In-Depth Notes on Geriatrics

Geriatrics Overview
  • Definition: Geriatrics is the branch of medicine that focuses on the health care of older adults, particularly those over the age of 65-80.
  • Physiologic vs. Chronologic Age: It is important to consider physiologic age, which may differ from chronological age due to individual health conditions.
Physiologic Aging Changes

  • Immune System:

    • Decreased neurohumoral response and white blood cell reserve.
    • Sluggish T-cell response leads to increased infection risk.

  • Sensory Changes:

    • Decreased salivation and altered taste sensitivity (more bitter/sour).
    • Changes in visual acuity, auditory sensitivity, and response to pain.
    • Decreased thirst sensation.

  • Central Nervous System:

    • Reduced neuronal density, altered reflexes, and decreased proprioception.

  • Cardiovascular System:

    • Increased myocardial irritability and dysrhythmias (e.g., PVC & PAC's).
    • Decreased sinus rate and increased arterial compliance.

  • Renal Changes:

    • Reduced renal blood flow and glomerular filtration rate leading to decreased clearance of drugs.

  • Body Composition Changes:

    • Decreased lean muscle mass and increased body fat.
    • Changes in skin elasticity.

  • Respiratory Changes:

    • Increased tidal volume but decreased vital capacity and lung compliance leading to reduced response to hypoxemia/hypercapnia.

  • Gastrointestinal Changes:

    • Decreased gastric emptying and absorption, altered hepatic blood flow, and motility changes.

  • Metabolic Changes:

    • Decreased basal metabolic rate and altered thermal regulation.
Preventative Healthcare Measures
  • Cancer Screening Recommendations:
    • Colorectal: Annual fecal tests or colonoscopy every 10 years starting at age 50.
    • Breast: Mammograms every 1-2 years after age 40, Pap and HPV tests as indicated.
    • Lung: Annual low-dose CT scans for high-risk groups (50-74 years).
Increased Vulnerability in Older Adults
  • Chronic Diseases:
    • Increased incidence of chronic conditions and reduced physiologic reserves.
    • Decline in organ functions and muscle strength increases vulnerability.
Geriatric Review of Systems

  • Social Assessment:

    • Evaluate living arrangements, caregiver support, and signs of neglect.

  • Functional Assessment:

    • Assess for independence in activities of daily living (ADL) and mobility concerns (e.g., driving safety).

  • Cognitive Assessment:

    • Screen for cognitive impairments and mental health issues (e.g., depression).

  • Medication Review:

    • Polypharmacy is common; assess for understanding and adherence to medication regimens.
Common Geriatric Syndromes

  • Falls:

    • Multifactorial risks, leading cause of injury.
    • Assessment of muscle strength, vision, and environmental safety measures is vital.

  • Urinary Incontinence:

    • Types include stress, urge, overflow, functional, and mixed incontinence. Treatment includes lifestyle modifications and appropriate medications.

  • Decisional Capacity:

    • Assess ability to make informed decisions considering cognitive impairments and social influences.
    • Importance of documentation of advance directives and surrogate decision-makers for care decisions.
Pain Management in Geriatrics
  • Recognize physiological changes that affect drug metabolism and clearance.
  • Consider a multi-modal approach to pain management, including non-pharmacological methods alongside medications.
Adverse Events and Complications

  • Nosocomial Infections:

    • Increased risk post-hospitalization due to malnutrition, cognitive impairment, and decreased mobility.

  • Adverse Drug Events:

    • More common due to polypharmacy and age-related changes in drug metabolism.
Conclusion
  • Ongoing Assessment: Regular review and assessment for a range of health and functional parameters in geriatric patients is critical for optimal care.