Geriatrics

From Wikipedia, the free encyclopedia

Geriatrics is the branch of internal medicine that focuses on health care of the elderly. It aims to promote health and to prevent and treat diseases and disabilities in older adults.

There is no set age at which patients may be under the care of a geriatrician. Rather, this is determined by a profile of the typical problems that geriatrics focuses on. This includes the so-called 'geriatric giants' of immobility, instability, incontinence and impaired intellect/memory. Health issues in older adults may also include elderly care, delirium, use of multiple medications, impaired vision and hearing.

The term geriatrics differs from gerontology. This is the study of the aging process itself. The term comes from the Greek geron meaning "old man" and iatros meaning "healer".

Scope

In the United States, geriatricians are primary care physicians who are board-certified in either family practice or internal medicine and have also acquired the additional training necessary to obtain the Certificate of Added Qualifications (CAQ) in geriatric medicine.

In the United Kingdom, most geriatricians are hospital physicians, while some focus on community geriatrics. While originally a distinct clinical specialty, it has been integrated as a specialism of general medicine since the late 1970s.^[1] Most geriatricians are therefore accredited for both. Specialized geriatrics services include orthogeriatrics (close cooperation with orthopedic surgery and a focus on osteoporosis and rehabilitation), psychogeriatrics (focus on dementia, delirium, depression and other conditions common in the elderly), Cardiogeriatrics (focus on cardic diseases of elderly) and rehabilitation of elderly.

Rehabilitation may also take in intermediate care, where patients are referred by a hospital or family doctor, when there is a requirement to provide hospital based short term intensive physical therapy aimed at the recovery of musculoskeletal function, particularly recovery from joint, tendon, or ligament repair and, or, physical medicine and rehabilitation care when elderly patients get out of synch with their medication resulting in a deterioration of their personal health which reduces their ability to live independently.

History

The Canon of Medicine,^[2] written by Abu Ali Ibn Sina (Avicenna) in 1025, was the first book to offer instruction for the care of the aged, foreshadowing modern gerontology and geriatrics. In a chapter entitled "Regimen of Old Age", Avicenna was concerned with how "old folk need plenty of sleep", how their bodies should be anointed with oil, and recommended exercises such as walking or horse-riding. Thesis III of the Canon discussed the diet suitable for old people, and dedicated several sections to elderly patients who become constipated.^[3][4][5]

The famous Arabic physician, Ibn Al-Jazzar Al-Qayrawani (Algizar, circa 898-980), also wrote a special book on the medicine and health of the elderly, entitled Kitab Tibb al-Machayikh^[6] or Teb al-Mashaikh wa hefz sehatahom.^[7] He also wrote a book on sleep disorders and another one on forgetfulness and how to strengthen memory, entitled Kitab al-Nissian wa Toroq Taqwiati Adhakira,^[8][9][10] and a treatise on causes of mortality entitled Rissala Fi Asbab al-Wafah.^[11] Another Arabic physician in the 9th century, Ishaq ibn Hunayn (died 910), the son of Hunayn Ibn Ishaq, wrote a Treatise on Drugs for Forgetfulness (Risalah al-Shafiyah fi adwiyat al-nisyan).^[12]

The term geriatrics was proposed in 1909 by Dr. Ignatz Leo Nascher, former Chief of Clinic in the Mount Sinai Hospital 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 emphasised that rehabilitation was essential to the care of older people. She took her experiences as a physician in a London Workhouse infirmary and developed the concept 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 history of multidisciplinary working, valuing all the professions, not just medicine, for their contributions in optimising the well-being and independence of older people.

Another "hero" of British Geriatrics is Bernard Isaacs, who described the "giants" of geriatrics: immobility and instability, incontinence and impaired intellect.^[13] Isaacs asserted that if you look closely enough, all common problems with older people relate back to one of these giants.

The care of older people in the UK has been forwarded by the implementation of the National Service Frameworks for Older People, which outlines key areas for attention.^[14]

Current trends

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 their needs are being met.

The Hospital Elder Life Program, HELP, is a system that was created at Yale New Haven Hospital and has been introduced to several hospitals. The goal of the program is to prevent delirium and thus improve the quality of care provided to the elderly. Yale New Haven Hospital has since developed HELP into the more comprehensive Elder Horizons Program, whose goals in addition to preventing delirium include maintenance of mobility and of functional and cognitive states.

In July 2007 the American Association of Medical Colleges (AAMC) and the 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 to older patients by new interns. There are 26 competencies in eight content domains. 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. The entire list is available on the Portal of Geriatric Online Education (www.pogoe.org).

Pharmacology

Pharmacological constitution and regimen for older people is an important topic, one which 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 the gastrointestinal system, in the distribution of drugs with changes in body fat and muscle and drug elimination.

Another area of importance is the potential for improper administration and usage of potentially inappropriate medications, and possibility of errors which result in dangerous drug interactions. One other important consideration is that of elderly persons (particularly those experiencing substantial problems of memory loss or other types of cognitive impairment) being able to adequately monitor and adhere to their own scheduled pharmacological administration. One study found that 25% of participants studied admitted to skipping doses or cutting them in half. Self-reported noncompliance with adherence to medication schedule was reported by a one-third of the participants.

See also

• Aging in Place
• Aging-associated diseases
• Commission for Certification in Geriatric Pharmacy
• Elderly care
• Gero-Informatics
• Life extension
• Geriatric medicine in Egypt

Notes

References

• Barton A, Mulley G. History of the development of geriatric medicine in the UK. Postgrad Med J 2003;79:229-34. Fulltext. PMID 12743345.
• Cannon, K.T., Choi, M.M., Zuniga, M.M. (2006). Potentially inappropriate medication use in elderly patients receiving home health care: a retrospective data analysis. The American Journal of Geriatric Pharmacotherapy, 4, 134-143.
• Gidal, B.E. (2006). Drug Absorption in the Elderly: Biopharmaceutical Considerations for the Antiepileptic Drugs. Epilepsy Research, 68S, S65-S69.
• Hutchison, L.C., Jones, S.K., West, D.S., Wei, J.Y. (2006). Assessment of Medication Management by Community-Living Elderly Persons with Two Standardized Assessment Tools: A Cross-Sectional Study. The American Journal of Geriatric Pharmacotherapy, 4, 144-153.
• Isaacs B. An introduction to geriatrics. London: Balliere, Tindall and Cassell, 1965.

External links

• British Geriatrics Society
• American Geriatrics Society
• Irish Gerontological Society
• American Board Family Medicine CAQ Geriatric Medicine
• Merck Manual of Geriatrics
• Geriatric Nursing

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