Download - Unique Features of Geriatric Patients
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Unique Featuresof Geriatric PatientsDr. Sadia Sharmin
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Introduction
• The term ‘geriatric’ means ‘healing the old’
• ‘Ageing’ can be defined as a progressive accumulation through life of random molecular defects that build up within tissues and cells.
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Ageing classification
• Elderly : 65-74• Aged : 75-84
• Very old : 85 or more
According to WHO
Old age occurred within:• 45-55 years for women
• 55-75 years for men
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What makes geriatric medicine different
• Physiological decline and difficulty distinguishing the effects of ageing and disease
• Increased frequency of multiple physical illness and of polypharmacy
• Increased relevance of functional ability and multidisciplinary assessment
• Greater difficulty in history taking• Atypical presentation of illness
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Physiological changes of ageing
1. Changes in autonomic functions and cellular homeostasis eg. temperature blood volumes and endocrine changes
2. Reduction in organic masses eg. Liver, brain kidney bones and muscles
3. Reduction in organic functional reserve eg; lungs, heart
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Central nervous system
Changes with ageing• Neuronal loss• Cochlear
degeneration• Increased lens rigidity• Lens opacification• Anterior horn cell loss• Dorsal column loss • Slowed reaction time
Clinical consequences • Increased risk of
delirium• Presbycusis/high tone
hearing loss• Presbyopia/abnormal
near vision• Muscle weakness• Reduced position and
vibration sense• Increased risk of falls
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Cardio vascular
Changes with ageing• Reduced maximum
heart rate• Dilatation of aorta• Reduced elasticity of
conduit/capacitance vessels
• Reduced number of pacing myocytes in SA node
Clinical consequences• Reduced exercise
tolerance• Widened aortic arch on
X-ray• Widened pulse
pressure • Increased risk of
postural hypotension• Increased risk of atrial
fibrilation
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Respiratory system
Changes with ageing• Reduced lung
elasticity and alveolar support
• Increased chest wall rigidity
• Reduced cough and cilliary action
Clinical consequences • Reduced vital capacity • Increased residual
volume• Reduced inspiratory
reserve volume• Increased risk of
infection
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Endocrine system
Changes with ageing• Deterioration in
pancreatic beta cell function
• Increased adrenal medullary secretion
Clinical consequences• Increased risk of
impaired glucose intolerance
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Renal system
Changes with ageing• Loss of nephrons• Reduced
glomerular filtration rate
• Reduced tubular function
Clinical consequences• Impaired fluid balance• Increased risk of
dehydration/overload• Impaired drug
metabolism and excretion
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Gastrointestinal system
Changes with ageing• Decreased strength
of muscle of mastication taste, thirst
• Decreased saliva• Reduced motility• Relaxed lower
esophageal sphincter
Clinical consequences• Loss of appetite• Constipation• Increased chance of
aspiration
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Musculoskeletal system
Changes with ageing
• Reduced bone mineral density
• Gradual tooth loss• Loss of muscle
mass
Clinical consequences
• Osteoporosis• Osteoarthritis • Edentualism
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Psychological issues
• Loss of physical strength
• Loss of mental abilities, self esteem, body image, independence
• Loss of control over life plans and lifestyles
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Frailty • The loss of ability to withstand minor stress due to
reserve of multiple organ system decline.
Linda Fried / Johns Hopkins Frailty Criteria
• unintentional weight loss,• exhaustion,• muscle weakness,• slowness while walking and• low levels of activity.
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Presenting problems of geriatric medicine
• Late presentation
• Atypical presentation
• Acute illness and changes in function
• Multiple pathology
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Atypical presentation
• Urinary tract infection
tired, poor appetite perhaps abdominal discomfort, foul smell of
urine, urine incontinence perhaps temperature
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…cont’d
• Pneumonia
Poor appetite, weakness, functional decline perhaps cough, shortness of breath
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…contd
• Heart failure with pulmonary edema
Tired, poor appetite perhaps shortness of breathe
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…cont’d
• Myocardial infarction
Fatigue, weak, restlessness, perhaps chest pain, dyspnoea
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…cont’d
• Acute pain
with constipation and decreased appetite rather than severe pain
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…contd
• Stroke
History of fallPerhaps focal weakness
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Palliative care for geriatric syndrome
• Dementia• Delirium• Falls• Frailty• Depression
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Association of cancer and ageing
• Consequence of duration of carcinogenesis
• Age related progressive changes in the internal environment of organism
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Any Questions ?
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Conclusion • Ageing inevitable leads to decline physiological function,
decreased reserve Leads to:
• Vulnerability to disease and functional declineBut
• There is evidence the potentially modifiable factors operating through out life have significant impact on the effects of ageing.
• physical exercise , diet habit, intervention of cognitive function
‘Old Age is Not a Disease’
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O AllahGive me serenity to accept the things which I can’t
Give me courage to do the things which I can
Thank You