Geriatrics - Merck Manuals Professional Edition

Approach to the Geriatric Patient

Geriatrics refers to medical care for older adults, an age group that is not easy to define precisely. Gerontology is the study of aging, including biologic, sociologic, and psychologic changes. “Older” is preferred over "elderly," but both terms are equally imprecise. It is important to avoid terms and attitudes that suggest bias against older people (ageism). Although there is no set age to define older age, > age 65 is often used because this is the age that determines eligibility for Medicare insurance in the US. However, some people with medical conditions require geriatrics expertise at a younger age. For example, the Program of All-Inclusive Care for the Elderly (PACE) sets the age for eligibility beginning at 55 for people who meet the need for nursing home level of care.
Aging and Quality Of Life

Quality of life (QOL) is the degree to which a person is healthy, comfortable, and able to participate in or enjoy life events. It is critical for health care practitioners to take quality of life into account when establishing each patient’s goals of care and to use it as a guide for all care decisions.
- Quality of Life in Older People
  - Health-Related Quality of Life
    - Influences
  - Assessment of Quality of Life
- Therapeutic Objectives in Older People
Drug Therapy in Older Adults

Prevalence of prescription drug use increases substantially with age. Survey data from 2010–2011 indicate that almost 90% of older adults regularly take at least 1 prescription drug, almost 80% regularly take at least 2 prescription drugs, and 36% take at least 5 prescription drugs ( 1). When over-the-counter and dietary supplements are included, these prevalence rates increase substantially. Drug use is greatest among frail older adults, hospitalized patients, and nursing home residents.
Elder Abuse

Elder abuse is physical or psychologic mistreatment, neglect, or financial exploitation of older adults.
- Elder Abuse
Falls in Older People

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 Older People
Gait Disorders in Older Adults

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 Older Adults
The Older Driver

For many older adults, driving an automobile is their preferred option for community transportation. Medical disorders that impair driving in older adults may have two serious adverse outcomes: injury or death resulting from a motor vehicle crash (MVC) or driving cessation.
Prevention of Disease and Disability in Older Adults

For older adults, prevention focuses mainly on disease, frailty, accidents (ie, unintentional injury), iatrogenic complications, psychosocial problems, and maintaining ability to perform activities of daily living. Not all older patients benefit from every preventive measure. Choice of preventive measures is guided by whether the patient’s general condition is:
Providing Care to Older Adults

Every 4 years, the US Department of Health and Human Services (HHS) updates its strategic plan and defines its mission and goals. The HHS strategic plan for 2022 to 2026 includes the following 5 goals ( 1):
Social Issues in Older Adults

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