Geriatric patient care

1. ADVANCED PHARMACEUTICAL CARE
Assignment: Geriatric patient care
SUBMITTED BY
Achyut Bikram Thapa
SUBMITTED TO
Prof. Anantha Naik Nagappa
Visiting Faculty
Department of Pharmacy
Kathmandu University
Dhulikhel, Kavre, Nepal
July 15, 2022

2. Contents
Introduction.......................................................................................................................................3
Geriatric syndromes Morbidity condition at geriatric age group ........................................................3
Age-Friendly Health System.............................................................................................................4
Approaches for geriatric patient care...................................................................................................5
Medication.....................................................................................................................................6
Injury Prevention............................................................................................................................6
Vision.............................................................................................................................................7
Nutrition and immunization ............................................................................................................7
Continence and mental status .........................................................................................................7
Social issues....................................................................................................................................7
Geriatric patient care case study:.........................................................................................................7
Conclusion .........................................................................................................................................8
Reference ..........................................................................................................................................8

3. Introduction
Ageing population is a natural and global phenomenon. Aged population is
rapidly increasing in developing countries as compared to developed
countries due to increase in life expectancy and betterment and accessibility
of health care facility. Most of developed countries consider 65 years as old
age.
The government of Nepal has declared that people with 60 years or more
are elderly citizens. Nepali Senior Citizens Act defined citizen of 60 years and
above as old aged. 8.1% of population is above 60 years (census 2021). The
growth rate of the elderly population is faster than that of the total
population in Nepal. As per census 2021, 5.9% of population were aged 65
years and above in Nepal. Population aged 65 years and above of Nepal
increased from 3.1 % in 1972 to 5.9 % in 2021 growing at an average
annual rate of 1.36%.
Geriatric social security in Nepal started from fiscal 1994/95 as a non-
contributing social assistance to elderly citizens with 70 years or more being
provided. The allowance was nominal at the beginning and currently each
geriatric person gets NRs 3000 on monthly basis. This social security is also
provided to single elderly person above 60 years. At present context, it is
not enough for the elderly citizens, but it is supportive for health care,
medicine, entertainment and desired foods and fruits.
In Nepal, traditionally, senior citizens reside with and are taken care of by
their sons and daughters-in-law. Sons are the primary source of health care
expenditures for older people; 49% of older parents' expenses were
managed by their son.
But the traditional system of joint families has been replaced by a nuclear
family, and the internal and external migration of youth leaves behind
elderly parents.
Geriatric syndromes Morbidity condition at geriatric age group
In the U.S., three-fourths of the total health care costs are related to the
treatment of chronic conditions. In the United States, approximately 40
million adults over the age 65 are affected by one or more forms of
cardiovascular disease (CVD). Unlike traditional medical syndromes, geriatric
syndromes do not fit a discrete condition and conditions like incontinence,
cognitive impairment, delirium, falls, pressure ulcers, pain, weight loss,
anorexia, functional decline, depression, and multi-morbidity are common.
Other less common morbid conditions associated with increased age are:

4.  Cancer,
 Chronic obstructive pulmonary disease (COPD),
 Parkinson disease,
 Dementia,
 chronic kidney disease,
 sensory changes (vision, hearing),
 psychiatric causes (depression, stress)
 Frailty and falls
Specialized health care facility needs to be provided to address the morbid
condition. People ≥ 65 years have the highest rate of inpatient hospital
stays, more than 2.5 times higher than those 45 to 64 years. The healthcare
cost is greater higher to age group above 85 years.
Because of their multiple chronic illnesses, older adults are likely to see
several health care practitioners and to move from one health care setting to
another. Providing consistent, integrated care across specific care settings,
sometimes called continuity of care, is thus particularly important for older
patients.
Age-Friendly Health System
The age friendly health system utilizes 4M framework that was developed by
a team led by the Institute for Healthcare Improvement (IHI) in August
2016. The which included experts in aging and geriatrics along with health
system leaders (Mate et al., 2018). The 4M framework was derived using
seventeen care models. A list of seventeen care models with level 1 or 2a
evidence of impact was then examined to determine the essential elements
of care as follows:
1. ACE unit (acute care for elders)
2. CM+ (care management plus)
3. Care transitions program
4. Center to advance palliative care
5. Geriatric emergency department
6. Geriatric interdisciplinary team training
7. GRACE (geriatric resources for assessment and care of elders)
8. Guided care
9. Home-meds
10. Hospital at home and mount Sinai MACT (mobile acute care
team)
11. HELP (hospital elder life program)
12. IMPACT (improving mood-promoting access to collaborative
treatment)

5. 13. NICHE (nurse improving care for health system elderly)
14. Patient priority care
15. PACE (program for all-inclusive care of the elderly)
16. TCM (transitional care model)
17. University of California at Los Angeles Alzheimer’s and Dementia
care program
The 4Ms include what matters, medication, mentation, and mobility.
What matters: adult specific health outcome goals and care preference
Medication: age friendly medication and dose adjustment
Mentation: mood and memory focusing on prevention, identification,
treatment, and management of dementia, depression, and delirium
Mobility: assisting or encouraging older adults to move safely every day to
maintain functional ability and do what matters
Figure: 4M framework
Approaches for geriatric patient care
Geriatric patient care is a multidisciplinary approach including wider
involvement of healthcare professional. Palliative care including moral and

6. mental relief to elderly population should be implemented. Following
approaches in combination or isolation are utilized for geriatric patient care
1. Medication
2. Injury prevention
3. Vision
4. Nutrition and immunization
5. Continence and mental status
6. Social issues
Medication
When medication is necessary, care must be taken not to negatively
influenced patient. Polypharmacy might have ADR to adults
Regular screening for the seven following drug categories known to harm
older adults is evidence-based best practice and better avoided:
• benzodiazepines,
• opioids,
• anticholinergic medications,
• all prescription and over-the-counter sedatives and sleep
medications,
• muscle relaxants,
• tricyclic antidepressants,
• antipsychotics
Injury Prevention
The annual incidence of falls in patients over 65 years of age who live
independently is approximately 25 percent but rises to 50 percent in patients
over 80 years of age. Falls are responsible for a significant number of
accidental deaths and traumatic injuries among the elderly. One third of
patients with confirmed falls may not recall falling. A checklist for potentiality
of geriatric patient for injury tendency is developed and applied. This
includes one-leg balance, get-up and go tests.
Injury to elderly patient can be minimized with use of safety belt, installation
of fire alarm, well lit conditioning, free walking space in room use of
handrails, and removal of slippery floor mats.

7. Vision
The annual incidence of falls in patients over 65 years of age who live
independently is approximately 25 percent but rises to 50 percent in patients
over 80 years of age. Falls are responsible for a significant number of
accidental deaths and traumatic injuries among the elderly. One third of
patients with confirmed falls may not recall falling. Regular eye checkup and
use of glasses for needy elderly patients could reduce vision related health
issues that might link with the falls and accidents.
Nutrition and immunization
Elderly person must be provided quality diet. Routine diet used by adult
population might not be applicable for elderly due to poor digestion and oral
conditions. Dentist visits and oral hygiene must be monitored. Influenza,
pneumococcal and tetanus vaccines must be provided on routine basis.
Continence and mental status
Changes in mental status can have a profound impact on elderly patients
and their families. Two of the more common changes are cognitive decline
and depression.
Dementia is chronic and progressive, and it is characterized by the gradual
onset of impaired memory and deficits in two or more areas of cognition,
such as anomia, agnosia or apraxia.
Depression significantly increases morbidity and mortality. As opposed to
dementia, depression is usually characterized by a relatively rapid onset,
intact but possibly retarded cognitive abilities and a generally time-limited
duration.
Social issues
Multiple aspects of the social situation can influence functional ability and
efficient use of time. Activities of daily living scale (bathing, dressing,
toileting and continence, transfer and feeding) needs to be monitored.
Other social activities like using telephone, walking, shopping, preparation of
meal, household work, laundry, use of medicines etc. needs to be taken
care.
Geriatric patient care case study:
Ms. R 82 years female was taken to emergency ward at hospital with hot
water burns. Upon interrogation she was having eyesight problem and tried
to prepare tea with electric heater. She was living alone and her children and
in laws were not living with her. Her mental health condition was

8. compromised, and she showed unfilled prescription for her antidepressant
medicines. She was admitted to the ward and treated for her injuries. She
developed family like relation with health care professionals within her 10
days stay at hospital. Her daughter was informed and later she was
discharged from the hospital with her daughter as escort. Her antidepressant
medication was continued and called for follow-up in next month.
Conclusion
Geriatric patient needs special care and proper medication. Medication
requirement should be based upon disease condition and proper attention
needs to be provided for polypharmacy as it might cause unwanted effects in
elderly patient. Certain categories of medication causing impairment of
activities needs to be used with caution. Approaches for injury protection
must be taken care. Proper eyesight is an important parameter to prevent
injury.
Reference
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and payer, 2000–2015. HCUP Statistical Brief #235. Agency for
Healthcare Research and Quality, 2018.
• Central Bureau of Statistics (CBS). (2022). Population monograph of
Nepal 2021. Kathmandu: National Planning Commission Secretariat,
Central Bureau of Statistics, Government of Nepal, Nepal.
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Social Care Needs Assessment of Elderly: The Context of Piloting
Service Developments and Care of Elderly in Pharping (2012).
Kathmandu: Central Department of Population Studies, Tribhuvan
University.
• Kedar Mate, Terry Fulmer et. Al, Evidence for the 4Ms: Interactions
and Outcomes across the Care Continuum; Journal of Aging and
Health, Vol 33, Issue 7-8, 2021
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