Unique Featuresof Geriatric PatientsDr. Sadia Sharmin

Introduction

• The term ‘geriatric’ means ‘healing the old’

• ‘Ageing’ can be defined as a progressive accumulation through life of random molecular defects that build up within tissues and cells.

Ageing classification

• Elderly : 65-74• Aged : 75-84

• Very old : 85 or more

According to WHO

Old age occurred within:• 45-55 years for women

• 55-75 years for men

What makes geriatric medicine different

• Physiological decline and difficulty distinguishing the effects of ageing and disease

• Increased frequency of multiple physical illness and of polypharmacy

• Increased relevance of functional ability and multidisciplinary assessment

• Greater difficulty in history taking• Atypical presentation of illness

Physiological changes of ageing

1. Changes in autonomic functions and cellular homeostasis eg. temperature blood volumes and endocrine changes

2. Reduction in organic masses eg. Liver, brain kidney bones and muscles

3. Reduction in organic functional reserve eg; lungs, heart

Central nervous system

Changes with ageing• Neuronal loss• Cochlear

degeneration• Increased lens rigidity• Lens opacification• Anterior horn cell loss• Dorsal column loss • Slowed reaction time

Clinical consequences • Increased risk of

delirium• Presbycusis/high tone

hearing loss• Presbyopia/abnormal

near vision• Muscle weakness• Reduced position and

vibration sense• Increased risk of falls

Cardio vascular

Changes with ageing• Reduced maximum

heart rate• Dilatation of aorta• Reduced elasticity of

conduit/capacitance vessels

• Reduced number of pacing myocytes in SA node

Clinical consequences• Reduced exercise

tolerance• Widened aortic arch on

X-ray• Widened pulse

pressure • Increased risk of

postural hypotension• Increased risk of atrial

fibrilation

Respiratory system

Changes with ageing• Reduced lung

elasticity and alveolar support

• Increased chest wall rigidity

• Reduced cough and cilliary action

Clinical consequences • Reduced vital capacity • Increased residual

volume• Reduced inspiratory

reserve volume• Increased risk of

infection

Endocrine system

Changes with ageing• Deterioration in

pancreatic beta cell function

• Increased adrenal medullary secretion

Clinical consequences• Increased risk of

impaired glucose intolerance

Renal system

Changes with ageing• Loss of nephrons• Reduced

glomerular filtration rate

• Reduced tubular function

Clinical consequences• Impaired fluid balance• Increased risk of

dehydration/overload• Impaired drug

metabolism and excretion

Gastrointestinal system

Changes with ageing• Decreased strength

of muscle of mastication taste, thirst

• Decreased saliva• Reduced motility• Relaxed lower

esophageal sphincter

Clinical consequences• Loss of appetite• Constipation• Increased chance of

aspiration

Musculoskeletal system

Changes with ageing

• Reduced bone mineral density

• Gradual tooth loss• Loss of muscle

mass

Clinical consequences

• Osteoporosis• Osteoarthritis • Edentualism

Psychological issues

• Loss of physical strength

• Loss of mental abilities, self esteem, body image, independence

• Loss of control over life plans and lifestyles

Frailty • The loss of ability to withstand minor stress due to

reserve of multiple organ system decline.

Linda Fried / Johns Hopkins Frailty Criteria

• unintentional weight loss,• exhaustion,• muscle weakness,• slowness while walking and• low levels of activity.

Presenting problems of geriatric medicine

• Late presentation

• Atypical presentation

• Acute illness and changes in function

• Multiple pathology

Atypical presentation

• Urinary tract infection

tired, poor appetite perhaps abdominal discomfort, foul smell of

urine, urine incontinence perhaps temperature

…cont’d

• Pneumonia

Poor appetite, weakness, functional decline perhaps cough, shortness of breath

…contd

• Heart failure with pulmonary edema

Tired, poor appetite perhaps shortness of breathe

…cont’d

• Myocardial infarction

Fatigue, weak, restlessness, perhaps chest pain, dyspnoea

…cont’d

• Acute pain

with constipation and decreased appetite rather than severe pain

…contd

• Stroke

History of fallPerhaps focal weakness

Palliative care for geriatric syndrome

• Dementia• Delirium• Falls• Frailty• Depression

Association of cancer and ageing

• Consequence of duration of carcinogenesis

• Age related progressive changes in the internal environment of organism

Any Questions ?

Conclusion • Ageing inevitable leads to decline physiological function,

decreased reserve Leads to:

• Vulnerability to disease and functional declineBut

• There is evidence the potentially modifiable factors operating through out life have significant impact on the effects of ageing.

• physical exercise , diet habit, intervention of cognitive function

‘Old Age is Not a Disease’

O AllahGive me serenity to accept the things which I can’t

Give me courage to do the things which I can

Thank You