Geriatric Health Issues

Introduction to Geriatrics - Age Old Wisdom

• Geriatrics: Branch of medicine for health, diseases, and care of older adults (India: ≥60 yrs).
• Ageing: Natural, progressive, irreversible process; NOT synonymous with disease.
• Demographic Shift (India): Rapid ↑ in elderly population.

  ⭐ India's elderly population (≥60 years) is projected to reach 319 million by 2050, constituting ~20% of total population.

• Key Physiological Changes:
  • ↓ Homeostatic reserve (reduced ability to cope with stressors).
  • Immunosenescence (↓ immune function).
  • Sensory decline (e.g., presbycusis, presbyopia).
  • Musculoskeletal: Sarcopenia (↓ muscle mass/strength), Osteoporosis (↓ bone density).

Common Geriatric Syndromes - The Falling I's

📌 Mnemonic: Key areas of decline, the 'I's:

• Instability (Falls):
  • Major cause of injury, disability in >65 yrs.
  • Risks: polypharmacy, weakness, poor vision/gait.
  • Timed Up and Go (TUG) test: >12s indicates ↑fall risk.
• Immobility:
  • Leads to: pressure ulcers, DVT, deconditioning.
  • Address pain, encourage safe mobility.
• Incontinence (Urinary):
  • Not normal aging. Types: stress, urge, overflow, functional.
  • Requires careful assessment.
• Intellectual Impairment:
  • Delirium (acute), Dementia (progressive).
  • Screen: Mini-Cog, MMSE.
• Iatrogenesis:
  • Harm from medical care (e.g., polypharmacy).
  • Review meds using BEERS criteria.
• Impaired Senses (Vision/Hearing):
  • Impact safety, communication, QoL.
  • Screen regularly.

⭐ Delirium in an elderly patient is often precipitated by a simple urinary tract infection (UTI) and can be the sole presenting symptom.

NCDs in the Elderly - Chronic Challenges

• Prevalent NCDs: Hypertension (HTN), Diabetes Mellitus (DM), Cardiovascular diseases (CVD - e.g., CAD, Stroke), COPD, Osteoarthritis, Osteoporosis, common Cancers (prostate, breast, colorectal), Dementia (esp. Alzheimer's), Depression.
• Key Challenges:
  • Atypical presentations: e.g., confusion with UTI/pneumonia, silent MIs.
  • Polypharmacy: ↑ risk of drug interactions & adverse drug reactions (ADRs).
  • Multiple comorbidities: complicating diagnosis and management.
  • Functional decline & frailty: impacting activities of daily living (ADLs).
  • "Geriatric Giants": Immobility, Instability (falls), Incontinence, Impaired Intellect/Memory.
• Management Focus:
  • Comprehensive Geriatric Assessment (CGA) for holistic care.
  • Individualized treatment goals: prioritizing Quality of Life (QoL) & function.
  • Medication review (e.g., Beers criteria, STOPP/START tools) to minimize polypharmacy.

⭐ Atypical presentation of myocardial infarction in elderly includes syncope, acute confusion, or stroke, often without chest pain (silent MI).

Geriatric Assessment & Prevention - Golden Years Guard

• Comprehensive Geriatric Assessment (CGA): Multidimensional, interdisciplinary evaluation for frail elderly. Assesses:
  • Medical: Comorbidities, polypharmacy (≥5 drugs).
  • Functional: ADL (Katz), IADL (Lawton).
  • Cognitive: MMSE, MoCA.
  • Psychosocial: GDS (depression), social support.
  • Nutritional: MNA.
  • Mobility: Timed Up and Go (TUG) test; >12 sec indicates ↑fall risk.
• Prevention Strategies:
  • Primary: Immunizations (influenza, pneumococcal, zoster), fall prevention programs, regular exercise.
  • Secondary: Early detection via screening (BP, diabetes, common cancers, osteoporosis with DEXA).
  • Tertiary: Rehabilitation, managing chronic conditions, palliative care.
• Key Initiative: National Programme for Health Care of the Elderly (NPHCE) in India.

⭐ Polypharmacy (≥5 drugs) is a major risk factor for adverse drug events and hospitalizations in the elderly.

High‑Yield Points - ⚡ Biggest Takeaways

• Geriatric Giants (5 Is): Immobility, Instability (falls), Incontinence, Intellectual Impairment (dementia/delirium), Iatrogenesis.
• Prevalent NCDs: Hypertension, Diabetes Mellitus, Osteoarthritis, COPD, Cancers, and Alzheimer's Disease.
• Assess functional status using ADL (Activities of Daily Living) & IADL (Instrumental ADL).
• Polypharmacy significantly ↑ risk of adverse drug events and drug interactions.
• Prioritize fall prevention strategies, adequate nutrition (Vit D, B12, Calcium), and key vaccinations (influenza, pneumococcal).
• Screen for depression and cognitive decline regularly; elder abuse awareness is crucial.