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.
Elderly female in residential care home
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
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
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