Aging geriatric medicine

1. Aging is a gradual, continuous
process of natural change that
begins in early adulthood. During
early middle age, many bodily
functions begin to gradually decline

2. Aging is a natural process of
structural decay that all living
organisms undergo. It is caused by
intrinsic processes (e.g., genomic
instability and telomeric attrition)
and interactions with the
environment (e.g., exposure to
sunlight and toxins)

3. People do not become old or
elderly at any specific age.
Traditionally, age 65 has been
designated as the beginning of old
age. But the reason was based in
history, not biology. Many years
ago, age 65 was chosen as the age
for retirement in Germany, the first
nation to establish a retirement
program

4. In 1965 in the United States, age 65
was designated as the eligibility age
for Medicare insurance. This age is
close to the actual retirement age of
most people in economically
advanced societies.

5. When a person becomes old can be
answered in different ways:
Biologic age refers to changes in the body
that commonly occur as people age.
Because these changes affect some people
sooner than others,
Psychologic age is based on how people act and feel.
For example, an 80-year-old who works, plans, looks
forward to future events, and participates in many
activities is considered psychologically younger
Chronologic age is based solely on the passage of
time. It is a person’s age in years. Chronologic age
has limited significance in terms of health

6. Healthy aging refers reduction in the undesired effects of
aging
•Following a nutritious diet
•Avoiding cigarette smoking and
excessive alcohol use
•Exercising regularly
•Staying mentally active

7. Geriatrics, or geriatric medicine,
is a medical specialty focused
on providing care for the unique
health needs of older adults.
The term geriatrics originates
from the Greek γέρων geron
meaning "old man", and ιατρός
iatros meaning "healer

8. characteristics of Geriatric medicine
Atypical presentations
Simple interventions can often
make a big difference
Multiple pathology
Reduced homeostatic reserve
Impaired immunity

9. The ‘geriatric giants’
The four Is were originally coined by
Bernard Isaacs, a professor of
geriatric medicine.
• Incontinence
• Immobility
• Instability (falls and syncope)
• Intellectual impairment (delirium
and dementia)

10. Several different illnesses can
present as one of the geriatric
giants. Two common examples also
begin with the letter ‘i’:
iatrogenic disease (caused by
medication), and infection. The
common sources of sepsis in older
people are the chest, urine and
biliary tract.

11. Prescribing in Older People
Most older people are on regular
medication
• Pharmacokinetics and
pharmacodynamics are different in this
age group
• Older people are much more likely
to suffer from the side-
effects of drugs
• Polypharmacy and problems with
concordance are particular
issues in geriatric medicine

12. Delirium Delirium is common in older
people, but is often not recognised
• It can present with a wide
range of symptoms and signs
• Patients at high risk of
developing delirium can be
identified and
it can sometimes be prevented
• Treatment of delirium
involves environmental measures
as well
as treatment of the underlying
cause

13. Falls
Falls in older people are common
• Recurrent falls are rarely
‘mechanical’ (i.e. accidental)
• The consequences of falls
in older people include loss of
confidence, loss of independence
and fractures
• There is good evidence that
simple interventions can prevent
falls

14. Syncope Collapse with transient loss of
consciousness is a common
clinical problem
• The most important diagnostic tool
is the history, including an
eye-witness account if possible
• In syncope, the underlying cause
will be obvious in more than
one-third of cases after history,
examination, lying and standing
blood pressure and a 12-lead
electrocardiogram
• Unexplained syncope requires
investigation if it is recurrent, or if
a single episode led to a signifi cant injury

15. Transient Ischemic
Attack and Stroke
Transient ischemic attack (TIA) and
stroke are medical
emergencies that require urgent
assessment
• Patients with a high-risk TIA
or stroke should be admitted to
hospital
• Stroke unit care significantly
reduces death and disability
• Modifying risk factors and
starting secondary prevention reduces
the risk of subsequent stroke

16. Dementia
Dementia is common in old age,
especially extreme old age
• People with dementia
should be assessed thoroughly
• The general management of
people with dementia in health
and social care should be improved

17. Urinary Incontinence
Incontinence is common among
older people
• The impact of incontinence
is signifi cant
• Incontinence is not an
inevitable consequence of ageing
• It can be treated after a
proper assessment
• A lot can be done to
promote the comfort and dignity of
older
people with intractable
incontinence