Geriatric Medicine

Introduction 

Geriatric medicine (GM) is a medical specialty related to the health and well-being of older adults. GM holds a significant role in promoting health and managing the complicated medical, cognitive, psychological, and social problems of older people. A geriatrician is a healthcare professional specially trained to meet the unique healthcare requirements of the elderly, both while sick in the hospital and in the outpatient settings. The geriatric team is a multidisciplinary team comprising healthcare professionals with specific knowledge and prowess in dealing with the issues of the elderly and delivering optimal care as per the requirements and aspirations of older individuals. The team runs comprehensive geriatric assessments and implements appropriate therapeutic plans. 

What is the Meaning of Geriatric Assessment? 

It is a multidimensional, interdisciplinary diagnostic approach to evaluate an older person’s functional status, cognition, medical conditions, psychological state, nutritional status, and social support.  

Common Health Problems Among the Elderly 

Diabetes: 

It is the predominant metabolic long-term condition in older adults. 

Causes 

• Sedentary lifestyle 
• Increasing obesity 
• Decrease in insulin secretion 

Symptoms  

• Excessive thirst and urination 
• Blurry vision 
• Tiredness 

Screening Tests 

• A1C Test - Estimates the average of blood glucose levels over the course of two or three months 
• Oral Glucose Tolerance Test - Blood glucose is measured both before and two hours after a person drinks a glucose-containing liquid 

Treatment and Management 

• Antihyperglycemic agents, such as metformin 
• Insulin therapy 
• Physical exercise, such as walking 

Sleep Disorders: 

These disorders involve a disrupted sleep pattern, including difficulty in falling or staying asleep, excessive sleep, or other abnormalities in sleep behaviors. 

Causes 

• Alterations in the body’s natural internal clock, causing certain individuals to fall asleep earlier in the evening 
• Physical pain of any sort 
• Stimulants such as caffeine and nicotine 
• Chronic disease 

Symptoms 

• Difficulty differentiating between night and day 
• Waking up frequently during the night 

Diagnosis 

Healthcare providers might recommend creating a sleep diary or a sleep study (polysomnography). 

Ways to Promote Sleep 

• Avoid large meals before bedtime 
• Sleeping in a quiet room that isn’t too cold or too hot and having a leisurely bedtime routine 

Dementia: 

This condition refers to cognitive impairment —remembering and thinking rationally — to such an extent that it interferes with an individual’s daily life and tasks.  

The symptoms can differ in different individuals and may include: 

• Memory loss 
• Poor judgment 
• Confusion 

Types and Causes 

• Alzheimer’s Disease - Caused by alterations in the brain due to abnormal buildups of proteins referred to as amyloid plaques and tau tangles 
• Frontotemporal Dementia - Associated with abnormal levels of the tau protein and TDP-43 
• Lewy Body Dementia - Caused by abnormal deposition of the alpha-synuclein protein 

Diagnosis 

• Cognitive and neurological tests 
• Brain scan 
• Cerebrospinal fluid tests 
• Blood tests 

Treatment 

• Medications such as acetylcholinesterase inhibitors, memantine, and so on 
• Cognitive stimulation therapy that involves participating in group activities designed to enhance language ability and problem-solving skills 

Delirium: 

It is an acute decrease in the attention and cognition of an individual. It is a prominent, life-threatening, and potentially preventable clinical syndrome among individuals who are 65 years of age or older. 

Causes 

• Advanced cancer 
• Organ failure 
• Metabolic disorders 
• Infections such as flu or urinary tract infections 

Symptoms 

• Alterations in alertness (generally more alert in the morning, less at night) 
• Varying degrees of consciousness 
• Confusion 
• Disorganized thinking, talking in a manner that doesn’t make sense 

Diagnosis 

• A medical history 
• Physical and neurological exams 
• Mental status testing, which looks for problems with thinking and alertness 
• Imaging tests 

Treatment 

• Controlling the environment, which comprises making sure that the room is peaceful and well-lit 
• Medications, including those that control aggression 
• If required, making sure that the individual has glasses, a hearing aid, or other devices that aid in communication 

Polypharmacy: 

Geriatric polypharmacy refers to a scenario when older adults are using five or more medications at the same time. Problems related to polypharmacy, like elevated risk for hip fractures, falls, and reduced cognitive functions, can help avoid several negative outcomes like falls and reduced healthcare burden. Therefore, optimizing their drug regimen is one of the crucial elements in comprehensive geriatric care. 

Frailty: 

It is an age-related biological syndrome characterized by reduced biological reserves due to improper regulation of various physiological systems, which puts a person at risk when facing minor stressors and is linked with poor outcomes (i.e., disability). 

Risk Factors 

• Malnutrition 
• Polypharmacy 
• Living alone 
• Low levels of physical activity 

Cause 

Age-related loss of muscle mass 

Ways to Beat Frailty 

• Walking 
• Mild strength training 

Falls: 

They are a critical health issue and often cause major injuries (especially fractures of the proximal femur) that lead to functional impairment, longstanding pain, disability, and mortality. 

Causes 

• Biological 
• Medical 
• Environmental or behavioral 

Risk Factors 

• Muscle weakness  
• Balance and gait problems  
• Poor vision 
• Cognitive and functional impairment 

Preventive Measures 

• Arranging the house and living ambiance 
• Vitamin D supplementation 
• Use of support and orthoses  

Discovering the Secret to Healthy Aging 

The point is not just about living longer. It is all about living happily and healthily for longer. Here are some ways to age gracefully: 

Taking Care of Physical Health 

It involves staying active, making smart food choices, getting adequate sleep, limiting alcohol consumption, and proactively managing healthcare. Minor changes in these lifestyle choices can go a long way. 

Taking Care of Mental and Cognitive Health 

Managing loneliness, depression, social isolation, stress, and mood through medical and self-care is a gateway to healthy aging. Learning novel skills might help keep the elderly cognitively healthy. By early screening, proper care, and providing effective therapeutic interventions, the quality of life of the elderly population can be improved. Fortis Healthcare is the eminent pioneer for geriatric medicine in India.