2. Outline of presentation
Objectives of presentation
Introduction
Geriatric gaints
Common geriatric syndromes
3. introduction
Nigeria with a population of 140million (NPC 2006) is the most popula
ted nation in Africa
with 5% of the total population aged 60 years and above.
Nigeria currently has the highest older persons population in Africa .By
2025 the population of Nigerians aged 60 and above will constitute 6 p
ercent of the entire population.
4. Absolute numbers of persons (in millions) above 60 years of age in
countries
with a total population approaching or above 100 million inhabitants
(in 2002)
2002 2025
China 134.2 China 287.5
India 81.0 India 168.5
United States of
America
46.9 United States of
America
86.1
Japan 31.0 Japan 43.5
Russian
Federation
26.2 Indonesia 35.0
Indonesia 17.1 Brazil 33.4
Brazil 14.1 Russian
Federation
32.7
Pakistan 8.6 Pakistan 18.3
Mexico 7.3 Bangladesh 17.7
5. They are also referred to as “Geriatric Giants” which
refers to the principal chronic disabilities of old age
Geriatric syndromes impact on physical, mental and
social domains of older adults.
Geriatric syndromes share many common factors
such as;-Older age,
-cognitive impairment,
-functional impairment,
-and impaired mobility
6. The Geriatric Syndrome
The term “syndrome” when applied to geriatric conditions has been
at odds with the traditional use of “syndrome”
They result from accumulated impairments in multiple systems”
They only manifest when the effect of these impairments in multiple
domains compromise compensatory ability.
7. The geriatric conditions is therefore the “ reverse” of the traditional
medical syndromes
They results from numerous rather than a single disruption.
The outcome is a single phenomenology rather than a spectrum of
symptoms and signs
Multiple abnormalities “run together” to cause a single
phenomenology.
9. Common geriatric syndromes in
primary care
• Falls
• Cognitive impairment ( dementia, delirium, depression)
• Dizziness
• Pressure ulcers
• Poly-pharmacy
• Urinary Incontinence
• Others ( failure to thrive, Sleep problems, elder abuse, frailty, syncope,
etc)
10. Falls; introduction
• About one-third of older persons over the age of 65
years living in the community fall each year.
• The risk for falls increases as the person ages. At 80
years and above the risk increase by 50% yearly.
• Falls are often marker for underlying disease
• 40% of falls result in minor injuries
• 10% result in major injuries (Fracture, soft tissue
injury, traumatic brain injury)
• 2.2% of injurious falls result in death
11. Risk factors
Increasing Age
past history of Falls
Female Gender
Medical Illness
Peripheral neuropathy
postural hypotension
Cognitive impairment
Visual impairment
Lower extremity
weakness
Abnormality of
gait/mobility
Incontinence
Depression
Foot problems
Hearing impairment
Intrinsic factors
Intrinsic factors
13. Evaluation of Falls; Ask
about:
• Duration of incident and how serious?
• Exact circumstances of fall (accident, trip, “black out”,
“legs just gave way”)
• Previous fractures with falling.
• Medications such as; diuretics, antihypertensives,
neuroleptics, antihistamines, antidepressants, long
acting benzodiazepines)
• alcohol consumption? How much and how often?
• Collateral history can be very useful!
14. Evaluation of Falls; Physical
Examination
Look for an orthostatic drop in blood pressure (about 25% in patients
who fall)
Pay attention to cardiovascular system; evidence of arrhythmias?
Murmurs of aortic stenosis?
15. Examine the CNS for;
-tremor and bradykinesia suggestive of Parkinson’s disease?
-Focal signs of a previous stroke (weakness, upgoing toe, asymmetrical
reflexes)?
-Impaired vibration sense or proprioception (suggestive of a peripheral
neuropathy)
16. Evaluation of Falls; Physical
Examination
• Assess the gait;
- examine the speed of movement
- Does patient shuffles when walking ?
- do they swing their arms or not ?
- See if they touch the wall for balance
- Do they wobble away from a straight line ?
- Are their turns smooth ?
- do they trip over their feet ?
17. prevention of falls; intrinsic
factors
a. Review medication regimen
(benzodiazepines and drugs
causing orthostatic
hypotension should be
carefully evaluated)
b. Assess alcohol use (may be
difficult to get accurate
history)
c. Assess cognitive abilities
d. Assess patient mood state
(especially for depression)
e. Provide and maintain assistive
devices for sensory deficits
(eyeglasses, hearing aids)
18. prevention of falls; intrinsic
factors
f. Increase strength of the
older adult
(physiotherapy)
g. Evaluate gait and
balance – provide
restorative
therapy/exercises
h. Assess client use of
assistive devices for
ambulation (hand rails,
canes, walkers)
i. Evaluate continence
needs and establish
toileting schedule as
appropriate
j. Assess patient’s
understanding of fall
risk and prevention
strategies
k. Assess
caregiver/surrogate’s
understanding of fall
risk and prevention
strategies
19. Prevention of falls; extrinsic
factors
a. Evaluate environment (lighting,
loose rugs, slippery or uneven
flooring, exposed cords)
b. Evaluate client footwear
(stable, proper fitting)
c. Shower and toilet grab bars
d. Elevated toilet seats/bed
e. Put frequently used items on
lower shelves in home, use
grabbing devices
d. Remove clutter
20. Urinary incontinence;
introduction
• The involuntary loss of urine sufficient in amount or frequency to be a
social or health problem.
• Urinary incontinence (UI) is a symptom, not a specific disease
• Approximately, 15-30% of non-institutionalized older persons are
affected by urinary incontinence, including 19% of men and 39% of
women.
21. 30% of elderly persons in nursing homes also experience faecal
incontinence
UI is about twice as prevalent in older women as in older men.
Even though there are aging associated changes in the bladder and
the urinary tract, UI should not be considered as part of ageing
23. Causes of Transient UI-DIAPERS
D: Delirium/confusional states
I: Infection—UTI’s
A: Atrophic urethritis/vaginitis
P: Pharmaceuticals (hypnotics, diuretics)
P: Psychological
E: Excessive urine production
R: Restricted mobility
S: Stool impaction
24. Pressure Ulcers ;
introduction
The prevalence of pressure ulcers is affected by;
- Quality of patient care,
- place of care,
- patient population.
25. Risk Factors
Mechanical/local environmental
factors:
Local Pressure
Friction/shear
Moisture: urinary/feacal
incontinence
• Malnutrition, decreased
albumin
• Excessively dry skin
• Immobility and debility
• Sensory impairment
• Decrease dermal
thickness, subcutaneous
adiposity, collagen tensile
strength, and skin
elasticity with aging
Extrinsic factors intrinsic factors
26. Pathophysiology
There are four physical factors that can lead to the
development of pressure ulcers:
(a) Pressure;
– Mild pressure can produce ischemia in tissue after
only two hours.
- This ischemia can lead to tissue necrosis
(b) Shear;
– A shearing force is produced where the skin is against
a fixed exterior surface while the subcutaneous tissues
are subjected to lateral forces.
27. (c) Friction;
– When the skin moves across another surface, abrasions can occur and
cause burns.
(d) Moisture ;
– Moisture can lead to tissue maceration. The presence of urinary or
fecal incontinence serve as a chemical irritant.
28. Prevention
1.Risk assessment using the Braden Scale for Predicting
Pressure Score Risk
2. Skin Care and Early Treatment through;
a. Inspect the skin at least daily and document
assessment results.
b. Individualize bathing frequency, use a mild cleansing
agent, avoid hot water and excessive friction.
c. Assess and treat incontinence.
d. Use moisturizers for dry skin; minimize environmental
factors leading to dry skin.
e. Avoid massage over bony prominences.
29. f. Use proper positioning, transferring and turning techniques to minimize
skin injury.
g. Use dry lubricants (cornstarch) or protective coverings to reduce
friction injury.
h. Identify and correct factors compromising protein / calorie intake and
consider nutritional supplement / support for nutritionally-
compromised persons.
i. Institute a rehabilitation program to maintain or improve mobility /
activity status..
30. 3. Mechanical Loading and Support Surfaces
a. Reposition bed-bound persons at least every 2 hours, chair-bound
persons every hour.
b. Use a written repositioning schedule.
c. Place at-risk persons on a pressure-reducing mattress/chair cushion.
d. Consider postural alignment, distribution of weight, balance and
stability, and pressure relief when positioning persons in chairs or
wheelchairs.
31. Dizziness;introduction
Dizziness is a subjective sensation of postural instability or of illusory
motion.
It is a common complaint of persons aged 65 years and older
The prevalence ranges from 4% to 30%
Dizziness is a nonspecific term and describe as; spinning, giddiness,
faintness, floating, feeling woozy, and many other sensations.
33. references
United Nations (UN) (2001). World Population Prospects:The
2000 Revision
Sharon K. Inouye, Stephanie Studenski, Mary E. Tinetti,
M.D.3, and George A. Kuchel. Geriatric Syndromes: Clinical,
Research and Policy Implications of a Core Geriatric Concept.
J Am Geriatr Soc. 2007 ; 55(5): 780–791.
Jonathan M. Flacker. What Is a Geriatric Syndrome Anyway? J
AM Geriatric Soc 2007;51: 574-6
Chih-Hsun Wu, Ching-I Chang, Ching-Yu Chen. Overview of
studies related to geriatric syndrome in Taiwan.Journal of
Clinical Gerontology & Geriatrics 2012;3: 14-20
34. Inouye SK. Delirium in older persons. N Engl J Med
2006;354:1157-65
Thomas c, Kreisel SH, Oster P, et al. Diagnosing delirium in older
hospitalized adults with dementia: adapting the confusion
assessment method to international classification of disease,
tenth revision, diagnostic criteria. J Am Geriatr Soc
2012;60:1471-7
Veronica Rivera. Approach to geriatric syndromes. Avaiable at
http://www.ucsfcme.com/2015/MFC15002. accessed on
23/12/2015
Siobhan Sundel. Geriatric syndromes. How to identify them,
How to diagnose them, How to reduce their impact on your
patient. Avaiable at c.ymcdn.com/.../. Accessed on 28/12/2015
35. Wade DT, Collin C. The Barthel ADL Index: a standard measure of physical
disability? Int Disabil Stud. 1988;10(2):64-67.
Black JM, Edsberg LE, Baharestani MM, et al. Pressure ulcers: avoidable or
unavoidable? Results of National Presure Ulcer Advisory Panel Consensus
Conference. Ostomy wound manage 2011;52:24-37
Reddy M, Gill S, Rochon P. Preventing pressure ulcers. A systemic review.
JAMA 2006;974-84
National Pressure Ulcer Advisory Panel and European Pressure Ulcers:
prevention and treatment of Presure Ulcers clinical practice guideline.
Washington, DC: National Pressure Ulcer Advisory Panel; 2009
36. Neuhauster Hk Radtke A, Brevern MV, et al Burden of dizziness and
vertigo in community. Arch Intern Med 2008; 168 (19): 2118-24
College NR, WilsonJa, Macintyre CCA, MacLennan WJ. The
prevalence and characteristics of dizziness in an elderly community.
Age Aging 1994:23;117-20
Tinetti ME, Williams CS, Gill TM. Dizziness among older adults: A
possible geriatric syndrome. Ann Intern Med 2000;132:337-44
Gupta V, Lipsitz La. Orthostatic hypotension in the elderly:
Diagnosis and treatment. Am J Med 2007;120(10):841-7
Upright posture and postprandial hypotension in elderly persons.
Ann Intern Med 2000;133:533
