Geriatrics

Definition

Seniors' health refers to the physical and mental conditions of senior citizens, those who are in their 60s and older.

Description

The cost of treatment varies. Cost of medical treatment will be determined by the type of procedure and whether a person has medical insurance. Another factor is the fee assessed by the health plan.

Nutrition plays an important role in senior health. Not only does a well-balanced diet keep a person from becoming obese, that same diet is a safeguard against health conditions that seniors face. Proper diet can help prevent a condition like diabetes or keep it from worsening.

The senior diet should consist of foods that are low in fat, particularly saturated fat and cholesterol. A person should choose foods that provide nutrients such as iron and calcium. Other healthy menu choices include:

• fish, skinless poultry, and lean meat
• proteins such as dry beans (red beans, navy beans, and soybeans), lentils, chickpeas, and peanuts
• low-fat dairy products
• vegetables, especially those that are dark green and leafy
• citrus fruits or juices, melons, and berries
• whole grains like wheat, rice, oats, corn, and barley
• whole grain breads and cereals

Physical activity should be rhythmic, repetitive, and should challenge the circulatory system. It should also be enjoyable so that a senior gets in the habit of exercising regularly for 30 minutes each day. It may be necessary to check with a doctor to determine the type of exercise that can be done.

Walking is recommended for weight loss, stress release, and many other conditions. Brisk walking is said to produce the same benefits as jogging. Other forms of exercise can include gardening, bicycling, hiking, swimming, dancing, skating or ice-skating. If weather prohibits outdoor activities, a person can work out indoors with an exercise video.

Exercise also offers a chance to socialize. In some cities, groups of seniors meet for regular walks at shopping malls. Senior centers offer exercise classes ranging from line dancing to belly dancing.

Costs for exercise range from the price of walking shoes to the fees for joining a gym.

Prevention is the best method of treating osteoporosis. Methods of preventing osteoporosis include regular weight-bearing exercise such as walking, jogging, weight lifting, yoga, and stair climbing.

People should not smoke since smoking makes the body produce less estrogen. Care should be taken to avoid falling.

Diet should include from 1,000–1,300 mg. of calcium each day. Sources of calcium include:

• leafy, dark-green vegetables such as spinach, kale, mustard greens, and turnip greens
• low-fat dairy products such as milk, yogurt, and cheeses such as cheddar, Swiss, mozzarella, and parmesan; also helpful are foods made with milk such as pudding and soup
• canned fish such as salmon, sardine, and anchovies
• tortillas made from lime-processed corn
• tofu processed with calcium-sulfate
• calcium tablets

MEDICAL TREATMENT. An x ray will indicate bone loss when much of the density has decreased. A more effective way of detecting osteoporosis is the DEXA-scan (dual-energy x-ray absorbtiometry). This whole-body scan will indicate whether a person is at risk for fractures. It could be useful for people at risk for osteoporosis as well as women near the age of menopause or older. People should ask their doctors about whether this test is needed.

During menopause, a woman loses estrogen. A pill or skin patch containing estrogen and progesterone eases symptoms of menopause and is used to treat osteoporosis. This treatment is known as hormone replacement therapy (HRT). In addition to restoring estrogen, HRT could reduce the risk of colon cancer and Alzheimer's disease. However, more research is needed in these areas.

Treatments for osteoarthritis range from preventative measures such as walking to joint replacement surgery. Treatment costs vary from no cost for soaking a joint in cold water, the price of over-the-counter remedies, to fees for surgery.

Preventive and maintenance remedies include low-impact exercise such as swimming and walking, along with maintaining proper posture. Nutritional aids include foods rich in vitamin C such as citrus fruits and broccoli. Also recommended is daily consumption of 400 international units of Vitamin E. A person should cut back on fats, sugar, salt, cholesterol, and alcohol.

HOME REMEDIES AND PHYSICAL THERAPY. The Arthritis Foundation recommends several remedies for easing pain. To treat inflammation, a person should use a cold treatment for 20 minutes. Methods include soaking the affected area in cold water or applying an ice pack. To soothe aches and stimulate circulation, a person applies heat to the affected area for 20 minutes. This should be done three times during the day.

Over-the-counter (OTC) remedies such as aspirin and ibuprofen and salves containing capsaicin can be helpful. Furthermore, a doctor may recommend anti-inflammatory medications.

SURGICAL TREATMENT. If osteoarthritis is suspected, a doctor's diagnosis will include an assessment of whether joint pain is part of a patient's medical history. The doctor may take an x ray to determine the presence of cartilage loss and how much degeneration occurred.

Acupuncture may be helpful in treating mild osteoarthritis. Generally, a person should have one to two treatments a week for several weeks. Afterward, one treatment is recommended. An assessment of results should be made after 10 treatments.

In cases of severe osteoarthritis, joint replacement surgery or joint immobilization may be required. Joints are replaced with metal, plastic, or ceramic material.

Fall prevention starts with regular exercise such as walking. This improves balance and muscles. The walk route should be on level ground. Other methods for preventing falls include:

• when rising from a chair or bed, a senior should move slowly to avoid dizziness
• shoes with low-heels and rubber soles are recommended
• medications should be monitored because of side effects that increase the probability of a fall
• vision and hearing should be checked periodically
• fall-proofing the home, including the installation of lighting, especially stairways, clearing up clutter and electrical cords that can cause falls, and the installation handrails and strips in bathtubs and rails on stairs.

MEDICAL TREATMENT FOR FALLS. After a fall, a senior may need First Aid treatment for cuts or fractures. The doctor may evaluate whether medications cause balance problems. If indicated, the doctor may examine the patient's central nervous system function, balance, and muscle/joint function. A hearing or vision test may be ordered.

Corrective measures could include adjusting prescriptions, vision surgery or having the patient use a cane or walker.

A person diagnosed with presbyopia may need bifocals or reading glasses to read print that appears too small. These lenses may need to be changed as vision changes over the years. Eventually, a person relies on glasses to focus on items that are near. Other seniors who never needed corrective lenses may need to wear eyeglasses. Publishers aware of this condition produce books with large print.

A senior should schedule periodic vision exams because early treatment helps prevent or lessen a risk of cataracts or glaucoma. Diet also plays a role in vision care. Dark green vegetables like broccoli are said to help prevent cataracts from progressing. Physical exercise is thought to reduce the pressure associated with glaucoma.

Glaucoma can be treated with eyedrops. Surgery can remove cataracts. The affected lens is removed and replaced with a permanent synthetic lens called an intraocular lens. There was no successful treatment for age-related macular degeneration as of 2001.

An audiologist can administer tests to determine the amount of hearing loss. Although there is no cure for presbycusis, hearing aids can help a senior affected by age-related hearing loss. If this treatment is not effective, the person might need to learn to read lips.

Losing weight can help with conditions such as snoring and sleep apnea. A doctor may advise the senior to quit smoking, reduce alcohol consumption, or to sleep on his or her side. In some cases, a doctor may refer the senior to a sleep disorder clinic. The senior may be prescribed a continuous positive airway pressure device. Known as a CPAP, the device is placed over the nose. It sends air into the nose.

PLMD and restless leg syndrome may be treated with the prescription drug Dopar. These disorders could be signs of kidney or circulation conditions. Treatment of those conditions should end these sleeping disorders.

Insomnia treatments include exercising and treating depression, stress, and other causes for sleeplessness.

After retirement, a senior must find activities and interests to provide a sense of fulfillment. Otherwise, feelings of loneliness and isolation can lead to depression and susceptibility to poor health.

Activities that stimulate a person physically and intellectually contribute to good health. A senior can start an exercise program, take up hobbies, take classes, or volunteer. Senior centers offer numerous activities. Lunch programs provide nutritional meals and companionship. This is important because a senior living alone may not feel motivated to prepare healthy meals.

Diagnosis of Alzheimer's disease starts with a thorough medical examination. The doctor should administer memory tests. Blood tests may be required, as well as a CT scan or MRI scan of the brain. If Alzheimer's is diagnosed, the doctor may prescribe medication to slow down progression of this form of dementia.

As of 2001, the FDA had approved four prescription medications for treatment of Alzheimer's. Tacrine, donepezil, riviastigmine, and galantamine are cholinesterase inhibitors that enhance memory. Modest improvement was reported in clinical trials on donepezil, riviastigmine, and galantamine. Tacrine's possible side effects include liver damage, so it is seldom prescribed.

— Liz Swain

Geriatrics literally means the care of old persons. Practically, geriatrics combines two elements: gerontology and chronic disease. Gerontology refers to the study of aging. It addresses all aspects of how aging affects individuals—physically, socially, psychologically, and economically. Geriatrics adapts this knowledge to improve the provision of care to older persons. Geriatricians must know how diseases present in older persons and how to manage them. Because one of the hallmarks of aging seems to be a loss of reserve capacity, and hence a loss of ability to respond to stress, many older persons may fail to exhibit the characteristic symptoms associated with a given disease. Most symptoms represent the body's response to the external stress of a disease, which may be dampened with age. Moreover, most older persons suffer from several chronic conditions, making it often difficult to distinguish clearly a new symptom in the context of many existing problems. Geriatric diagnosis thus requires a substantial degree of insight and subtlety.

Geriatric management is likewise complicated by the presence of multiple, simultaneously inter-active problems, which often reach across several domains of life. One must treat not only the immediate illness in the context of several others, but also address their financial and social consequences. Inadequate income may make it difficult to buy needed medications. Housing may need to be altered to accommodate physical limitations. Social support may be needed to provide both direct assistance and social stimulation.

Geriatrics overlaps substantially with chronic-disease care. Most of the illnesses older people suffer are chronic. According to C. Hoffman, D. Rice, and H.-Y. Sung (1996), approximately 95 cents of every health care dollar spent on older persons goes toward a chronic illness. However, the same study notes that chronic disease is, in fact, predominant in virtually all ages—over two-thirds of the money spent on health care in this country goes toward chronic illness. Yet, somehow, the medical care system has failed to adapt to this epidemiological reality. Health care continues to be organized as it was during the era of acute disease. A substantial contribution to public health would be to translate this fundamental epidemiological observation into a more appropriate system of health care—one that changed the focus of care to extend over longer periods, that shifted attention from single clinical interactions to episodes of care, and that created a more meaningful participatory role for consumers of care.

Perhaps the most dreaded manifestation of aging is dementia. Much has been learned about dementia. It is no longer viewed as an inevitable consequence of aging, although its incidence is likely in very old age. While new drugs are constantly being developed, no effective treatments are yet available. Some currently available agents appear to be able to slow the progression somewhat, but their overall contribution is still uncertain.

Much of geriatrics involves the intersection of medicine and long-term care. For some time, these have been viewed as separate areas of endeavor, responsible to medical and social models, respectively. Here too, epidemiology has a valuable insight to contribute. Most older persons needing long-term care suffer from serious problems that have led to the loss of physical and/or cognitive abilities. The underlying conditions often require close medical attention. Thus, those in long-term care usually need more, not less, medical attention.

The goal of geriatric care is to maximize the functioning of patients. Function can be viewed as the end result of several factors. The first of these is the appropriate treatment of medical conditions. The first maxim of geriatrics is to treat the treatable. This step is not always easy. One of the most difficult differential diagnoses in medicine may be distinguishing pathological change from that simply associated with aging. Good treatment is necessary but not sufficient. The next step is to recognize the potential effects of environment, both physical and social. Much of the modern health care institution (hospital and nursing home) actually serves to dehabilitate patients, especially those who are most vulnerable. The environment is alien, the timetable suits the schedules of the providers of care, and individual patient identity is easily lost. Something as simple as a hospital bed with bedrails may create a new series of barriers for a frail older person. It is hardly surprising that delirium is common among older persons in hospitals. Perhaps most pernicious of all, the pressures for efficient care prompt staff to do many tasks for older patients, thereby creating an atmosphere of learned dependence. At the very time when they should be fostering self-reliance, institutions encourage dependency. As the advocate for vulnerable populations, public health has a duty to alter this inappropriate and dangerous system.

One of the most successful accomplishments of geriatrics has been the demonstration of the value of comprehensive geriatric assessment, or, more specifically, geriatric evaluation and management. The latter term is used to emphasize the importance of adequate ongoing involvement until the problems uncovered are sufficiently managed. A long series of studies is now available to demonstrate the benefits of such interventions. This approach has been applied in various settings, from inpatient situations to home assessments. The results have been generally positive, including improvements in function and reduction in subsequent medical costs. In public health terms, this assessment represents a variation on secondary prevention.

Geriatrics offers other opportunities for prevention. Primary prevention usually focuses on such elements as immunizations, especially for influenza and pneumococcal disease; but other risk factors can be addressed. The role of estrogens is still being explored. They seem to have a positive effect on delaying osteoporosis and heart disease, although they do carry an added risk for gynecological cancers. Exercise is widely touted as beneficial for both physical and social well-being. Smoking cessation is beneficial well into old age. Efforts have been made to prevent falls with only modest success. The most preventable problem among older persons is iatrogenic disease. Multiple medications, which transform older patients into living chemistry sets, are probably the most ubiquitous threats. Mention has already been made of the dangers of institutionalization. Misdiagnosis, including both overtreatment and undertreatment, is a recurrent problem.

Public health has an obvious stake in the health of older persons. They are the ones who are most likely to be ill. They are the most rapidly growing segment of the population and represent some of the most difficult elements of care. Approaches that are successful with older persons should be readily adaptable to serving other subgroups. Because chronic disease is endemic among older persons, they provide the impetus to develop a more effective and appropriate approach to health care, an approach that has broad applications in the face of changing demographics and a new epidemiological reality.

(SEE ALSO: Aging of Population; Alzheimer's Disease; Chronic Illness; Dementia; Gerontology; Hip Fractures; Life Expectancy and Life Tables; Medicare; National Institute on Aging; Osteoarthritis)

Bibliography

Davis, K. L.; Thal, L. J.; Gamzu, E. R.; Davis, C. S.; Woolson, R. F.; and Group, T. C. (1992). "A Double-Blind, Placebo-Controlled Multicenter Study of Tacrine for Alzheimer's Disease." New England Journal of Medicine 327:1253–1259.

Hoffman, C.; Rice, D.; and Sung, H.-Y. (1996). "Persons with Chronic Conditions: Their Prevalence and Costs." Journal of the American Medical Association 276(18):1473–1479.

Inouye, S. K.; Bogardus, S. T.; Charpenter, P. A.; Leo-Summers, L.; Acampora, D.; Holford, T. R.; and Cooney, L. M. J. (1999). "A Multicomponent Intervention to Prevent Delirium in Hospitalized Older Patients." The New England Journal of Medicine 340(9):669–676.

Inouye, S. K.; Wagner, D. R.; Acampora, D.; Horwitz, R. I.; Cooney, L. M.; and Tinetti, M. E. (1993). "A Controlled Trial of a Nursing-Centered Intervention in Hospitalized Elderly Medical Patients: The Yale Geriatric Care Program." Journal of the American Geriatrics Society 41(12):1353–1360.

Jaijich, C. L.; Ostfeld, A. M.; and Freeman, D. H. (1984). "Smoking and Coronary Heart Disease Mortality in the Elderly." Journal of American Medical Association 252:2831–2834.

Kane, R.; Ouslander, J.; and Abrass, I. (1999). Essentials of Clinical Geriatrics, 4th edition. New York: McGraw-Hill.

Larson, E. B. (1991). "Exercise, Functional Decline, and Frailty." Journal of the American Geriatrics Society 39(6):635–636.

Province, M. A.; Hadley, E. C.; Hornbrook, M. C.; Lipsitz, L. A.; Miller, J. P.; Mulrow, C. D.; Ory, M. G.; Sattin, R. W.; Tinetti, M. E.; and Wolf, S. L. (1995). "The Effects of Exercise on Falls in Elderly Patients: A Preplanned Meta-Analysis of the FICSIT Trials." JAMA 273(17):1341–1347.

Rubenstein, L.; Wieland, D.; and Bernabei, R. (1995). Geriatric Assessment Technology: The State of the Art. Milan, Italy: Eidtrice Kurtis.

Stuck, A. E.; Siu, A. L.; Wieland, G. D.; Adams, J.; and Rubenstein, L. Z. (1993). "Comprehensive Geriatric Assessment: A Meta-Analysis of Controlled Trials." The Lancet 342:1032–1036.

Tinetti, M.; Baker, D.; McAvay, G.; Claus, E.; Garrett, P.; Gottschalk, M.; Koch, M.; Trainor, K.; and Hurwitz, R. (1994). "A Multifactorial Intervention to Reduce the Risk of Falling among Elderly People Living in the Community." New England Journal of Medicine 331(13):821–827.

— ROBERT L. KANE

Geriatrics is the branch of 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.

Geriatrics was separated from internal medicine as a distinct entity in the same way that pediatrics is separated from adult internal medicine and neonatology is separated from pediatrics.^[1]

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.

The term geriatrics differs from gerontology which is the study of the aging process itself. The term comes from the Greek geron meaning "old man" and iatros meaning "healer". However "Geriatrics" is considered by some as "Medical Gerontology".

Contents 1 Scope 1.1 Differences between adult and geriatric medicine 1.2 Geriatrics giants and elderly diseases 1.3 Geriatrics subspecialties and related specialties 1.4 Medical 1.5 Surgical 1.6 Other geriatrics subspecialties 2 History 3 Geriatricians' training 3.1 Minimum Geriatric Competencies 4 Geriatrics organizations 5 Research 5.1 Hospital Elder Life Program 5.2 Pharmacology 6 Ethical and medico-legal issues 7 See also 8 References 9 Further reading 10 External links

Scope

Differences between adult and geriatric medicine

Geriatrics differs from adult medicine in many respects. The body of an elderly person is substantially different physiologically from that of an adult. Old age is the period of manifestation of decline of the various organ systems in the body. This varies according to various reserves in the organs, as smokers, for example, consume their respiratory system reserve early and rapidly.

Many people cannot differentiate between Disease and Aging effects, e.g. renal impairment may be a part of aging but renal failure is not. Also urinary incontinence is not part of normal aging, but it is a disease that may occur at any age and is frequently treatable. Geriatricians aim to treat the disease and to decrease the effects of aging on the body. Years of training and experience, above and beyond basic medical training, go into recognizing the difference between what is normal aging and what is in fact pathological.

The decline in physiological reserve in organs makes the elderly develop diseases (such as dehydration from a mild gastroenteritis) and be liable to complications from mild problems. Fever in elderly persons may cause confusion leading to a fall and to a fracture of the neck of the femur ("breaking her/his hip").

Functional ability, independence and quality of life issues are of greater concern to geriatricians, perhaps, than to adult physicians.

Treating an elderly person is not like treating an adult. A major difference between geriatrics and adult medicine is that elderly persons sometimes cannot make decisions for themselves. The issues of power of attorney, privacy, legal responsibility, advance directives and informed consent must always be considered in geriatric procedure. Elder abuse is also a major concern in this age group. In a sense, geriatricians often have to "treat" the caregivers and sometimes, the family, rather than just the elder.

Elderly people have specific issues as regard medications. Elderly people particularly are subjected to polypharmacy due to many causes. Some elderly people have multiple medical disorders; some use many herbs & OTCs; some adult physicians just prescribe medications to their specialty without reviewing other medications used by the elder patient. This polypharmacy may result in many drug interactions and may cause some drug adverse reactions. Drugs are excreted mostly by the kidneys or the liver, either of which maybe impaired in the elderly, and as a result the medication might need adjustment, either renal (kidneys) or hepatic (liver).

The presentation of disease in elderly persons may be vague and non-specific, or it may include delirium or falls. (Pneumonia, for example, may present with fever, low-grade fever, dehydration, confusion or falls.) Some elderly people may find it hard to describe their symptoms in words, especially if the disease is active and causing confusion, or if they have cognitive impairment. Delirium in the elderly may be caused by a minor problem such as constipation or by something as serious and life-threatening as a heart attack (myocardial infarction).

Geriatrics giants and elderly diseases

The so-called 'Geriatric giants' are 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.

Geriatrics subspecialties and related specialties

Some diseases commonly seen in elderly are rare in adults, e.g. dementia, delirium, falls, etc. As societies aged, many specialized geriatric- and geriatrics-related services emerged^[2][3] including:

Medical

• Geriatric psychiatry or psychogeriatrics (focus on dementia, delirium, depression and other psychiatric disorders).
• Cardiogeriatrics (focus on cardiac diseases of elderly)
• Geriatric nephrology (focus on kidney diseases of elderly)
• Geriatric dentistry (focus on dental disorders of elderly)
• Geriatric Rehabilitation (focus on physical therapy in elderly)
• Geriatric oncology (focus on tumors in elderly)
• Geriatric rheumatology (focus on joints and soft tissue disorders in elderly)
• Geriatric neurology (focus on neurologic disorders in elderly)
• Geriatric diagnostic imaging
• Geriatrics dermatology (focus on skin disorders in elderly)
• Geriatric subspeciality medical clinics (As Geriatric Anticoagulation Clinic Geriatric Assessment Clinic, Falls and Balance Clinic, Continence Clinic, Palliative Care Clinic, Elderly Pain Clinic, Cognition and Memory Disorders Clinic
• Geriatric emergency medicine
• Geriatric public health or Preventive Geriatrics (focuses on geriatrics public health issues including disease prevention and health promotion in elderly)
• Geriatric pharmacotherapy

Surgical

• Orthogeriatrics (close cooperation with orthopedic surgery and a focus on osteoporosis and rehabilitation).
• Geriatric Cardiothoracic Surgery
• Geriatric Urology
• Geriatric Otolaryngology
• Geriatric General Surgery
• Geriatrics trauma
• Geriatric Gynecology
• Geriatric ophthalmology

Other geriatrics subspecialties

• Geriatric Anesthesia (focuses on anesthesia & perioperative care of elderly)
• Geriatric Intensive Care Unit: (a special type of intensive care unit dedicated to citically-ill elderly)
• Geriatric nursing (focuses on nursing of elderly patients and the aged).
• Geriatric Nutrition
• Geriatric Occupational Therapy(part of Geriatric Rehabilitation)
• Geriatric Pain Management
• Geriatric Physical Therapy
• Geriatric Podiatry
• Geriatric Psychology

History

The Canon of Medicine, written by Abu Ali Ibn Sina (Avicenna) in 1025, was the first book to offer instruction in 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.^[4][5][6]

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^[7] or Teb al-Mashaikh wa hefz sehatahom.^[8] 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,^[9][10][11] and a treatise on causes of mortality entitled Rissala Fi Asbab al-Wafah.^[7] 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 first modern geriatric hospital was founded in Belgrade, Serbia in 1881 by doctor Laza Lazarević.^[13]

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 emphasized that rehabilitation was essential to the care of older people. Using her experiences as a physician in a London Workhouse infirmary, she believed 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 multi-disciplinary history. It values all the professions, not just medicine, for their contributions in optimizing the well-being and independence of older people.

Another "hero" of British Geriatrics is Bernard Isaacs, who described the "giants" of geriatrics mentioned above: immobility and instability, incontinence and impaired intellect.^[14] Isaacs asserted that if you look closely enough, all common problems with older people relate back to one or more of these giants.

The care of older people in the UK has been advanced by the implementation of the National Service Frameworks for Older People, which outlines key areas for attention.^[15]

Geriatricians' training

In the United States, geriatricians are primary care physicians who are board-certified in either family medicine or internal medicine and who 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 specialisation of general medicine since the late 1970s.^[16] Most geriatricians are therefore accredited for both. In contrast to the United States, geriatric medicine is a major specialty in the United Kingdom; geriatricians are the single most numerous internal medicine specialists.

Minimum Geriatric Competencies

In July 2007 the Association of American Medical Colleges (AAMC) and the John A. 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 by new interns to older patients. Twenty-six (26) Minimum Geriatric Competencies in eight content domains were endorsed by the American Geriatrics Society (AGS), the American Medical Association (AMA), and the Association of Directors of Geriatric Academic Programs (ADGAP). 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 competencies list is available at: http://www.pogoe.org/Minimum_Geriatric_Competencies.

Geriatrics organizations

• American geriatrics society
• British geriatrics society
• Canadian geriatrics society

Research

Hospital Elder Life Program

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 her/his 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.

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 oral protective reflexes (dryness of the mouth caused by diminished salivary glands), in the gastrointestinal system (such as with delayed emptying of solids and liquids possibly restricting speed of absorption), and in the distribution of drugs with changes in body fat and muscle and drug elimination.

Psychological considerations include the fact that elderly persons (particularly those experiencing substantial memory loss or other types of cognitive impairment) are unlikely to be able to adequately monitor and adhere to their own scheduled pharmacological administration. One study (Hutchinson et al., 2006) found that 25% of participants studied admitted to skipping doses or cutting them in half. Self-reported noncompliance with adherence to a medication schedule was reported by a striking one-third of the participants. Further development of methods which might possibly help monitor and regulate dosage administration and scheduling is an area that deserves attention.

Another important area is the potential for improper administration and use of potentially inappropriate medications, and the possibility of errors which could result in dangerous drug interactions. Polypharmacy is often a predictive factor (Cannon et al., 2006). Research done on home/community health care found that "nearly 1 of 3 medical regimens contain a potential medication error" (Choi et al., 2006).

Ethical and medico-legal issues

• Elder abuse.
• Informed consent in elderly.
• Power of attorney (endurable & durable).
• Advance directives.
• End of life issues & Do Not Resuscitate (DNR) orders.
• Euthanasia.

See also

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

References

1. ^ Geriatrics separation from internal medicine
2. ^ GERIATRICSFOR-SPECIALISTS INITIATIVE (GSI)
3. ^ Increasing Geriatrics Expertise in Surgical and Medical Specialties
4. ^ Howell, Trevor H. (January 1987), "Avicenna and His Regimen of Old Age", Age and Ageing 16: 58–9, doi:10.1093/ageing/16.1.58, PMID 3551552, http://ageing.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=3551552 
5. ^ Howell TH (1972). "Avicenna and the care of the aged". Gerontologist 12 (4): 424–6. PMID 4569393. 
6. ^ Pitskhelauri GZ, Dzhorbenadze DA (1970). "[Gerontology and geriatrics in the works of Abu Ali Ibn Sina (Avicenna) (on the 950th anniversary of the manuscript, Canon of Medical Science)]" (in Russian). Sov Zdravookhr 29 (10): 68–71. PMID 4931547. 
7. ^ ^{a b} Al Jazzar
8. ^ Vesalius Official journal of the International Society for the History of Medicine
9. ^ Algizar a web page in french
10. ^ Ibn Jazzar
11. ^ [Geritt Bos, Ibn al-Jazzar, Risala fi l-isyan (Treatise on forgetfulness), London, 1995]
12. ^ Islamic culture and medical arts
13. ^ New bibliography of scientific papers by Dr. Laza K. Lazarević
14. ^ Isaacs 1965
15. ^ Department of Health Older People's information
16. ^ Barton A, Mulley G (April 2003). "History of the development of geriatric medicine in the UK". Postgrad Med J 79 (930): 229–34; quiz 233–4. doi:10.1136/pmj.79.930.229. PMID 12743345. PMC 1742667. http://pmj.bmjjournals.com/cgi/content/full/79/930/229. 

Further reading

• Cannon KT, Choi MM, Zuniga MA (June 2006). "Potentially inappropriate medication use in elderly patients receiving home health care: a retrospective data analysis". Am J Geriatr Pharmacother 4 (2): 134–43. doi:10.1016/j.amjopharm.2006.06.010. PMID 16860260. 
• Gidal BE (January 2006). "Drug absorption in the elderly: biopharmaceutical considerations for the antiepileptic drugs". Epilepsy Res. 68 (Suppl 1): S65–9. doi:10.1016/j.eplepsyres.2005.07.018. PMID 16413756. 
• Hutchison LC, Jones SK, West DS, Wei JY (June 2006). "Assessment of medication management by community-living elderly persons with two standardized assessment tools: a cross-sectional study". Am J Geriatr Pharmacother 4 (2): 144–53. doi:10.1016/j.amjopharm.2006.06.009. PMID 16860261. 
• Isaacs B (1965). An introduction to geriatrics. London: Balliere, Tindall and Cassell. 

External links

• American Geriatrics Society
• British Geriatrics Society
• Canadian Geriatrics Society
• Irish Gerontological Society
• American Board Family Medicine CAQ Geriatric Medicine
• Merck Manual of Geriatrics
• Health-EU Portal Care for the elderly in the EU

v • d • e Health science > Medicine Specialties and Subspecialties Surgery Anesthesiology · Cardiac surgery · Cardiothoracic surgery · Colorectal surgery · General surgery · Neurosurgery · Oral and maxillofacial surgery · Orthopedic surgery (Hand surgery) · Otolaryngology (ENT) · Pediatric surgery · Plastic surgery · Podiatric surgery · Surgical oncology · Thoracic surgery · Transplant surgery · Trauma surgery · Urology · Vascular surgery Internal medicine Andrology · Cardiology · Dermatology · Endocrinology · Gastroenterology · Gynaecology · Hematology · Hepatology · Immunology · Neonatology · Nephrology · Neurology · Oncology · Pulmonology · Rheumatology · Urology Diagnostic Clinical laboratory sciences (Cellular pathology, Clinical chemistry, Clinical microbiology, Clinical immunology, Transfusion medicine) · Radiology (Interventional radiology, Nuclear medicine) · Pathology (Anatomical, Clinical) · Clinical neurophysiology Other specialties Allergy · Pediatrics · Disaster medicine · Emergency medicine · Family medicine · Fertility medicine · General practice · Obstetrics  · Occupational medicine · Angiology · Ophthalmology · Palliative care · Pediatrics · Adolescent medicine · Physical medicine and rehabilitation (Physiatry) · Preventive medicine (Public health) · Psychiatry · Reproductive medicine · Sleep medicine · Sports medicine · Transplantation medicine · Tropical medicine Others Biomedical research · Epidemiology · History of medicine · Hospital medicine · Medical education · Medical genetics · Medical school · Osteopathic medicine · Personalized medicine · Pharmacy · Physician (MD/MBBS and DO) · Physician assistant · Nurse practitioner · Chief Physician · DPM · Predictive medicine

This entry is from Wikipedia, the leading user-contributed encyclopedia. It may not have been reviewed by professional editors (see full disclaimer)