GERIATRICS

1. GERIATRICS Dr. Meg-angela Christi Amores

2. AGING defined • progressive, universal decline first in functional reserve and then in function that occurs in organisms over time • Heterogeneous • varies widely in different individuals and in different organs within a particular individual

3. Aging defined • is not a disease • however, the risk of developing disease is increased, often dramatically, as a function of age

4. AGING • biochemical composition of tissues changes • physiologic capacity decreases • ability to maintain homeostasis in adapting to stressors declines • vulnerability to disease processes increases • mortality rate increases exponentially with age

5. Epidemiology • Between 2000 and 2030, the number of older adults worldwide is expected to increase from 420 to 974 million • Only 13% of those 80 years live in the United States; over 40% of those 80 years live in Asia. • WOMEN outlive MEN • only 15% of centenarians are men • older women are frequently single and live alone

6. Biology of Aging • As we age, we become increasingly unlike one another • homeostatic mechanisms are slower to respond to stressors • take longer to restore normal function • Allostasis - ability to maintain stable function in the face of a change in the environment • Decreases with age

7. 75-year-old with a blood pressure of 170/90 mmHg might have been considered to have an age-related increase in systolic blood pressure • we now know that such a reading is a reflection of increased vascular stiffness

8. Gerontology – study of aging • aimed at understanding the cellular and molecular basis of age-related changes • preserving function as long as possible and extending life span

9. Aging studies • Alteration of genes involved in DNA repair often leads to premature aging • Alteration of genes involved in insulin signaling often leads to life extension • Calorie restriction (at least 30% lower than an ad lib diet) increases both average and maximal life span in a wide range of species

10. Theories of aging

11. Approach to the Geriatric Patient • functional status is the best indicator of prognosis and longevity • how well a person is able to provide for his or her own daily needs

12. Approach to the Geriatric patient • First opportunity: when HE is greeted, and taken to exam room: • what way is the greeting received • Does the patient need assistance in getting out of a chair • use of an assistive device, such as a cane or walker • The patient's gait speed and stability • Is the patient fatigued after a short walk

13. Approach to the Geriatric Patient • ADL (activities of daily living) • dressing, bathing, feeding, toileting, transferring, and ambulating • IADL (instrumental activities of daily living) • money management, medication administration, using transportation, using the telephone, shopping, housekeeping, and meal preparation

14. Approach to the Geriatric Patient • gait and balance, cognition, vision and hearing, dental and nutritional health, and driving ability • Timed Get Up and Go Test • patient is observed and timed as he or she rises from a chair, walks 3 m, turns around, and returns to sit down in the chair • healthy older adult should be able to complete the test in <10 s

15. Approach to the Geriatric Patient • MMSE • Confusion Assessment Method (CAM) • Visual acuity

16. Geriatric Syndromes • a symptom presentation that is common in older adults • most are multifactorial in origin • DELIRIUM and DEMENTIA • FALLS • URINARY INCONTINENCE • PRESSURE ULCERS

18. Dimensia and Delirium • Dementia is a syndrome of progressive decline in which multiple intellectual abilities deteriorate, causing both cognitive and functional impairment • dementia is a state of chronic confusion, delirium is an acute state of confusion

19. Dimentia and Delirium • Both are characterized by disorientation, memory impairment, paranoia, hallucinations, emotional lability, and sleep-wake cycle reversal • features of delirium are acute onset, impaired attention, and an altered level of consciousness

20. Dimentia • Most Common Causes of Dementia • Alzheimer's disease • Vascular dementia • Multi-infarct • Diffuse white matter disease (Binswanger's) • Alcoholisma • Parkinson's disease • Drug/medication intoxicationa

22. Alzheimer’s Disease • most often presents with subtle onset of memory loss followed by a slowly progressive dementia that has a course of several years • diffuse atrophy of the cerebral cortex with secondary enlargement of the ventricular system

24. Alzheimer’s Disease • Tend to follow a characteristic pattern • beginning with memory impairment and spreading to language and visuospatial deficits • 20% of AD patients present with nonmemory complaints • cognitive problems begin to interfere with daily activities • the patient is unable to work, easily lost • some persons remain ambulatory but wander aimlessly in severe stages

25. Epidemiology • most important risk factors for AD are old age and a positive family history • Female gender • past history of head trauma with concussion • frequency of AD increases with each decade of adult life

27. Treatment of AD • primary focus is on long-term amelioration of associated behavioral and neurologic problems • No cure • Memory aids, pleasant home, safe living space, stop driving, communication, repeated calm reassurance • Meds: Donepezil, rivastigmine, galantamine, memantine