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Encyclopedia > Geriatrics

Geriatrics is the branch of medicine that focuses on health promotion and the prevention and treatment of disease and disability in later life. The term itself can be distinguished from gerontology, which is the study of the aging process itself. The term comes from the Greek "geron" meaning "old man" and "iatros" meaning "healer". It is cognate with Jara in Sanskrit which also means old. medicines, see medication and pharmacology. ... It has been suggested that aging research be merged into this article or section. ... This does not adequately cite its references or sources. ...

Contents

Scope

In the United States, geriatricians are primary care physicians who are board-certified in either family practice or internal medicine and have also acquired the additional training necessary to obtain the Certificate of Added Qualifications (CAQ) in geriatric medicine. A primary care physician (often abbreviated as PCP) is a physician who generally does not specialize in the treatment of certain organ systems (eg: neurology, cardiac, pulmonary) or the surgical specialties, but are trained in general medical or holistic-types of patient care. ... A general practitioner (GP) or family physician (FP) is a physician who provides primary care. ... Doctors of internal medicine (internists) are medical specialists who focus on adult medicine and have had special study and training focusing on the prevention and treatment of adult diseases. ...


In the United Kingdom, most geriatricians are hospital physicians, while some focus on community geriatrics. While originally a distinct clinical specialty, it has been integrated as a specialism of general medicine since the late 1970s.[1] Most geriatricians are therefore accredited for both. Specialized geriatrics services include orthogeriatrics (close cooperation with orthopedic surgery and a focus on osteoporosis and rehabilitation), psychogeriatrics (focus on dementia, depression and other conditions common in the elderly), and rehabilitation. This fracture of the lower cervical vertebrae, known as a teardrop fracture is one of the conditions treated by orthopaedic surgeons. ... Osteoporosis is a disease of bone in which the bone mineral density (BMD) is reduced, bone microarchitecture is disrupted, and the amount and variety of non-collagenous proteins in bone is altered. ... For other uses, see Dementia (disambiguation). ... Clinical depression (also called major depressive disorder, or sometimes unipolar when compared with bipolar disorder) is a state of intense sadness, melancholia or despair that has advanced to the point of being disruptive to an individuals social functioning and/or activities of daily living. ...


Rehabilitation may also take in intermediate care, where patients are referred by a hospital or family doctor, when there is a requirement to provide hospital based short term intensive physical therapy aimed at the recovery of musculoskeletal function, particularly recovery from joint, tendon, or ligament repair and, or, physical medicine and rehabilitation care when elderly patients get out of synch with their medication resulting in a deterioration of their personal health which reduces their ability to live independently. Physical therapy (or physiotherapy[1]) is the provision of services to people and populations to develop, maintain and restore maximum movement and functional ability throughout the lifespan. ... Physical medicine and rehabilitation (PM&R) or physiatry is a branch of medicine dealing with functional restoration of a person affected by physical disability. ...


History

Modern geriatrics in the United Kingdom really began with the "Mother" of Geriatrics, Dr. Marjorie Warren. Warren emphasised that rehabilitation was essential to the care of older people. She took her experiences as a physician in a London Workhouse infirmary and developed the concept that merely keeping older people fed until they died was not enough- they needed diagnosis, treatment, care and support. She found that patients, some of whom had previously been bedridden, were able to gain some degree of independence with the correct assessment and treatment. The practice of geriatrics in the UK is also one with a rich history of multidisiplinary working, valuing all the professions, not just medicine, for their contributions in optimising the well being and independence of older people.


Another "hero" of British Geriatrics is Bernard Isaacs, who described the "giants" of geriatrics: incontinence, immobility, impaired intellect and instability (Isaacs 1965). Isaacs asserted that if you look closely enough, all common problems with older people relate back to one of these giants. Look up incontinence in Wiktionary, the free dictionary. ... For other uses, see Dementia (disambiguation). ... Instability in systems is generally characterized by some of the outputs or internal states growing without bounds. ...


The care of older people in the UK has been forwarded by the implementation of the National Service Frameworks for Older People, which outlines key areas for attention.Department of Health Older People's information


Current trends

Perhaps the most pressing issue facing geriatrics is the treatment and prevention of delirium. This is a condition in which hospitalized elderly patients become confused and disoriented when confronted with the uncertainty and confusion of a hospital stay. The health of the patient will decline as a result of dilerium and can increase the length of hospitalization and lead to other health complications. The treatment of delirium involves keeping the patient mentally stimulated and oriented to reality, as well as providing specialized care in order to ensure that their needs are being met. The Hospital Elder Life Program, HELP, is a system that was created at Yale New Haven Hospital and has been introduced to several hospitals. The goal of the program is to prevent delirium and thus improve the quality of care provided to the elderly. Yale New Haven Hospital has since developed HELP into the more comprehensive Elder Horizons Program, whose goals in addition to preventing delirium include maintenance of mobility and of functional and cognitive states. Yale-New Haven Hospital (abbreviated Y-NHH) is a 944-bed hospital located in downtown New Haven, Connecticut. ...


Pharmacology

Pharmacological constitution and regimen for older humans is an important topic, one which is related to changing and differing physiological and psychological processes and requirements. In situations of pharmacological necessity and related administration, several factors are involved. Some of these considerations include drug interactions, treatment patterns and medication management.


Certain physiological aspects of aging and drug effects include changes in the gastrointestinal system, oral protective reflexes (dryness of the mouth caused by diminished function of the salivary glands), delayed esophageal emptying, altered gastric pH and differing gastric emptying rates, and possible slower transit times. Oral and esophageal changes, while perhaps not having a direct effect on absorption, “may affect oral administration of certain dosage forms” (Gidal 2006). Instance of reduced intestinal function may actually “increase the overall extent of absorption, and, hence, systemic drug exposure” (Gidal 2006), and emptying of solids and liquids may be delayed. Eating small meals throughout the day may result in lower stomach pH only in the morning hours, which may in turn affect drugs that “may display pH-dissolution and/or activation profiles” (Gidal 2006). Delayed gastric emptying may restrict speed of absorption, and may alternatively also facilitate dissolution and subsequent increased absorption. Age-related changes in the intestine, such as manometric patterns (patterns in liquid level and effected pressure), may also affect transit times and related drug absorption process.


Another area of importance is the potential for improper administration and usage of potentially inappropriate medications (PIM), and possibility of errors which result in dangerous drug interactions (DDI). Research done on home/community health care found that “nearly 1 of 3 medical regimens contained a potential medication error” (Choi et al, 2006). The medications found most to be inappropriately prescribed include tricyclic antidepressants, antihistamines, urinary antispasmodics, narcotic analgesics, long-acting benzodiazepines, and muscle relaxants. Occurrence of statistically significant PIM was 31%, with DDI at 10%. The study showed that polypharmacy was a predictive factor in both PIM and DDI, in comparison to those receiving between and 1 to 3 medications, with instance increasing with the number of medications. Concurrently, the study noted the importance of polypharmacy increasing since a similar study done in 1996-1998. Factors that could have possibly affected the study is that it was centered in a general Midwestern area, as well as demographics on prescribing physicians (Cannon et al, 2006).


One other important consideration is that of elderly persons (particularly those experiencing substantial problems of memory loss or other types of cognitive impairment) being able to adequately monitor and adhere to their own scheduled pharmacological administration. A study done by Hutchinson, Jones, West & Wei (2006), found that 25% of participants studied admitted to skipping doses or cutting them in half. Self-reported noncompliance with adherence to medication schedule was reported by a striking one-third of the participants. Further development of methods which might possibly help monitor and regulate dosage administration and scheduling is an area that deserves further attention.


Notes

  1. ^ Barton & Mulley 2003

References

  • Barton A, Mulley G. History of the development of geriatric medicine in the UK. Postgrad Med J 2003;79:229-34. Fulltext. PMID 12743345.
  • Cannon, K.T., Choi, M.M., Zuniga, M.M. (2006). Potentially inappropriate medication use in elderly patients receiving home health care: a retrospective data analysis. The American Journal of Geriatric Pharmacotherapy, 4, 134-143.
  • Gidal, B.E. (2006). Drug Absorption in the Elderly: Biopharmaceutical Considerations for the Antiepileptic Drugs. Epilepsy Research, 68S, S65-S69.
  • Hutchison, L.C., Jones, S.K., West, D.S., Wei, J.Y. (2006). Assessment of Medication Management by Community-Living Elderly Persons with Two Standardized Assessment Tools: A Cross-Sectional Study. The American Journal of Geriatric Pharmacotherapy, 4, 144-153.
  • Isaacs B. An introduction to geriatrics. London: Balliere, Tindall and Cassell, 1965.

See also

Aging in place is growing older without having to move. ... Elderly care or simply eldercare is the fulfillment of the special needs and requirements that are unique to senior citizens. ... Life extension refers to an increase in maximum or average lifespan, especially in humans, by slowing down or reversing the processes of aging. ... RUOK? or Are You OK? is the common name for a service offered by many local communities that contacts the elderly or handicapped on a daily basis using a phone service. ...

External links

  • British Geriatrics Society
  • American Geriatrics Society
  • American Board Family Medicine CAQ Geriatric Medicine
  • American Board Internal Medicine CAQ Geriatric Medicine
  • Merck Manual of Geriatrics
  • On-Line Geriatric Journal Club (via JournalReview.org)
  • What is Geriatrics?
  • Geriatric Nursing
  • Pharmaton's Geriatric Manual

  Results from FactBites:
 
FHA - What is Geriatrics? (935 words)
Geriatrics is the branch of medicine that focuses on health promotion and the prevention and treatment of disease and disability in later life.
Founded in 1942, the American Geriatrics Society (AGS) - www.americangeriatrics.org - is the nation's leading non-profit association of geriatrics health care professionals dedicated to improving the health, independence, and quality of life of all older people.
Our mission is to build a bridge between geriatrics health care professionals and the public and to advocate on behalf of older adults and their special needs: wellness and preventive care, self-responsibility and independence, and connections to family and community.
Geriatrics - Wikipedia, the free encyclopedia (578 words)
Specialized geriatrics services include orthogeriatrics (close cooperation with orthopedic surgery and a focus on osteoporosis and rehabilitation), psychogeriatrics (focus on dementia, depression and other conditions common in the elderly), and rehabilitation.
The practice of geriatrics in the UK is also one with a rich history of multidisiplinary working, valuing all the professions, not just medicine, for their contributions in optimising the well being and independence of older people.
Another "hero" of British Geriatrics is Bernard Isaacs, who described the "giants" of geriatrics: incontinence, immobility, impaired intellect and instability (Isaacs 1965).
  More results at FactBites »

 
 

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