Marije HamakerDepartment of Geriatric Medicine
Diakonessenhuis
Utrecht, the Netherlands
Other geriatric syndromes
Treviso, Italy, 2017
Disclosure
Nothing to disclose
Programme
• Malnutrition
• Sarcopenia
• Osteoporosis
• Falls and mobility
• Disability
• Frailty
• Incontinence
Malnutrition
Prevalence
• 2-10% of free-living elderly population
• 30-60% of institutionalised elderly
• 40-85% nursing home residents
• 20-60% home care patients
A vicious circle
Malnutrition
Poor appetiteReduced
mobility
Reduced
feeding
capacity
Apathy, depression,
poor concentration
Loss of muscle
strength
Causes “Meals on wheels”
Medications
Emotional (depression)
Alcoholism, abuse
Late life paranoia
Swalling problems
Oral problems
Nosocomial infections
Wandering/dementia
Hyperthyroidism, hypercalcemia, hypoadrenalism
Enteric problems (malabsoption)
Eating problems (e.g. tremor)
Low salt, low cholesterol diet
Shopping and meal preparation problems
Consequences of malnutrition
• Malnourished elderly are:
– 2x more likely to visit the doctor
– 3x more likely to be hospitalized
– more prone to infections
– experience poor healing
– suffer from diminished muscle strength
Sarcopenia
• Syndrome characterised by progressive and
generalised loss of skeletal muscle mass and strength
• Risk of adverse outcomes such as physical disability,
poor quality of life and death
Assessment of sarcopenia
Age and Ageing 2010; 39: 412–423
Osteoporosis
• A systemic disorder of
the skeleton
characterized by a
loss of bone strength
and increased risk of
fractures
Epidemiology
• World wide: 200 million people
• European Union: 22 million women and 5.5 million
men
• United stated: 8 million women and 2 million men
• Effect:
1:3 women and 1:5 over the age of 50 years will have one or
more osteoporotic fractures in their lifetime
Ostoporosis risk
Diseases that can cause osteoporosis
• Decreased mechanical stress
• Weight loss
• Catabolic state
• Acidosis
• Chronic inflammation
• Medication
16
Sequelae of a hip fracture
• 25-33% mortality after 1 year
• In those >75 years: 50% mortality
• 25% permanent immobility
• Only 14-21% full recover of ADL capacity
Mobility impairment and falls
• Loss of symmetry of movement
• Difficulty initiating or maintaining gait
• Footdrop
• Short step length
• Wide based gait
• Stops walking when talking
Gait speed
J Geriatr Phys Ther. 2003;26(3):14-22.
0.82 m/s
BMJ2011;343:d7679
Falls
• Yearly, 1 in 3 adults over 65 years falls
• In nursing homes, 1 in 2
• In 40% to 60% of the elderly, a fall results in physical
damage, of which 10-15% serious damage
Medical risk factors
• Impaired musculoskeletal function, osteoporosis, gait
abnormality
• Cardiar arrythmias, blood pressure fluctuation
• Depression, dementia
• Athritis, hip weakness and imbalance
• Neurologic disorders
• Vision or hearing loss
• Side effect of medications
Other risk factors
• Lack of activity
• Intoxications
• Dehydration
• Malnutrition
• Shoes and walking aids
• Risk factors at home
The dangers of lying in bed
“Look at a patient lying long in bed. What a pathetic
picture he makes! The blood clotting in his veins, the
lime draining from his bones, the scybala stacking up in
this colon, the flesh rotting from his seat, the urine
leaking from his distended bladder and the spirit
evaporating from this soul.”
R. Asher. The dangers of lying in bed. BMJ 1946
Functional impairments
• Limitations in IADL 40%
• Limitations in ADL 28%
• Impaired mobility 34%
Ageing and disability
Incontinence
• Prevalence in women
– 20-39 years 7%
– 40-59 years 17%
– 60-79 years 23%
– ≥80 years 32%
– Nursing homes 60-80%
• Prevalence in men: approximately 1/3 in early years,
equal over 80 years
Etiology
• Changes in the lower urinary tract and innervation
• Patient level
– Comorbidities
– Medication
– Functional and mobility impairments
Consequences
• Impact on self-esteem
• Social withdrawal
• Falls risk
• Caregiver burden
Care giver burden
• 44% care givers for older cancer patients say that the
burden of care is too great
• In many cases, the caregiver is required to make
oncologic treatment feasible!
Take home message
• Many geriatric syndromes interact and amplify each other
• Geriatric syndromes and functional impairments are highly prevalent and easily missed if not specifically looked for
• The presence of geriatric syndromes reflects a patient’s fitness/vulnerability which has significant consequences for oncologic treatment