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Geriatrics

Approach to the Geriatric Patient
Aging and Quality Of Life
- Quality of Life in the Elderly
  - Health-Related Quality of Life
    - Influences
  - Assessment
    - Barriers to assessment
    - Method
- Therapeutic Objectives in the Elderly
Drug Therapy in the Elderly
Elder Abuse
- Elder Abuse
Falls in the Elderly
- Falls in the Elderly
Funding Health Care for the Elderly

Gait Disorders in the Elderly
- Gait Disorders in the Elderly
The Older Driver
Prevention of Disease and Disability in the Elderly
Provision of Care to the Elderly
Social Issues in the Elderly

Geriatrics is a specialty that focuses on the health care of elderly people. Geriatricians typically manage disorders in a number of specialty areas with a focus on health issues unique to the elderly, including the appropriate use of drugs in the elderly, the interaction among multiple diseases, the need to coordinate care among multiple practitioners, and the impact of age-related cognitive and physical changes on treatment. Geriatricians also aim to promote health by anticipating, preventing, and treating diseases and disabilities that become more common with age.

GeriatricsSections (A-Z)

Aging and Quality Of Life

Quality of life often depends on health and health care. However, health care practitioners, especially when establishing therapeutic objectives, may underemphasize its importance to patients.

Quality of Life in the Elderly
Therapeutic Objectives in the Elderly

Approach to the Geriatric Patient

Geriatrics refers to medical care for the elderly, an age group that is not easy to define precisely. “Older people” is sometimes preferred but is equally imprecise; > 65 is the age often used, but most people do not need geriatrics expertise in their care until age 70 or 75. Gerontology is the study of aging, including biologic, sociologic, and psychologic changes.

Introduction to Geriatrics
Physical Changes With Aging
Evaluation of the Elderly Patient
Unusual Presentations of Illness in the Elderly

Drug Therapy in the Elderly

Prevalence of prescription drug use among older adults increases substantially with age. Among people ≥ 65, 90% use at least 1 drug per week, > 40% use at least 5 different drugs per week, and 12% use ≥ 10 different drugs per week. Women take more drugs, particularly psychoactive and arthritis drugs. Drug use is greatest among the frail elderly, hospitalized patients, and nursing home residents; typically, a nursing home resident is given 7 to 8 different drugs on a regular basis.

Introduction to Drug Therapy in the Elderly
Pharmacokinetics in the Elderly
Pharmacodynamics in the Elderly
Drug-Related Problems in the Elderly
Drug Categories of Concern in the Elderly

Elder Abuse

Elder abuse is physical or psychologic mistreatment, neglect, or financial exploitation of the elderly.

Elder Abuse

Falls in the Elderly

A fall is defined as a person coming to rest on the ground or another lower level; sometimes a body part strikes against an object that breaks the fall. Typically, events caused by acute disorders (eg, stroke, seizure) or overwhelming environmental hazards (eg, being struck by a moving object) are not considered falls.

Falls in the Elderly

Funding Health Care for the Elderly

In the US, health care services for the elderly are funded mainly by Medicare, Medicaid, the Veterans Health Administration, private insurance, and out-of-pocket payments. In addition, many states offer health-related benefits and programs, such as subsidies for transportation, housing, utilities, telephone, and food expenses, as well as help at home and nutrition services. Health care workers should help elderly patients learn about health benefits and programs they are entitled to.

Introduction to Funding Health Care for the Elderly
Medicare
Medicaid
Other Federal Programs Affecting the Elderly
Private Insurance for the Elderly
Models for Comprehensive Health Care Coverage for the Elderly

Gait Disorders in the Elderly

Gait disorders encompass a number of issues, including slowing of gait speed and loss of smoothness, symmetry, or synchrony of body movement.

Gait Disorders in the Elderly

Prevention of Disease and Disability in the Elderly

For the elderly, prevention focuses mainly on disease, frailty, accidents (ie, unintentional injury), iatrogenic complications, and psychosocial problems. Not all elderly patients benefit from every preventive measure. Choice of preventive measures is guided by the patient’s general condition:

Overview of Prevention in the Elderly
Prevention of Disease in the Elderly
Prevention of Frailty
Prevention of Injuries in the Elderly
Prevention of Iatrogenic Complications in the Elderly
Prevention of Psychosocial Problems in the Elderly

Provision of Care to the Elderly

Because older adults tend to have multiple disorders and may have social or functional problems, they use a disproportionately large amount of health care resources. In the US, people ≥ 65 account for

Overview of Geriatric Care
Home Health Care
Day Care for the Elderly
Respite Care
Hospital Care and the Elderly
Skilled Nursing Facilities
Board-and-Care Facilities
Assisted-Living Programs
Life-Care Communities
Program of All-Inclusive Care for the Elderly
Pharmacists and the Elderly

Social Issues in the Elderly

Social issues influence an elderly person’s risk and experience of illness as well as a health care practitioner’s ability to deliver timely and appropriate care.

Introduction to Social Issues in the Elderly
Family Caregiving for the Elderly
The Elderly Living Alone
Self–Neglect in the Elderly
Alternative Living Arrangements for the Elderly
Effects of Life Transitions on the Elderly
Intimacy and the Elderly
Religion and Spirituality in the Elderly

The Older Driver

For adults, driving is the most important method of independent transportation. In 2011, there were 35 million licensed drivers ≥ 65 yr in the US, including many ≥ 80 yr ( Percentage of Drivers by Age and Sex ). Progressive disease that impairs driving in older adults may have two serious adverse outcomes: injury or death resulting from a motor vehicle crash (MVC) or driving cessation.

Overview of the Older Driver
Functional Assessment of the Older Driver
Medical Assessment of the Older Driver
Interventions with the Older Driver

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Also of Interest

Test your knowledge

In the elderly, many common conditions can exist without their characteristic features. Instead, the elderly may have ≥ 1 nonspecific geriatric syndromes (eg, delirium, dizziness, syncope, falling, weight loss, incontinence). For example, biliary disorders may result in nonspecific mental and physical deterioration (eg, malaise, confusion, loss of mobility). Which of the following may be the only indication of a biliary disorder in the elderly?

Abdominal pain Abnormal liver function test results Jaundice Fever