Transcript Basics of Individual Aging

OLDER PERSONS AS A
PATIENT
Specialization
in Health
Management
for Older
Adults
MODULE IV
UNIT 2
WHAT IS GERIATRICS?
 Geriatric medicine is a sub specialty of family medicine
that focuses on health care of
elderly people. It aims to
promote health by preventing
and treating diseases and
disabilities in older adults.
 Primary care doctors and
geriatricians need to know the
medical aspects of aging,
which include the atypical
presentation of diseases,
demanding a dif ferent
approach and the integral
evaluation and management of
health.
VARIABLES THAT AFFECT THE
PRESENTATION OF DISEASES IN
GERIATRICS
 Comorbidity is frequent in the elderly patient, and no disease
dominates the clinical picture.
 Multi-Organ Failure
 The presentation of a social problem can obscure an
underlying disease or complicate health management.
 The use of multiple medications can complicate health
management.
 Some medications can cure health problems while causing
other health problems. This can be critical in older adults.
DIFFERENT PRESENTATION OF DISEASE
COMPARED WITH YOUNGER ADULTS
 For a given symptom,
diagnosis may vary greatly
between older and younger
adults. For example,
symptoms that habitually
correspond to gastro
esophageal reflux in the
young adult can correspond
to carcinoma in the older
adult.
 What can appear to be the
same disease in different
age groups can in reality
have very diverse
etiologies.
AGING AND DISEASE
 There exists epidemiological evidence of a relationship
between aging and disease; this by no means implies that all
diseases increase with age. Therefore we should distinguish 2
disease groups: 1) Diseases dependent on age: those whose
incidences increase exponentially as age increases and 2)
Diseases relating to age: those which are associated more
frequently with a specific age.
 There are certain disorders associated with the intrinsic
changes which accompany aging of which older adults are
particularly prone. Oesophagic motor disorders and
osteoarthritis are examples.
 Some complications of common diseases only occur decades
after the process starts and are therefore more frequently
observed in older adults. For example, the complications of
arterial hypertension or the late manifestation of diabetes.
DELAYED PRESENTATION OF DISEASE
 The principal complaint at the time of consultation may not
directly reflect the main problem. In reality the chief
complaint corresponds more frequently with the symptoms
that are most easily recognized by the patient or caregiver.
 Conditions frequently associated with old age such as falls,
incontinence and cerebral accidents don’t always constitute
the patients principal complain even through they are
frequently present.
 The main health problem may be hidden by a facilitating
complaint which corresponds with what the patient thinks will
evoke the most favorable response from the doctor.
GERIATRICS IN THE CONTEXT OF
PRIMARY CARE
 One of the pillars of primary
care is prevention; to avoid
the development of health
problems that are hard to
reverse.
 Quality primary care is
recognized by its capacity to
prevent, detect, anticipate
and intervene early in the
following key conditions:
1.
2.
3.
4.
5.
Immobility
Instability
Incontinence
Intellectual Deterioration
Iatrogenesis
IMMOBILIT Y
 Immobility is a risk to functional independence and has
negative repercussions on health and quality of life. In its
highest level where the patient is confined to a bed,
immobility causes problems inherent in itself, independent of
the disease or condition which initially caused immobility.
 Stasis ulcers and muscle contractures are examples of
frequent complications in bed ridden patients.
 Doctors and geriatric teams must prioritize motivation,
activity and functional recuperation to address immobility.
INSTABILIT Y
 Postural instability and falls are problems common to older
adults. In addition to causing an increased risk of fractures
and being associated with increased mortality, the principal
complications of falls are the functional and psychological
limitations which result from fear of falling. This may lead to
decreased social activities and immobility.
INCONTINENCE
 Fecal and urinary incontinence, in addition to their own
medical significance, have a profound impact on the wellbeing
of elderly adults, compromising their self -esteem.
Incontinence does not routinely attract the attention of
doctors.
 In the independent elderly adult, incontinence constitutes a
motive for the abandonment of social activities and the
initiation of his/her restriction to the home environment.
 In the immobilized and dependent patient, incontinence can
be the sign of deficient care; patients may urinate in bed as
they are not able to seek help or because they are not
attended to when they ask for help in going to the bathroom.
INTELLECTUAL DETERIORATION
 Cognitive problems are highly prevalent among older adults
and constitute one of the principal causes of incapacity and
loss of autonomy and independence.
 Dementia is progressive and irreversible, and it is estimated
that at least 10% of the population 65 years and older have at
least one form of dementia.
 While Alzheimer’s disease is the most frequent cause of
dementia, the importance of vascular dementias should not
be underscored. These af flictions have a great impact on the
life of patients and their families. The presence of non cognitive disturbances, such as personality changes,
aggressiveness, sleep changes, and others increase the
necessity of permanent care and the need for admittance to
geriatric institutions or homes.
IATROGENESIS
 Iatrogenesis is an inadvertent adverse ef fect or complication
oftentimes resulting from complex drug interactions.
 In addressing itatrogenesis, doctors and caregivers should
avoid the excessive use of medication and work to prevent
self-prescribing.
 Other forms of iatrogenesis include doctors giving the wrong
advice to patients due to lack of knowledge or prejudice.
DOCTOR-PATIENT RELATIONSHIP
 An older patient’s physician must always be diligent in the
diagnosis and treatment of diseases.
 It has been found that visits between older adults and health
personnel do not result in an appropriate therapeutic
response in a significant number of cases.
 Many diseases and conditions that are commonly perceived as
an inevitable part of aging actually can be cured or limited.
The existence of specific models of disease presentation
allows you to improve detection of common problems among
the elderly.
COMPREHENSIVE ASSESSMENT OF THE
ELDERLY
 Both the aging of organs and systems and the atypical and
simultaneous presentation of disease made necessary the
implementation of a special system of assessment for older
adults.
 A comprehensive health assessment is a clinical approach
tool focused on the predominant health problems in the
elderly. It is a structured and dynamic diagnostic that allows
you to detect the problems, needs and capabilities of the
elderly in the clinical, functional, mental and social spheres to
develop an interdisciplinary strategy of intervention and long term follow -up in order to optimize resources, achieve the
highest degree of independence and quality of life.
CLINICAL EVALUATION OF OLDER ADULTS
 A clinical evaluation should include:
 Medical history of the patient
 A clinical interview that includes a personal history of:










Falls
Previous surgeries and hospitalizations
History of delirium
Prevention of infectious disease
Skills, hobbies, caregiver details, daily activity routine, etc.
Physical examination
Functional assessment
Evaluation of the mental and emotional status
Nutritional assessment
Social assessment
BIBLIOGRAPHY
 C h o d o s h J , M c C a n n R M , F r a n k e l R M , e t a l . G e r i t r i c A s s e s s m e n t a n d t h e Tw e n t y M i n u t e V i s i t .
R o c h e s t e r, N e w Yo r k : D i v i s i o n o f G e r i a t r i c s , U n i v e r s i t i y o f R o c h e s t e r, S c h o o l o f M e d i c i n e a n d
D e n t i s t r y ; 1 9 97.
 Detsky AS, Abrams, HB, McLaughlin JR, et al. Predicting cardiac complications in patients
u n d e r g o i n g n o n - c a r d i a c s u r g e r y. J G e n I n t e r n M e d . 1 9 8 6 ; 1 : 2 1 1 - 2 1 9
 E d e l b e r g H K , W e i J Y. P r i m a r y - c a r e g u i d e l i n e s f o r c o m m u n i t y - l i v i n g o l d e r p e r s o n s . C l i n
G e r i a t r i c s . 1 9 9 9 ; 7: 4 2 - 5 5 .
 Goldberg TH, Chaving SI. Preventive medicine and screening in older adults. J Am Geriatric
S o c i e t y. 1 9 97 ; 4 5 ( 3 ) : 3 4 4 - 3 5 4 .
 L u b i n M F. I s a g e a r i s k f a c t o r f o r s u r g e r y ? M e d C l i n N o r t h A m 1 9 9 3 ; 7 7: 3 27 - 3 3 3 .
 Moore AA , Su Al, “Screening for common problems in ambulator y elderly: clinical confirmation
of a screen instrument.” Am J Med 1996, 100:440 -5
 R e u b e n , D e t a l . G e r i a t r i c s A t Yo u r F i n g e r t i p s , 1 9 9 8 / 9 9 E d i t i o n , A m e r i c a n G e r i a t r i c s S o c i e t y,
Belle Mead, NJ: Medical Expert, Inc., 1998.
 R o w e J W, K a h n R L . S u c c e s f u l A g i n g . N e w Yo r k : P a n t h e o n P r e s s ; 1 9 9 8 .
 Thomas DR, Ritchie CS. Preoperataive assessment of older adults. JAGS 1995; 43:811-821
 . B o M , M a r t i n i B , R u a t t a C , M a s s a i a M , R i c a u d a N A , Va r e t t o A , A s t e n g o M , To r t a R . G e r i a t r i c
ward hospitalization reduced incidence delirium among older medical inpatients. Am J Geriatr
P s y c h i a t r y. 2 0 0 9 S e p ; 17 ( 9 ) : 76 0 - 8
 Siddiqi N, Stockdale R, Britton AM, Holmes J. Inter ventions for preventing delirium in
h o s p i t a l i s e d p a t i e n t s . C o c h r a n e D a t a b a s e S y s t R e v. 2 0 07 A p r 1 8 ; ( 2 ) : C D 0 0 5 5 6 3 .
 A v i l a - B e l t r á n R , G a r c í a - M a yo E , G u t i é r r e z - R o b l e d o L M , A v i l a - F u n e s J A . G e r i a t r i c m e d i c a l
consultation is associated with less prescription of potentially inappropriate medications. J
A m G e r i a t r S o c . 2 0 0 8 S e p ; 5 6 ( 9 ) : 17 7 8 .
BIBLIOGRAPHY
 H e r m u s h V, D a l i o t D , W e i s s A , B r i l l S , B e l o o s e s k y Y. T h e i m p a c t o f g e r i a t r i c c o n s u l t a t i o n o n t h e
c a r e o f t h e e l d e r s i n c o m m u n i t y c l i n i c s . A r c h G e r o n t o l G e r i a t r. 2 0 0 9 S e p - O c t ; 4 9 ( 2 ) : 2 6 0 - 2 .
 Reuben DB , Frank JC, Hir sc h SH, Mc Guigan KA , Maly RC. A randomized c linic al trial of
outpatient comprehensive geriatric assessment coupled with an inter vention to increase
a d h e r e n c e t o r e c o m m e n d a t i o n s . J A m G e r i a t r S o c . 1 9 9 9 M a r ; 47 ( 3 ) : 2 6 9 - 76 .
 Bachmann S, Finger C, Huss A, Egger M, Stuck AE, Clough -Gorr KM. Inpatient rehabilitation
specifically
 S a n J o a q u í n R o m e r o A C , F e r n á n d e z A r i n E , M e s a L a m p r é M P, G a r c í a - A r i l l a C a l v o E . Va l o r a c i ó n
G e r i á t r i c a i n t e g r a l e n : S o c i e d a d E s p a ñ o l a d e G e r i a t r í a y G e r o n t o l o g í a . Tr a t a d o d e G e r i a t r í a
para residentes. Madrid 2006. p. 59 -68.
 Strauss SE, Tinetti ME. Evaluation, Management, and Decision Making with the Older Patient.
In Halter JB, Ouslander JG, Tinetti ME et al. ed. Hazzard´s Geriatric Medicine and Gerontology
N e w Yo r k . M c G r a w - H i l l C o m p a n i e s , I n c 2 0 0 9 . p . 1 3 3 - 1 4 0 .
 Rubenstein LZ. Geriatric assessment: an over view of its impacts. Clin Geriatr Med. 1987
Feb;3(1):1-15.
 B a z t á n J J , S u á r e z - G a r c í a F M , L ó p e z - A r r i e t a J , R o d r í g u e z - M a ñ a s L , R o d r í g u e z - A r t a l e j o F.
Ef fectiveness of acute geriatric units on functional decline, living at home, and case fatality
among older patients admitted to hospital for acute medical disorders: meta -analysis. BMJ.
2 0 1 0 A p r 2 0 ; 3 4 0 : c 171 8 .
 L i C M , C h e n C Y, L i C Y, Wa n g W D , W u S C . T h e e f f e c t i v e n e s s o f a c o m p r e h e n s i v e g e r i a t r i c
assessment intervention program for frailty in community -dwelling older people: a
r a n d o m i z e d , c o n t r o l l e d t r i a l . A r c h G e r o n t o l G e r i a t r. 2 0 1 0 F e b ; 5 0 S u p p l 1 : S 3 9 - 4 2 .
 C r u z J e n t o f t A J , S e r r a R e x a c h J A , L á z a r o d e l N o g a l M , G i l G r e g o r i o P, R i b e r a C a s a d o J M . T h e
e f f e c t i v e n e s s o f g e r i a t r i c i n t e r c o n s u l t a t i o n i n e l d e r l y p a t i e n t s a d m i t t e d t o t r a u m a t o l o g y. A n
M e d I n t e r n a . 1 9 9 4 J u n ; 1 1 ( 6 ) : 27 3 - 7.
BIBLIOGRAPHY
 Reye s G u e r r e r o J . E v a l u a c i ó n g e r i á t r i c a i n te g r a l e n : d ’ H y v e r d e l a s D e s e s C , G u t i é r r e z

Ro b l e d o L M . G e r i a t r í a . M a n u a l m o d e r n o M é x i c o n 2 0 0 6 . p . 3 3 - 4 4 .
 D o u b o v a S V, To r r e s - A r r e o l a L d e l P, Ro s a s - C a r r a s c o O , P é r e z - C u e v a s R . Q u a l i t y o f
m e d i c a t i o n p r e s c r i b i n g fo r e l d e r l y p a t i e n t s w i t h n o n - m a l i g n a n t p a i n s y n d r o m e a t te n d i n g
f a m i l y m e d i c i n e c l i n i c s . Re v I nv e s t C l i n . 2 0 07 N ov - D e c ; 5 9 ( 6 ) : 4 2 8 - 3 6 .
 D o u b o v a D u b ov a S V, Reye s - M o r a l e s H , To r r e s - A r r e o l a L d e l P, S u á r e z - O r te g a M . Po te n t i a l
d r u g - d r u g a n d d r u g - d i s e a s e i n te r a c t i o n s i n p r e s c r i p t i o n s fo r a m b u l a t o r y p a t i e n t s o v e r 5 0
ye a r s o f a g e i n f a m i l y m e d i c i n e c l i n i c s i n M e x i c o C i t y. B M C H e a l t h S e r v Re s . 2 0 07 S e p
1 9 ; 7: 1 47.
 Reye s - M o r a l e s H , E s p i n o s a - A g u i l a r A , J i m é n e z - U r i b e R , Pe ñ a - Va l d o v i n o s A , D o u b o v a S V,
G a r c í a - G o n z á l e z J J , M e n d o z a - N ú ñ e z V M . G u i d e l i n e fo r i n te g r a t e d g e r i a t r i c a s s e s s m e n t .
Re v M e d I n s t M e x S e g u r o S o c . 2 0 0 9 M ay - J u n ; 47 ( 3 ) : 2 91 - 3 0 6 .
 Surós Batllo A, Suros Batllo J. Semiología médica y técnica exploratoria. Barcelona.
M a s s o n . 2 0 01 .
 Kaya G , S a u r a t J H . D e r m a to p o r o s i s : a c h r o n i c c u t a n e o u s i n s u f fi c i e n c y / f r a g i l i t y s y n d r o m e .
C l i n i c o p a t h o l o g i c a l fe a t u r e s , m e c h a n i s m s , p r e v e n t i o n a n d p ote n t i a l t r e a t m e n t s .
D e r m a to l o g y. 2 0 07 ; 21 5 ( 4 ) : 2 8 4 - 9 4 .
 P i r o z z o S , P a p i n c z a k T, G l a s z i o u P. W h i s p e r e d v o i c e te s t fo r s c r e e n i n g f o r h e a r i n g
i m p a i r m e n t i n a d u l t s a n d c h i l d r e n : s y s te m a t i c r e v i e w. B M J . 2 0 0 3 O c t 2 5 ; 3 27 ( 74 21 ) : 9 6 7.
 M e n é n d e z J , G u e v a r a A , A r c i a N , L e ó n D í a z E M , M a r í n C , A l fo n s o J C . C h r o n i c d i s e a s e s a n d
functional limitation in older adults: a comparative study in seven cities of Latin America
a n d t h e C a r i b b e a n . Re v P a n a m S a l u d P u b l i c a . 2 0 0 5 M ay - J u n ; 17 ( 5 - 6 ) : 3 5 3 - 61 .
BIBLIOGRAPHY
 d e L e ó n - A r c il a R , M i l i á n - S ua z o F, C a m a c h o - C a l d e r ó n N , A r é v a l o - C e d a n o R E ,
E s c a r t ín - C h á v e z M . R i s k f a c to r s f o r c o g n i t iv e a n d f u n c t i o n al i m p a i r me n t i n t h e
e l d e r l y. Rev M e d I n s t M ex S e g u ro S o c . 2 0 0 9 M ay - J un ; 47 ( 3 ) : 277 - 8 4 .
 E s p i n o s a - A g ui l ar, A , C a r av e o - A n d ua g a , J , Z a m o r a - Ol ve r a , M , A r r o n te - Ro s o l e s , A ,
K r u g - Ll a m a s , E , O l i va r e s - S a n to s , R , et a l . C l i ni c a l g u i d el i n e f o r d i a g n o s i s a n d
t r e a t m e n t o f d e p r e s s i o n i n e l d e r y. S a l u d M e n t a l 2 0 07 ; 3 0 ( 6 ) : 6 9 - 8 0 .
 A l b e r t M S , B l a c ke r D . M i l d c o g ni t i ve i m p a i r me n t a n d d e m e n t i a . A n n u Rev C l i n
P s yc h o l . 2 0 0 6 ; 2 :37 9 - 8 8 .
 Wo r l d H e a l t h O r g a n i z a t i o n : E x p e r t C o m m i t te e o n P hy s i c a l S t a t u s: T h e u s e a n d
i n te r p r et a t i o n o f a n t h r o p om et r i c p hy s i c a l s t a t u s . W H O ; 1 9 9 5 .
 D o uket i s J D , P a r a d i s G , Ke l l e r H , M a r t i n e a u C . C a n a d i a n g u i d el i n e s f o r b o d y w e i g h t
c l a s s i fi c a t io n i n a d u l t s : a p p l i c a t i o n i n c l i ni c a l p r a c t i ce to s c r e e n f o r o v e r wei g h t a n d
o b e s i t y a n d to a s s e s s d i s e a s e r i s k . C M A J 2 0 0 5 ;17 2 ( 8 ) : 9 9 5 - 9 9 8 .
 S á n c h e z - G a rc í a S , G a r c í a - Pe ñ a C , D u q ue - L ó p e z M X , J u á r e z - C e d i ll o T, C o r t é s - N úñ e z
A R , Reye s - B e a m a n S . A n t h r o p o met r ic m e a s u r e s a n d