geriatrics
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Introduction
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
- Mind
- maintaining mental health
- managing dementia
- prevention & treatment of delirium
- evaluation & treatment of depression
- Mobility
- maintaining ambulation
- maintaining balance
- prevention of injury, especially due to falls
- Medications
- reducing polypharmacy
- medication deprescribing
- appropriate prescribing for the elderly
- encourage awareness of drug adverse effects
- Multicomplexity
- older patients may have a multiplicity of health conditions
- living conditions may be impacted by age, health conditions, & social concerns
- 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:
- delirium
- malnutrition
- pressure ulcers
- falls
- depression
- infection
- adverse drug effects
- drug interactions
see elderly for demographics 'the graying of America'
What distinguishes geriatrics from internal medicine & family practice?
- 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.
- 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.
- The prevalence of dependence in the elderly is high, thus a geriatrician may often deal with caregivers.
- 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...
- a geriatrican must also be alert for signs of elder abuse.
- 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
More general terms
More specific terms
Additional terms
- 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
References
- ↑ Geriatric Medicine: An Evidence-Based Approach, 4th ed, Cassel CK et al (eds), Springer-Verlag, New York, 2003
- ↑ Jump up to: 2.0 2.1 The Sepulveda VA GRECC Guide to Geriatric Assessment
- ↑ Jump up to: 3.0 3.1 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: https://www.ncbi.nlm.nih.gov/pubmed/17679703
- ↑ Jump up to: 4.0 4.1 Fernandez HM et al, House staff member awareness of older inpatients' risks for hazards of hospitalization. Arch Intern Med 2008, 168:390 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18299494
- ↑ In: Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 29-Oct 2, 2004
- ↑ 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 - ↑ Principles of Geriatric Medicine, 4th ed,, Hazzard et al (eds), McGraw-Hill, NY, 1999
- ↑ Wikipedia: Geriatrics http://en.wikipedia.org/wiki/Geriatrics
- ↑ 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
- ↑ 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: https://www.ncbi.nlm.nih.gov/pubmed/16796625
- ↑ 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: https://www.ncbi.nlm.nih.gov/pubmed/24738753
- ↑ Jump up to: 12.0 12.1 12.2 12.3 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: https://www.ncbi.nlm.nih.gov/pubmed/34101822 https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.17291
- ↑ HealthinAging.org The 5Ms of Geriatrics https://www.va.gov/covidtraining/docs/HIA_TipSheet_Geriatric_5Ms_19.pdf
- ↑ Stanford Geriatric Education Center http://sgec.stanford.edu/