Geriatrics - AbsoluteAstronomy.com

Geriatrics is a sub-specialty of internal medicine

Internal medicine

Internal medicine is the medical specialty dealing with the prevention, diagnosis, and treatment of adult diseases. Physicians specializing in internal medicine are called internists. They are especially skilled in the management of patients who have undifferentiated or multi-system disease processes...

and family medicine

Family medicine

Family medicine is a medical specialty devoted to comprehensive health care for people of all ages. It is a division of primary care that provides continuing and comprehensive health care for the individual and family across all ages, sexes, diseases, and parts of the body...

that focuses on health care of elderly people. It aims to promote health

Health

Health is the level of functional or metabolic efficiency of a living being. In humans, it is the general condition of a person's mind, body and spirit, usually meaning to be free from illness, injury or pain...

by preventing and treating disease

Disease

A disease is an abnormal condition affecting the body of an organism. It is often construed to be a medical condition associated with specific symptoms and signs. It may be caused by external factors, such as infectious disease, or it may be caused by internal dysfunctions, such as autoimmune...

s and disabilities in older adults. There is no set age at which patients may be under the care of a geriatrician, or physician who specializes in the care of elderly people. Rather, this decision is determined by the individual patient's needs, and the availability of a specialist.

Geriatrics, the care of aged people, differs from gerontology

Gerontology

Gerontology is the study of the social, psychological and biological aspects of aging...

, which is the study of the aging process itself. The term geriatrics comes from the Greek

Greek language

Greek is an independent branch of the Indo-European family of languages. Native to the southern Balkans, it has the longest documented history of any Indo-European language, spanning 34 centuries of written records. Its writing system has been the Greek alphabet for the majority of its history;...

γέρων geron meaning "old man" and ιατρός iatros meaning "healer". However, geriatrics is sometimes called medical gerontology.

Differences between adult and geriatric medicine

Geriatrics differs from standard adult medicine

Medicine

Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....

because it focuses on the unique needs of the elderly person. The aged body is different physiologically from the younger adult body, and during old age, the decline of various organ systems becomes manifest. Previous health issues and lifestyle choices produce a different constellation of diseases and symptoms in different people. The appearance of symptoms depends on the remaining healthy reserves in the organs. Smokers, for example, consume their respiratory system reserve early and rapidly.

Geriatricians distinguish between disease

Disease

s and the effects of normal ageing

Ageing

Ageing or aging is the accumulation of changes in a person over time. Ageing in humans refers to a multidimensional process of physical, psychological, and social change. Some dimensions of ageing grow and expand over time, while others decline...

. For example, renal impairment may be a part of ageing, but renal failure

Renal failure

Renal failure or kidney failure describes a medical condition in which the kidneys fail to adequately filter toxins and waste products from the blood...

and urinary incontinence

Urinary incontinence

Urinary incontinence is any involuntary leakage of urine. It is a common and distressing problem, which may have a profound impact on quality of life. Urinary incontinence almost always results from an underlying treatable medical condition but is under-reported to medical practitioners...

are not. Geriatricians aim to treat any diseases that are present and to decrease the effects of aging on the body.

Increased complexity

The decline in physiological reserve in organs makes the elderly develop some kinds of diseases and have more complications from mild problems (such as dehydration

Dehydration

In physiology and medicine, dehydration is defined as the excessive loss of body fluid. It is literally the removal of water from an object; however, in physiological terms, it entails a deficiency of fluid within an organism...

from a mild gastroenteritis

Gastroenteritis

Gastroenteritis is marked by severe inflammation of the gastrointestinal tract involving both the stomach and small intestine resulting in acute diarrhea and vomiting. It can be transferred by contact with contaminated food and water...

). Multiple problems may compound: A mild fever

Fever

Fever is a common medical sign characterized by an elevation of temperature above the normal range of due to an increase in the body temperature regulatory set-point. This increase in set-point triggers increased muscle tone and shivering.As a person's temperature increases, there is, in...

in elderly persons may cause confusion, which may lead to a fall

Falling (accident)

Falling is a major cause of personal injury, especially for the elderly. Builders, electricians, miners, and painters represent worker categories representing high rates of fall injuries. The WHO estimate that 392,000 people die in falls every year...

and to a fracture

Fracture

A fracture is the separation of an object or material into two, or more, pieces under the action of stress.The word fracture is often applied to bones of living creatures , or to crystals or crystalline materials, such as gemstones or metal...

of the neck of the femur

Femur

The femur , or thigh bone, is the most proximal bone of the leg in tetrapod vertebrates capable of walking or jumping, such as most land mammals, birds, many reptiles such as lizards, and amphibians such as frogs. In vertebrates with four legs such as dogs and horses, the femur is found only in...

("breaking her/his hip").

Elderly people require specific attention to medications. Elderly people particularly are subjected to polypharmacy

Polypharmacy

Polypharmacy is the use of multiple medications by a patient, especially when too many forms of medication are used by a patient, when more drugs are prescribed than is clinically warranted, or even when all prescribed medications are clinically indicated but there are too many pills to take ....

(taking multiple medications). Some elderly people have multiple medical disorders; some have self-prescribed many herbal medications and over-the-counter drug

Over-the-counter drug

Over-the-counter drugs are medicines that may be sold directly to a consumer without a prescription from a healthcare professional, as compared to prescription drugs, which may be sold only to consumers possessing a valid prescription...

s; some adult physicians prescribe medications to their specialty without reviewing other medications used by the elder patient. This polypharmacy may result in many drug interaction

Drug interaction

A drug interaction is a situation in which a substance affects the activity of a drug, i.e. the effects are increased or decreased, or they produce a new effect that neither produces on its own. Typically, interaction between drugs come to mind...

s and may cause some adverse drug reaction

Adverse drug reaction

An adverse drug reaction is an expression that describes harm associated with the use of given medications at a normal dosage. ADRs may occur following a single dose or prolonged administration of a drug or result from the combination of two or more drugs...

s. In one study, it was found that prescription and nonprescription medications were commonly used together among older adults, with nearly 1 in 25 individuals potentially at risk for a major drug-drug interaction. Drugs are excreted mostly by the kidneys or the liver

Liver

The liver is a vital organ present in vertebrates and some other animals. It has a wide range of functions, including detoxification, protein synthesis, and production of biochemicals necessary for digestion...

, either of which may be impaired in the elderly, and as a result the medication might need adjustment to avoid overwhelming the kidneys or liver.

The presentation of disease in elderly persons may be vague and non-specific, or it may include delirium

Delirium

Delirium or acute confusional state is a common and severe neuropsychiatric syndrome with core features of acute onset and fluctuating course, attentional deficits and generalized severe disorganization of behavior...

or falls. (Pneumonia

Pneumonia

Pneumonia is an inflammatory condition of the lung—especially affecting the microscopic air sacs —associated with fever, chest symptoms, and a lack of air space on a chest X-ray. Pneumonia is typically caused by an infection but there are a number of other causes...

, for example, may present with low-grade fever

Fever

, dehydration, confusion or falls, rather than the high fever and cough seen in middle-aged adults.) Some elderly people may find it hard to describe their symptoms in words, especially if the disease is causing confusion, or if they have cognitive impairment. Delirium in the elderly may be caused by a minor problem such as constipation

Constipation

Constipation refers to bowel movements that are infrequent or hard to pass. Constipation is a common cause of painful defecation...

or by something as serious and life-threatening as a heart attack

Myocardial infarction

Myocardial infarction or acute myocardial infarction , commonly known as a heart attack, results from the interruption of blood supply to a part of the heart, causing heart cells to die...

. Many of these problems are treatable, if the root cause can be discovered.

Geriatric giants

The so-called geriatric giants are the major categories of impairment that appear in elderly people, especially as they begin to fail. These include immobility, instability, incontinence

Urinary incontinence

and impaired intellect/memory

Dementia

Dementia is a serious loss of cognitive ability in a previously unimpaired person, beyond what might be expected from normal aging...

.

Impaired vision and hearing loss are common chronic problems among older people. Hearing problems can lead to social isolation, depression, and dependence as the person is no longer able to talk to other people, receive information over the telephone, or engage in simple transactions, such as talking to a person at a bank or store. Vision problems lead to falls from tripping over unseen objects, medicine being taken incorrectly because the written instructions could not be read, and finances being mismanaged.

Practical concerns

Functional abilities, independence and quality of life

Quality of life

The term quality of life is used to evaluate the general well-being of individuals and societies. The term is used in a wide range of contexts, including the fields of international development, healthcare, and politics. Quality of life should not be confused with the concept of standard of...

issues are of great concern to geriatricians and their patients. Elderly people generally want to live independently as long as possible, which requires them to be able to engage in self-care

Self-care

Self care is personal health maintenance. It is any activity of an individual, family or community, with the intention of improving or restoring health, or treating or preventing disease....

and other activities of daily living

Activities of daily living

Activities of Daily Living is a term used in healthcare to refer to daily self-care activities within an individual's place of residence, in outdoor environments, or both...

. A geriatrician may be able to provide information about elder care options, and refers people to home care

Home care

Home Care, , is health care or supportive care provided in the patient's home by healthcare professionals Home Care, (also referred to as domiciliary care or social care), is health care or supportive care provided in the patient's home by healthcare professionals Home Care, (also referred to as...

services, skilled nursing facilities, assisted living facilities, and hospice

Hospice

Hospice is a type of care and a philosophy of care which focuses on the palliation of a terminally ill patient's symptoms.In the United States and Canada:*Gentiva Health Services, national provider of hospice and home health services...

as appropriate.

Frail elderly

Frailty syndrome

The frailty syndrome is a collection of symptoms or markers, primarily due to the aging-related loss and dysfunction of skeletal muscle and bone, that place older adults at increased risk of adverse events such as death, disability, and institutionalization.-Sarcopenia:Sarcopenia, refers to loss...

people may choose to decline some kinds of medical care, because the risk-benefit ratio is different. For example, frail elderly women routinely stop screening mammograms, because breast cancer

Breast cancer

Breast cancer is cancer originating from breast tissue, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk. Cancers originating from ducts are known as ductal carcinomas; those originating from lobules are known as lobular carcinomas...

is typically a slowly growing disease that would cause them no pain, impairment or loss of life before they would die of other causes. Frail people are also at significant risk of post-surgical complications and the need for extended care, and an accurate prediction—based on validated measures, rather than how old the patient's face looks—can help older patients make fully informed choices about their options. Assessment of older patients before elective surgeries can accurately predict the patients' recovery trajectories. One frailty scale uses five items: unintentional weight loss, muscle weakness

Muscle weakness

Muscle weakness or myasthenia is a lack of muscle strength. The causes are many and can be divided into conditions that have true or perceived muscle weakness...

, exhaustion, low physical activity, and slowed walking speed. A healthy person scores 0; a very frail person scores 5. Compared to non-frail elderly people, people with intermediate frailty scores (2 or 3) are twice as likely to have post-surgical complications, spend 50% more time in the hospital, and are three times as likely to be discharged to a skilled nursing facility instead of to their own homes. Frail elderly patients (score of 4 or 5) who were living at home before the surgery have even worse outcomes, with the risk of being discharged to a nursing home rising to twenty times the rate for non-frail elderly people.

Subspecialties and related services

Some diseases commonly seen in elderly are rare in adults, e.g., dementia, delirium, falls. As societies aged, many specialized geriatric- and geriatrics-related services emerged including:

Medical

Geriatric psychiatry
Geriatric psychiatry
Geriatric psychiatry, also known as geropsychiatry, psychogeriatrics or psychiatry of old age, is a subspecialty of psychiatry dealing with the study, prevention, and treatment of mental disorders in humans with old age. After a 4 year residency in psychiatry, a psychiatrist can complete a one year...

or psychogeriatrics (focus on dementia
Dementia
Dementia is a serious loss of cognitive ability in a previously unimpaired person, beyond what might be expected from normal aging...

, delirium
Delirium
Delirium or acute confusional state is a common and severe neuropsychiatric syndrome with core features of acute onset and fluctuating course, attentional deficits and generalized severe disorganization of behavior...

, depression
Clinical depression
Major depressive disorder is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and by loss of interest or pleasure in normally enjoyable activities...

and other psychiatric disorders).
Cardiogeriatrics
Cardiogeriatrics
Cardiogeriatrics or Geriatric cardilogy is the branch of cardiology and geriatric medicine that deals with the cardiovascular disorders in edlerly....

(focus on cardiac diseases of elderly)
Geriatric nephrology
Geriatric nephrology
Geriatric nephrology is the branch of internal medicine and geriatric medicine that deals with diseases of the kidneyIt is a growing subspecialty of geriatrics...

(focus on kidney diseases of elderly)
Geriatric dentistry
Geriatric dentistry
Geriatric dentistry or gerodontics is the delivery of dental care to older adults involving the diagnosis, prevention, and treatment of problems associated with normal aging and age-related diseases as part of an interdisciplinary team with other health care professionals.-Overview:Last century has...

(focus on dental disorders of elderly)
Geriatric Rehabilitation
Geriatric rehabilitation
Geriatric rehabilitation or Geriatric Physical Therapy is the branch of medicine that studies rehabilitation and physical therapy issues in elderly.- Origins :...

(focus on physical therapy in elderly)
Geriatric oncology
Geriatric oncology
Geriatric oncology is the branch of medicine that studies benign and malignant tumors in elderly.- Origin :While anyone can develop cancer, the risk of getting the disease increases with age...

(focus on tumors in elderly)
Geriatric rheumatology
Geriatric rheumatology
Geriatric rheumatology is the branch of medicine that studies rheumatologic disorders in elderly . Sometimes it is called Gerontorheumatology.- Origin :...

(focus on joints and soft tissue disorders in elderly)
Geriatric neurology
Geriatric neurology
Geriatric neurology is the branch of medicine that studies neurologic disorders in elderly.- Origin :In 1991 Advanced Fellowship Program in Geriatric Neurology was started by the Department of Veterans Affairs...

(focus on neurologic disorders in elderly)
Geriatric diagnostic imaging
Geriatrics dermatology (focus on skin disorders in elderly)
Geriatric subspeciality medical clinics (As Geriatric Anticoagulation Clinic Geriatric Assessment Clinic, Falls and Balance Clinic, Continence Clinic, Palliative Care Clinic, Elderly Pain Clinic, Cognition and Memory Disorders Clinic)
Geriatric emergency medicine
Geriatric Physical Examination of interest especially to Physicians & Physician Assistants.
Geriatric public health or Preventive Geriatrics (focuses on geriatrics public health issues including disease prevention and health promotion in elderly)
Geriatric pharmacotherapy

Surgical

Orthogeriatrics (close cooperation with orthopedic surgery
Orthopedic surgery
Orthopedic surgery or orthopedics is the branch of surgery concerned with conditions involving the musculoskeletal system...

and a focus on osteoporosis
Osteoporosis
Osteoporosis is a disease of bones that leads to an increased risk of fracture. In osteoporosis the bone mineral density is reduced, bone microarchitecture is deteriorating, and the amount and variety of proteins in bone is altered...

and rehabilitation).
Geriatric Cardiothoracic Surgery
Geriatric urology
Geriatric otolaryngology
Geriatric General Surgery
Geriatric trauma
Geriatric trauma
Geriatric trauma refers to a traumatic injury that occurs to an elderly person. The three prevailing causes of traumatic death in the elderly are falls , traffic collisions and burns....
Geriatric gynecology
Geriatric ophthalmology

Other geriatrics subspecialties

Geriatric anesthesia
Geriatric anesthesia
Geriatric anesthesia is the branch of medicine that studies anesthesia approach in elderly.- Origin :The perioperative care of elderly patients differs from that of younger patients for a number of reasons. Some of these can be attributed to the changes that occur in the process of aging, but many...

(focuses on anesthesia & perioperative care of elderly)
Geriatric intensive-care unit: (a special type of intensive care unit
Intensive Care Unit
thumb|220px|ICU roomAn intensive-care unit , critical-care unit , intensive-therapy unit/intensive-treatment unit is a specialized department in a hospital that provides intensive-care medicine...

dedicated to critically ill elderly)
Geriatric nursing
Geriatric nursing
Geriatric nursing is the specialty that concerns itself with the provision of nursing services to geriatric or aged individuals.-Geriatric nursing:...

(focuses on nursing of elderly patients and the aged).
Geriatric nutrition
Geriatric Occupational Therapy (part of Geriatric Rehabilitation)
Geriatric Pain Management
Geriatric Physical Therapy
Geriatric podiatry
Geriatric psychology
Geriatric Mental Health Counselor/Specialist (focuses on treatment more so than assessment)

History

The Canon of Medicine
The Canon of Medicine
The Canon of Medicine is an encyclopedia of Galenic medicine in five books compiled by Ibn Sīnā and completed in 1025. It presents a clear and organized summary of all the medical knowledge of the time...

, written by Abu Ali Ibn Sina

Avicenna

Abū ʿAlī al-Ḥusayn ibn ʿAbd Allāh ibn Sīnā , commonly known as Ibn Sīnā or by his Latinized name Avicenna, was a Persian polymath, who wrote almost 450 treatises on a wide range of subjects, of which around 240 have survived...

(Avicenna) in 1025, was the first book to offer instruction in the care of the aged

Ageing

, foreshadowing modern gerontology

Gerontology

Gerontology is the study of the social, psychological and biological aspects of aging...

and geriatrics. In a chapter entitled "Regimen of Old Age", Avicenna was concerned with how "old folk need plenty of sleep" and how their bodies should be anointed

Anointing

To anoint is to pour or smear with perfumed oil, milk, water, melted butter or other substances, a process employed ritually by many religions. People and things are anointed to symbolize the introduction of a sacramental or divine influence, a holy emanation, spirit, power or God...

with oil

Oil

An oil is any substance that is liquid at ambient temperatures and does not mix with water but may mix with other oils and organic solvents. This general definition includes vegetable oils, volatile essential oils, petrochemical oils, and synthetic oils....

, and recommended exercises such as walking

Walking

Walking is one of the main gaits of locomotion among legged animals, and is typically slower than running and other gaits. Walking is defined by an 'inverted pendulum' gait in which the body vaults over the stiff limb or limbs with each step...

or horse-riding

Equestrianism

Equestrianism more often known as riding, horseback riding or horse riding refers to the skill of riding, driving, or vaulting with horses...

. Thesis III of the Canon discussed the diet

Diet (nutrition)

In nutrition, diet is the sum of food consumed by a person or other organism. Dietary habits are the habitual decisions an individual or culture makes when choosing what foods to eat. With the word diet, it is often implied the use of specific intake of nutrition for health or weight-management...

suitable for old people

Old age

Old age consists of ages nearing or surpassing the average life span of human beings, and thus the end of the human life cycle...

, and dedicated several sections to elderly patients who become constipated

Constipation

Constipation refers to bowel movements that are infrequent or hard to pass. Constipation is a common cause of painful defecation...

.

The famous Arabic physician

Islamic medicine

In the history of medicine, Islamic medicine, Arabic medicine or Arabian medicine refers to medicine developed in the Islamic Golden Age, and written in Arabic, the lingua franca of Islamic civilization....

, Ibn Al-Jazzar

Ibn Al-Jazzar

Ahmed Ben Jaafar Ben Brahim Ibn Al Jazzar Al-Qayrawani , was an influential 10th-century Muslim physician who became famous for his writings on Islamic medicine. He was born in Qayrawan in modern-day Tunisia...

Al-Qayrawani (Algizar, circa 898-980), also wrote a special book on the medicine and health of the elderly, entitled Kitab Tibb al-Machayikh or Teb al-Mashaikh wa hefz sehatahom. He also wrote a book on sleep disorder

Sleep disorder

A sleep disorder, or somnipathy, is a medical disorder of the sleep patterns of a person or animal. Some sleep disorders are serious enough to interfere with normal physical, mental and emotional functioning...

s and another one on forgetfulness

Forgetting

Forgetting refers to apparent loss of information already encoded and stored in an individual's long term memory. It is a spontaneous or gradual process in which old memories are unable to be recalled from memory storage. It is subject to delicately balanced optimization that ensures that...

and how to strengthen memory

Memory

In psychology, memory is an organism's ability to store, retain, and recall information and experiences. Traditional studies of memory began in the fields of philosophy, including techniques of artificially enhancing memory....

, entitled Kitab al-Nissian wa Toroq Taqwiati Adhakira, and a treatise on causes of mortality

Death

Death is the permanent termination of the biological functions that sustain a living organism. Phenomena which commonly bring about death include old age, predation, malnutrition, disease, and accidents or trauma resulting in terminal injury....

entitled Rissala Fi Asbab al-Wafah. Another Arabic physician in the 9th century, Ishaq ibn Hunayn

Ishaq ibn Hunayn

Abū Yaʿqūb, Isḥāq ibn Ḥunayn was an influential physician and translator, known for writing the first biography of physicians in the Arabic language. He is also known for his translations of Euclid's Elements and Ptolemy's Almagest...

(died 910), the son of Hunayn Ibn Ishaq

Hunayn ibn Ishaq

Hunayn ibn Ishaq was a famous and influential Assyrian Nestorian Christian scholar, physician, and scientist, known for his work in translating Greek scientific and medical works into Arabic and Syriac during the heyday of the Islamic Abbasid Caliphate.Ḥunayn ibn Isḥaq was the most productive...

, wrote a Treatise on Drugs for Forgetfulness (Risalah al-Shafiyah fi adwiyat al-nisyan).

The first modern geriatric hospital was founded in Belgrade, Serbia in 1881 by doctor Laza Lazarević

Laza Lazarevic

Laza K. Lazarević was a Serbian writer, psychiatrist, and neurologist. The primary interest of Lazarević throughout his short life was the science of medicine...

.

The term geriatrics was proposed in 1909 by Dr. Ignatz Leo Nascher

Ignatz Leo Nascher

Ignatz Leo Nascher was born in Austria and later became a doctor. He coined the term "geriatrics" in 1909.- Biography :Nascher was born in Vienna, Austria, and immigrated to New York City where he was brought up Later he also assumed US-citizenship. He drew on the Austrian system of care for the...

, former Chief of Clinic in the Mount Sinai Hospital

Mount Sinai Hospital, New York

Mount Sinai Hospital, founded in 1852, is one of the oldest and largest teaching hospitals in the United States. In 2011-2012, Mount Sinai Hospital was ranked as one of America's best hospitals by U.S...

Outpatient Department (New York City) and a "Father" of geriatrics in the United States.

Modern geriatrics in the United Kingdom really began with the "Mother" of Geriatrics, Dr. Marjorie Warren. Warren emphasized that rehabilitation was essential to the care of older people. Using her experiences as a physician in a London Workhouse infirmary, she believed that merely keeping older people fed until they died was not enough; they needed diagnosis, treatment, care, and support. She found that patients, some of whom had previously been bedridden, were able to gain some degree of independence with the correct assessment and treatment.

The practice of geriatrics in the UK is also one with a rich multi-disciplinary history. It values all the professions, not just medicine, for their contributions in optimizing the well-being and independence of older people.

Another "hero" of British Geriatrics is Bernard Isaacs, who described the "giants" of geriatrics mentioned above: immobility and instability, incontinence

Urinary incontinence

, and impaired intellect

Dementia

Dementia is a serious loss of cognitive ability in a previously unimpaired person, beyond what might be expected from normal aging...

. Isaacs asserted that, if examined closely enough, all common problems with older people relate back to one or more of these giants.

The care of older people in the UK has been advanced by the implementation of the National Service Frameworks for Older People, which outlines key areas for attention.

Geriatricians' training

In the United States

United States

The United States of America is a federal constitutional republic comprising fifty states and a federal district...

, geriatricians are primary-care physicians who are board-certified in either family medicine

Family medicine

or internal medicine

Internal medicine

and who have also acquired the additional training necessary to obtain the Certificate of Added Qualifications (CAQ) in geriatric medicine. Geriatricians have developed an expanded expertise in the aging process, the impact of aging on illness patterns, drug therapy in seniors, health maintenance, and rehabilitation. They serve in a variety of roles including hospital care, long-term care, home care, and terminal care. They are frequently involved in ethics consultations to represent the unique health and diseases patterns seen in seniors. The model of care practiced by geriatricians is heavily focused on working closely with other disciplines such as nurses, therapists, social workers, and pharmacists.

In the United Kingdom, most geriatricians are hospital physicians, whereas some focus on community geriatrics. While originally a distinct clinical specialty, it has been integrated as a specialisation of general medicine since the late 1970s. Most geriatricians are, therefore, accredited for both. In contrast to the United States, geriatric medicine is a major specialty in the United Kingdom; geriatricians are the single most numerous internal medicine specialists.

Minimum Geriatric Competencies

In July 2007, the Association of American Medical Colleges

Association of American Medical Colleges

The Association of American Medical Colleges is a non-profit organization based in Washington, DC and established in 1876. It administers the Medical College Admission Test...

(AAMC) and the John A. Hartford Foundation hosted a National Consensus Conference on Competencies in Geriatric Education where a consensus was reached on minimum competencies (learning outcomes) that graduating medical student needed to assure competent care by new interns to older patients. Twenty-six (26) Minimum Geriatric Competencies in eight content domains were endorsed by the American Geriatrics Society (AGS), the American Medical Association (AMA), and the Association of Directors of Geriatric Academic Programs (ADGAP). The domains are: cognitive and behavioral disorders; medication management; self-care capacity; falls, balance, gait disorders; atypical presentation of disease; palliative care; hospital care for elders, and health care planning and promotion. Each content domain specifies three or more observable, measurable competencies.

Hospital Elder Life Program

Perhaps the most pressing issue facing geriatrics is the treatment and prevention of delirium. This is a condition in which hospitalized elderly patients become confused and disoriented when confronted with the uncertainty and confusion of a hospital stay. The health of the patient will decline as a result of delirium and can increase the length of hospitalization and lead to other health complications. The treatment of delirium involves keeping the patient mentally stimulated and oriented to reality, as well as providing specialized care in order to ensure that her/his needs are being met.

The Hospital Elder Life Program (HELP) is an innovative model of hospital care created by Sharon Inouye, MD, MPH and her colleagues at the Yale University School of Medicine. It is designed to prevent delirium and functional decline among elderly individuals in the hospital inpatient setting. HELP uses a core team of interdisciplinary staff and targeted intervention protocols to improve patients' outcomes and to provide cost-effective care. Unique to the program is the use of specially trained volunteers who carry out the majority of the non-clinical interventions.

In up to 40% of the cases, incident delirium can be prevented. To that end, HELP promotes interventions designed to maintain cognitive and physical functioning of older adults throughout the hospitalization, maximize patients' independence at discharge, assist with the transition from hospital to home and prevent unplanned hospital readmissions. Customized interventions include daily visitors; therapeutic activities to provide mental stimulation; daily exercise and walking assistance; sleep enhancement; nutritional support and hearing and vision protocols.

HELP has been replicated in over 63 hospitals across the world. Although the majority of the sites are based in the United States located in 25 different states, there is a growing international presence. International sites include: Australia, Canada, the Netherlands, Taiwan and the United Kingdom. HELP is protected by copyright held by Sharon Inouye MD, MPH. The Dissemination Team including Dr. Inouye are located at Hebrew SeniorLife at the Institute for Aging Research in Boston, MA.

Pharmacology

Pharmacological constitution and regimen for older people is an important topic, one that is related to changing and differing physiology and psychology.

Changes in physiology with aging may alter the absorption, the effectiveness and the side effect profile of many drugs. These changes may occur in oral protective reflexes (dryness of the mouth caused by diminished salivary glands), in the gastrointestinal system (such as with delayed emptying of solids and liquids possibly restricting speed of absorption), and in the distribution of drugs with changes in body fat and muscle and drug elimination.

Psychological considerations include the fact that elderly persons (in particular, those experiencing substantial memory loss or other types of cognitive impairment) are unlikely to be able to adequately monitor and adhere to their own scheduled pharmacological administration. One study (Hutchinson et al., 2006) found that 25% of participants studied admitted to skipping doses or cutting them in half. Self-reported noncompliance with adherence to a medication schedule was reported by a striking one-third of the participants. Further development of methods that might possibly help monitor and regulate dosage administration and scheduling is an area that deserves attention.

Another important area is the potential for improper administration and use of potentially inappropriate medications, and the possibility of errors that could result in dangerous drug interactions. Polypharmacy is often a predictive factor (Cannon et al., 2006). Research done on home/community health care found that "nearly 1 of 3 medical regimens contain a potential medication error" (Choi et al., 2006).

Ethical and medico-legal issues

Elderly persons sometimes cannot make decisions for themselves. They may have previously prepared a power of attorney

Power of attorney

A power of attorney or letter of attorney is a written authorization to represent or act on another's behalf in private affairs, business, or some other legal matter...

and advance directives to provide guidance if they are unable to understand what is happening to them, whether this is due to long-term dementia or to a short-term, correctable problem, such as delirium

Delirium

from a fever.

Geriatricians must respect the patients' privacy while seeing that they receive appropriate and necessary services. More than most specialties, they must consider whether the patient has the legal responsibility

Moral responsibility

Moral responsibility usually refers to the idea that a person has moral obligations in certain situations. Disobeying moral obligations, then, becomes grounds for justified punishment. Deciding what justifies punishment, if anything, is a principle concern of ethics.People who have moral...

and competence

Competence (law)

In American law, competence concerns the mental capacity of an individual to participate in legal proceedings. Defendants that do not possess sufficient "competence" are usually excluded from criminal prosecution, while witnesses found not to possess requisite competence cannot testify...

to understand the facts and make decisions. They must support informed consent

Informed consent

Informed consent is a phrase often used in law to indicate that the consent a person gives meets certain minimum standards. As a literal matter, in the absence of fraud, it is redundant. An informed consent can be said to have been given based upon a clear appreciation and understanding of the...

and resist the temptation to manipulate the patient by withholding information, such as the dismal prognosis for a condition or the likelihood of recovering from surgery at home.

Elder abuse

Elder abuse

Elder abuse is a general term used to describe certain types of harm to older adults. Other terms commonly used include: "elder mistreatment," "senior abuse," "abuse in later life," "abuse of older adults," "abuse of older women," and "abuse of older men."...

is the physical, financial, emotional, sexual, or other type of abuse of an older dependent abuse. Adequate training, services, and support can reduce the likelihood of elder abuse, and proper attention can often identify it. For elderly people who are unable to care for themselves, geriatricians may recommend legal guardianship or conservatorship

Conservatorship

Conservatorship is a legal concept in the United States of America, where an entity or organization is subjected to the legal control of an external entity or organization, known as a conservator. Conservatorship is established either by court order or via a statutory or regulatory authority...

to care for the person or the estate.

End of life issues & Do Not Resuscitate
Do not resuscitate
In medicine, a "do not resuscitate" or "DNR" is a legal order written either in the hospital or on a legal form to respect the wishes of a patient to not undergo CPR or advanced cardiac life support if their heart were to stop or they were to stop breathing...

(DNR) orders.
Euthanasia
Euthanasia
Euthanasia refers to the practice of intentionally ending a life in order to relieve pain and suffering....

.

External links

The source of this article is wikipedia, the free encyclopedia. The text of this article is licensed under the GFDL.

Differences between adult and geriatric medicine

Increased complexity

Geriatric giants

Practical concerns

Subspecialties and related services

Medical

Surgical

Other geriatrics subspecialties

History

Geriatricians' training

Minimum Geriatric Competencies

Hospital Elder Life Program

Pharmacology

Ethical and medico-legal issues

See also

External links