House staff member awareness of older inpatients' risks for hazards of hospitalization. Arch Intern Med 2008, 168:390 PMID: 18299494
  5. In: Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 29-Oct 2, 2004
  6. Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004 - Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
  7. Principles of Geriatric Medicine, 4th ed,, Hazzard et al (eds), McGraw-Hill, NY, 1999
  8. Wikipedia: Geriatrics http://en.wikipedia.org/wiki/Geriatrics
  9. U.S. Department of Health and Human Services (HHS) Aging in 2015: HHS and the White House Conference on Aging. July 13, 2015 http://www.hhs.gov/news/press/2015pres/07/20150713c.html
  10. Yalcin B, Tamer E, Toy GG, Oztas P, Hayran M, Alli N The prevalence of skin diseases in the elderly: analysis of 4099 geriatric patients. Int J Dermatol. 2006 Jun;45(6):672-6. PMID: 16796625
  11. Partnership for Health in Aging Workgroup on Interdisciplinary Team Training in Geriatrics. Position statement on interdisciplinary team training in geriatrics: an essential component of quality health care for older adults. J Am Geriatr Soc. 2014 May;62(5):961-5. PMID: 24738753
  12. Growdon ME, Gan S, Yaffe K, Steinman MA. Polypharmacy among older adults with dementia compared with those without dementia in the United States. J Am Geriatr Soc 2021 Sep; 69:2464 PMID: 34101822 https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.17291
  13. HealthinAging.org The 5Ms of Geriatrics https://www.va.gov/covidtraining/docs/HIA_TipSheet_Geriatric_5Ms_19.pdf
  14. Stanford Geriatric Education Center http://sgec.stanford.edu/