This document discusses common problems in the elderly population and principles of geriatric care. It outlines several key issues: 1. Common geriatric syndromes include impaired cognition, urinary incontinence, falls, depression, and polypharmacy. Chronic diseases such as hypertension, diabetes, and osteoarthritis are also prevalent. 2. Effective geriatric care requires a comprehensive approach that considers multimorbidity, screening for underdiagnosed conditions, and goals of maintaining function rather than cure. 3. Key principles of care include considering aging itself is not a disease, screening for cognitive and affective disorders, preventing iatrogenic illnesses, and providing interprofessional and person-centered care.

1. PROBLEMS
IN THE
ELDERLY
Dr. Amrutha M.K
Senior Resident
Dept. Of General Medicine

2. GERIATRICS AND
AGING
 GERIATRICS is the field of
Medicine dedicated to
providing care for the
elderly.
 GERIATRICIAN is a physician
who has special training in
this field
 AGING is defined as a
gradual, insidious and
progressive decline in
structure and function
which begins to unfold after
the achievement of sexual
maturity.

3. WHAT ARE THE
COMMON PROBLEMS
IN THE ELDERLY?

4. Impaired Intellect/Memory
Urinary Incontinence
Instability and Falls
Self Neglect
Depression
Polypharmacy Impaired Vision
Impaired Hearing

5. HYPERTENSION
DIABETES MELLITUS
OSTEOARTHRITIS
CANCER
STROKE

6. The geriatric population requires different approaches to care for several
reasons.
Effectively caring for the geriatric population requires consideration of several
key principles:
1. Aging is not a disease.
2. Medical conditions are commonly multiple (“multimorbidity”) and
multifactorial in origin, requiring a comprehensive approach to evaluation
and management.

7. 3. Many potentially reversible and treatable conditions are
underdiagnosed and underevaluated in this population, such as
fall risk, urinary incontinence, and elder abuse and neglect;
simple screening tools can help detect them.
4. Similarly, cognitive and affective disorders (e.g., mild cognitive
impairment, dementia, depression, anxiety) are common and
may be undiagnosed in early stages; simple screening tools can
help detect them.

8. 5. Iatrogenic illnesses are common, especially related to adverse
drug reactions and immobility and related deconditioning and
other complications.
6. Functional ability and quality of life, as opposed to cure, are key
goals of care.
7. Social history, social support, and patient preferences are critical
to treat older people in a safe and person-centered manner.

9. 8. Effective geriatric care requires interprofessional collaboration
among many different disciplines.
9. Geriatric care is provided largely outside the hospital (e.g., at
home, in skilled nursing and assisted living settings), and
attention to care transitions between settings is essential for
effective care.
10.Ethical issues, palliative care, and end-of-life care are critical
aspects of caring for the geriatric population.

10. KEY CONCEPTS IN
CARING FOR THE
GERIATRIC POPULATION
THE 5Ms OF GERIATRICS

11. INSTABILITY AND FALLS
Causes of falls in the elderly
Ask all patients about falls in the past
year
 No falls: Recommend fall prevention,
eduation and exercise program
 <1 Fall: Check for gait or balance
problems.
 >1 Fall : Multifactorial Risk Assessment
Intervene with identified risks
Reassess periodically
Risk factor Intervention
Medications Modify Medications
Gait and balance Impairment Gait training, assistive devices,
balance and strengthening
exercises
Feet and footware Address foot/ shoe problem
Visual acuity Treat vision impairement
Postural hypotension Behavioral recommendations
and substitution of Meds
Lower limb joint function Supplement Vitamin D
Arrythmias, Parkinson’s
Disease, Seizure Disorder
Antiarrythmics,
Antiparkinsonian Drugs,
Antiepileptics

12. POLYPHARMACY
Polypharmacy is defined as the prescription of multiple medications using various
thresholds (usually 5-9 simultaneous drugs) and has been identified a major challenge
in the geriatric population.
General Recommendations for Geriatric Prescribing:
 Evaluate thoroughly
 Manage medical conditions without drugs as far as possible
 Weigh Risks v/s Benefit of prescribing drugs
 Avoid drugs causing potential drug-drug interaction
 Start with a small dose, monitor drug levels
 Ensure adherence
 Monitor frequently

13. DELIRIUM
Definition: Delirium is an acute syndrome of transient, reversible cognitive dysfunction.
Management:
Prevention is the best medicine
• Eliminate extra medications, reverse metabolic abnormalities, hydration, and
nutrition
• Education of patients and family
• Reorientation by staff, family, sitters, clocks, calendars
• Remove nonessential lines and tubes

14. • Drug therapy:
- Delirium that causes injury to the patient or others should be treated with
medications
- The most common medications used are neuroleptics (haloperidol,
risperidone, olanzapine)
- Benzodiazepines (lorazepam) often are used for withdrawal states
- Thiamine, cyanocobalamin supplementation

15. DEPRESSION
• Depression is the most common psychiatric illness in the elderly. Although
common, it is not a natural part of aging.
• Depression is NOT present in ALL older adults, but is under recognized and
under treated.
• Treatment
 Pharmacotherapy: anti depressants for 4-6 weeks
 Psychological: Cognitive Behavioral Therapy (CBT), Interpersonal Therapy
(IPT)
 Non pharmacacological treatment : Electroconvulsive therapy

16. URINARY
INCONTINENCE
• Urinary incontinence is defined as the involuntary loss of urine.
• It is a heterogeneous condition that ranges in severity from dribbling small
amounts of urine to continuous incontinence.
• The prevalence increases with age, but is not a part of normal aging.
Consequences:
• Social stigmata – leads to restricted activities and depression
• Medical complications – skin breakdown, increased urinary tract infections
• Institutionalization – urinary incontinence is the second leading cause of
nursing home placement.

17. Categories of incontinence
 Urge incontinence:
• Abrupt desire to void cannot be suppressed.
• Management: Bladder retaining antimuscarinic drugs: solifenacin,
tolterodine.
 Stress incontinence:
• Occurs with increase in abdominal pressure; cough, sneeze, etc.
• Management: Pelvic floor muscle training and surgical intervention.

18.  Overflow incontinence:
• Overdistention of bladder.
• Management: Residual volume >10mL Resection of prostate,
intermittent catheterization
 Functional incontinence:
• Result of psychological, cognitive or physical impairment.

19. General treatment options in urinary incontinence :
• Avoid bladder stimulants (caffeine)
• Use diuretics judiciously (not before bed)
• Reduce physical barriers to toilet (use bedside commode)
• Bladder training

20. • Patient education
• Scheduled voiding
• Positive reinforcement
• Pelvic floor exercises (Kegel exercises)
• Biofeedback
• Caregiver interventions: Scheduled toileting, habit training,
prompted voiding

21. FRAILTY
• Frailty = Loss of reserve
• Defined as the loss of an individual’s ability to withstand minor stresses
because the reserves in function of several organ systems are severely
reduced.

22. PATHOPHYSIOLOGICAL
BASIS OF FRAILTY

23. Treatment:
• Address the precipitating acute illness
• Address the underlying loss of reserve
• Exercise – improve musculoskeletal function, balance and
aerobic capacity
• Medication review and deprescribing
• Nutritional support to improve weight loss

24. ELDER ABUSE AND
NEGLECT
Elder Abuse
• More than a million people world over aged 65 or older have
been injured, exploited, or otherwise mistreated by someone on
whom they depended for care or protection. Neglect is the most
common form of abuse followed by financial and emotional
abuse.

25. Indicators of Abuse
• Unexplained physical injury
• Unexplained malnutrition/decubitus ulcers
• Unkempt appearance
• Failure of a medical condition to improve or the continued presence of pain
• Fear of certain family members, friends, or caregivers
• The older person is largely ignored or treated passively by caregivers or others
• Caregivers who are entirely ignorant of the medical problems or treatments for the
older person they are directly caring for.

26. Who are the abusers?
• Domestic elder abuse (caregivers/distant relatives)
• Institutional elder abuse
• Self-abuse/neglect

27. Reasons for abuse
• Caregiver stress/burnout
• Impairment of dependent elder (i.e., dementia)
• Transgenerational “cycle of violence”
• Material or other gain

28. Major Forms of Abuse
1. Physical and sexual abuse
2. Emotional and psychological abuse
3. Financial abuse and material exploitation
4. Abandonment and neglect
5. Medical abuse