Disease - Principles of geriatrics

From CambridgeNotes

It is important to combine the science of medicine (i.e. establishing the problem list) with the art of caring for the elderly (i.e. which problems should we be treating and how can we optimise QoL)

Aging Changes:

Aging changes are seen in most organs and are significant in Geriatrics because…

  • They lead to increased variability between individuals
  • They may cause a patients to be stable at rest but mean they fail to adapt when stressed
  • They lead to impaired homeostasis
  • They may cause physical signs to have a different significance in old people as compared to middle aged

Multiple Pathology:

Old people often have several diseases because * the prevalence of many diseases increases with age

  • some chronic diseases cause complications in several body systems or may increase the likelihood of other pathology
  • a certain risk factor may predispose to several diseases.

Altered response to disease:

The elderly may present atypically or in a non-specific manner. New pathology is often masked by existing disease or may be complicated by the consequences of immobility (e.g. dehydration, incontinence, pressure sores, DVT)

Other issues:

  • Different susceptibility to disease (e.g. due to exposure, immune status,

socioeconomic factors)

  • Different differential diagnoses
  • Polypharmacy and inappropriate prescribing
  • Low expectations
  • Social problems
  • Different risk factors

Adapted from a lecture given by Dr C Nicholl (DME, Addenbrooke’s Hospital)


History:

  • Several informants
  • Phone the GP / carers
  • Don’t forget to ask about incontinence and other “embarrassing” topics
  • Social Hx is very important
  • Perform mental-state exam on all patients
  • Pre-morbid state
  • Medication (remember OTC drugs)

Examination:

  • May be limited by immobility or mental status
  • If necessary ask for help with moving / lifting but try to minimise discomfort
  • Very important to maintain dignity of patient

Investigations:

  • Urine tests
  • Blood tests: U&E, FBC, Creatinine, TFTs, LFTs etc.
  • Bacteriology / Serology / Virology etc.
  • Lying and standing BP
  • CXR
  • ECG
  • Other: Echo, 24-hr tape, tilt-testing, lung function tests, EEG,
  • Imaging: Plain films, Barium Studies, Isotope scans, CT, MRI, PET etc.

Management:

Aim is to maximise function (physical / mental / social)

  • Education
  • Physiotherapy, Speech therapy, Occupational therapy
  • Social services
  • Medications (take admission as opportunity to rationalise and optimise drug therapies)
  • Control of remaining symptoms
  • Improve general health (e.g. would they benefit from dietary advice, Calcium supplementation etc)
  • Treat other treatable conditions
  • MDT approach is vital
MediaWiki