Geriatrics , or geriatric medicine , is a specialty that focuses on elderly health care. It aims to improve health by preventing and treating diseases and disabilities in older adults. No age is prescribed where the patient may be under the care of a geriatrician , or geriatric physician , a physician specializing in parental care. Instead, this decision is determined by the needs of each patient, and the availability of specialists. It is important to note the difference between geriatrics, elderly care, and gerontology, which is the study of the aging process itself. The term geriatrics comes from the Greek ????? geron which means "old man", and ?????? iatros meaning "physician". However, geriatrics is sometimes called medical gerontology .
Video Geriatrics
Coverage
Difference between adult and geriatric drugs
Geriatrics are different from standard adult drugs because they focus on the unique needs of parents. Physiologically different physiological bodies of younger adult bodies, and during old age, the decline of various organ systems becomes apparent. Previous health problems and lifestyle choices result in different constellations of illness and symptoms in different people. The appearance of symptoms depends on the healthy reserves left in the organs. Smokers, for example, consume their respiratory system reserves early and quickly.
Geriatric distinguishes disease and the effects of normal aging. For example, kidney damage can be part of aging, but kidney failure and urinary incontinence do not. Geriatricians aim to treat existing diseases and achieve healthy aging. Geriatricians focus on achieving the highest priority of patients in the context of multiple chronic conditions, and on function preservation.
Increased complexity
The decrease in physiological reserves in the organs makes the parents develop several types of diseases and has more complications than minor problems (such as dehydration of mild gastroenteritis). Some problems can arise: A mild fever in the elderly can cause confusion, which can cause femur crashes and fractures ("broken hips").
Parents need special attention to drugs. Old people are specifically targeted for polypharmacy (taking a lot of drugs). Some elderly people have many medical disorders; some of which have prescriptions of herbal medicines and self-sold drugs. This polypharmacy may increase the risk of drug interactions or adverse drug reactions. In one study, it was found that prescribed and non-prescribed drugs were commonly used among older adults, with nearly 1 in 25 people potentially at risk for large drug interactions. Metabolite drugs are excreted mostly by the kidneys or liver, which may be disrupted in the elderly, requiring drug adjustment.
Presentation of illness in the elderly may be vague and non-specific, or may include delirium or fall. (Pneumonia, for example, may appear with mild fever and confusion, rather than the high fever and cough seen in younger people.) Some elderly people may find it difficult to describe their symptoms in words, especially if the disease causes confusion, or if they have cognitive impairment. Delirium in the elderly can be caused by minor problems such as constipation or by something serious and life-threatening as a heart attack. Many of these problems can be treated, if the root cause can be found.
geriatric giant
The so-called geriatric giants are the main categories of disorders that occur in the elderly, especially when they begin to fail. These include immobility, instability, incontinence and intellect/memory impairment.
Impaired vision and hearing loss are common chronic problems among parents. Hearing problems can lead to social isolation, depression, and dependency because the person is no longer able to talk to others, receive information over the phone, or engage in simple transactions, such as talking to someone in a bank or store. Vision problems cause falling from tripping invisible objects, wrongly taken drugs because written instructions can not be read, and financial mismanagement.
Practical concerns
Functional capability, independence and quality of life issues are a major concern for geriatrics and their patients. Parents generally want to live independently for as long as possible, which requires them to be able to engage in self-care and other activities of daily life. A geriatric may be able to provide information about elderly care options, and refer people to home care services, skilled care facilities, assisted living facilities, and appropriate home care.
Weak parents may choose to refuse certain types of medical care, since the risk-benefit ratio is different. For example, weak old women routinely stop screening mammograms, because breast cancer is usually a slow-growing disease that will cause them no pain, disturbance, or loss of life before they die from other causes. The vulnerable are also at greater risk of post-operative complications and extended care needs, and accurate predictions - based on validated measurements, rather than how long the patient's face is visible - can help older patients make informed choices of choice. An older patient's assessment before elective surgery can accurately predict the patient's recovery path. One weakness scale uses five items: unintentional weight loss, muscle weakness, fatigue, low physical activity, and slow walking speed. A healthy person gets a score of 0; scores of very weak people 5. Compared with the elderly who are not weak, people with moderate fragile values ​​(2 or 3) are twice as likely to have post-operative complications, spend 50% more time in the hospital, and three times greater will likely be discharged to a skilled treatment facility instead of their own home. Old, exhausted patients (scores 4 or 5) who live at home before surgery have a worse outcome, with the risk of being discharged to a nursing home up to twenty times the rate for the elderly who is not weak.
Maps Geriatrics
Some common diseases seen in the elderly are rare in adults, for example, dementia, delirium, falls. As the elderly, many of the specialized geriatric and geriatric services that have emerged include:
Medical
- cardiogeriatric (focus on elderly heart disease)
- geriatric dentistry (focus on elderly dental disorders)
- geriatric dermatology (focus on skin disorders of the elderly)
- geriatric diagnostic imaging
- geriatric emergency medicine
- geriatric nephrology (focus on elderly kidney disease)
- geriatric neurology (focus on neurological disorders in the elderly)
- geriatric oncology (focus on tumors in the elderly)
- geriatric pharmacotherapy
- geriatric physical examination of interest especially for doctors & amp; doctor's assistant.
- geriatric or psychogeriatric psychiatry (focus on dementia, delirium, depression, and other psychiatric disorders)
- general health geriatric or geriatric prevention (focusing on geriatric public health issues including disease prevention and health promotion in the elderly)
- geriatric rehabilitation (focus on physical therapy in the elderly)
- geriatric rheumatology (focus on joints and soft tissue disorders in the elderly)
- geriatric sexology (focus on sexuality in the elderly)
- geriatric subspecialty medical clinics (such as geriatric anticoagulant clinics, geriatric assessment clinics, fall and equilibrium clinics, care clinics, palliative care clinics, elderly pain clinics, cognition clinics and memory disorders)
Surgery
- Orthogeriatrics (close cooperation with orthopedic surgery and focus on osteoporosis and rehabilitation).
- Cardiothoracic Geriatric Surgery
- geriatric urology
- Geriatric Otolaryngology
- Geriatric General Surgery
- Geriatric trauma
- Geriatric Gynecology
- Geriatric ophthalmology
Other geriatric subspecies
- Geriatric anesthesia (focusing on elderly perioperative anesthesia & care)
- Intensive care unit Geriatric: (special type of intensive care unit dedicated to critically ill parents)
- Geriatric nursing (focusing on nursing elderly and elderly patients).
- Geriatric Nutrition
- Geriatric Work Therapy (part of Geriatric Rehabilitation)
- Geriatric Pain Management
- Geriatric Physical Therapy
- Geriatric podiatry
- Geriatric Psychology
- Geriatric Speech-Language Pathology (focusing on neurological disorders such as dysphagia, stroke, aphasia, and traumatic brain injury)
- Geriatric Mental Health Counselor/Specialist (focus on care over assessment)
- Geriatric Audiology
History
Ayurveda (before 1500 BC), an ancient Indian medical system, has mentioned eight branches (Ayurveda Ashtanga) of Ayurveda viz kayachikitsa (common medicine), balaroga (pediatrics), chhatsa graha (treatment of diseases related to psychology), urdhvanga chikitsa (head and neck disease, ENT), tantra shalya (surgery), damshtra (sting treatment and poisonous bite), Jara/Rasayana (geriatrics) and vajikarana (andrology). So it can be said that geriatric was first mentioned in Ayurveda. The term geria is very close to the Sanskrit word jara .
According to Lascaratos and Poulacou-Rebelacou, "The study and analysis of the original medical and historical texts of Byzantium"
The Canon of Medicine , written by Avicenna in 1025, is the first book to offer instruction in the care of the elderly, portraying modern and geriatric gerontology. In a chapter entitled "The Old Age Regiment", Avicenna is concerned with how "parents need a lot of sleep" and how their bodies should be anointed with oil, and recommends exercises such as walking or horseback riding. Thesis III of Canon discusses a diet suitable for the elderly, and dedicates some parts for elderly patients who become constipated.
The Arab doctor Algizar (ca. 898-980) wrote a special book on medicine and the health of the elderly. He also wrote a book about sleep disorders and another about forgetfulness and how to strengthen memories, and a treatise on the cause of death. Another 9th century Arab physician, Ishaq ibn Hunayn (died 910), the son of Nestorian Christian scholar Hunayn Ibn Ishaq, wrote a Drugs Treatise for Forgotten Purpose.
George Day published The Disease of Advanced Life in 1849, one of the first publications on the subject of geriatric medicine. The first modern geriatric hospital was founded in Belgrade, Serbia, in 1881 by physician Laza Lazarevi ?.
The term geriatrics was proposed in 1909 by Dr. Ignatz Leo Nascher, former Clinic Head of the Outpatient Department at Mount Sinai Hospital (New York City) and a "father" of geriatrics in the United States.
Modern geriatrics in England begin with the "mother" of geriatric, Dr. Marjorie Warren. Warren emphasized that rehabilitation is essential for the care of parents. Using his experience as a doctor at the London Workhouse hospital, he believes that only by feeding the parents until they die is not enough; they need diagnosis, care, care, and support. He found that patients, some of whom were previously bedridden, may gain some degree of independence with correct assessment and care.
Geriatric practice in England is also one of the rich multidisciplinary histories. It respects all professions, not just drugs, for their contribution in optimizing the welfare and independence of older people.
Another British geriatric "hero" is Bernard Isaacs, who describes the geriatric "giant" mentioned above: immobility and instability, incontinence, and intellectual impairment. Isaacs asserted that, if examined carefully enough, all common problems with parents relate to one or more of these giants.
The concern of the elderly in the UK has been put forward by the implementation of the National Service Framework for the Elderly, which outlines key areas for attention.
Geriatrician Training
United States
In the United States, geriatrics are primary care physicians (DO or MD) who are board-certified in either family medicine or internal medicine and who have also received the additional training required to obtain the Additional Qualification Certificate (CAQ) in geriatric medicine. Geriatric experts have developed an expanded expertise in the aging process, the impact of aging on disease patterns, drug therapy in the elderly, health care, and rehabilitation. They serve in a variety of roles including hospital care, long-term care, home care, and terminal maintenance. They are often involved in ethical consultations to represent the unique health and disease patterns seen in the elderly. The model of care practiced by geriatricians is highly focused on working with other disciplines such as nurses, pharmacists, therapists, and social workers.
United Kingdom
In the UK, most geriatrics are hospital doctors, while some focus on community geriatrics. Despite initially different clinical specialties, it has been integrated as a specialty of general medicine since the late 1970s. Most geriatric people, therefore, are accredited to both. Unlike the United States, geriatric medicine is a major specialty in the UK; geriatric experts are the most numerous specialists in internal medicine.
Canada
In Canada, there are two pathways that can be followed to work as a physician in a geriatric setting.
- Doctors of Medicine (M.D.) can complete a three-year core internal core therapy program, followed by two years of specialized geriatric residency training. This pathway leads to certification, and possibly a partnership after several years of additional academic training, by the Royal College of Physicians and Surgeons of Canada.
- The Doctor of Medicine may choose a two-year residency program in family medicine and complete an enhanced one-year skill program in elderly care. This post-doctoral pathway is accredited by the College of Family Physicians of Canada.
Many Canadian universities also offer gerontology training programs to the general public, so nurses and other health care professionals can continue further education in the discipline to better understand the aging process and their roles in the presence of patients and older residents.
India
In India, Geriatrics is a relatively new special offer training and three-year post-graduate training (M.D) can be combined after completing 5.5 years of MBBS undergraduate training. Unfortunately, only four major institutes provide M.D in Geriatric Medicine and subsequent training. Training at some institutes is exclusive in the Department of Geriatric Medicine, with rotations in internal medicine, medical subspecialty, etc. But in certain institutions, it is limited to 2 years training in internal and subspecialty treatment followed by a year of exclusive training in Geriatric Medicine..
Minimum geriatric competence
In July 2007, the American Medical Colleges Association (AAMC) and John A. Hartford Foundation held a National Consensus Conference on Competence in Geriatric Education where consensus was reached on the minimum competencies (learning outcomes) that graduated from medical students needed to ensure competence. treatment by a new apprentice doctor for an older patient. Twenty six (26) Minimum Geriatric Competencies in eight content domains supported by the American Geriatrics Society (AGS), the American Medical Association (AMA), and the Association of Directors of Geriatric Academic Programs (ADGAP). The domains are: cognitive and behavioral disorders; drug management; capacity of self-care; fall, balance, gait disturbance; atypical presentation of the disease; palliative care; hospital care for the elderly, and health care planning and promotion. Each content domain specifies three or more observable and measurable competencies.
Research
Elder Life Hospital Program
Perhaps the most urgent problem facing geriatrics is the care and prevention of delirium. This is a condition in which elderly patients admitted to the hospital become confused and confused when confronted with uncertainty and confusion in hospital. Patient health will decrease as a result of delirium and may increase the duration of hospitalization and lead to other health complications. Delirium treatment involves keeping the patient mentally stimulated and reality-oriented, as well as providing special care to ensure that his needs are met.
The Elder Life Hospital Program (HELP) is a model of hospital treatment developed at Yale University School of Medicine. It is designed to prevent delirium and functional decline among the elderly in hospitalized hospital settings. HELP uses the core team of interdisciplinary staff and targeted intervention protocols to improve patient outcomes and to provide cost effective care. Unique to this program is the use of specially trained volunteers who carry out most of the non-clinical interventions.
In up to 40% of cases, delirium incidents can be prevented. To that end, HELP promotes interventions designed to maintain older adults' cognitive and physical functioning throughout hospitalization, maximize patient independence on return, assist in the transition from hospital to home and prevent unplanned hospitalization of the hospital. Customized interventions include daily visitors; therapeutic activities to provide mental stimulation; daily practice and walking assistance; increased sleep; nutrition and hearing support and vision protocols.
HELP has been replicated in over 63 hospitals worldwide. Although most of these sites are based in the United States located in 25 different states, there is a growing international presence. International sites include: Australia, Canada, Netherlands, Taiwan and the United Kingdom.
Pharmacology
Constitutions and pharmacology regimens for parents are an important topic, related to different changes and physiology and psychology.
Physiological changes with aging can alter the absorption, effectiveness and profile of side effects of many drugs. This change may occur in the mouth-protective reflex (dryness of the mouth caused by decreased salivary glands), in the gastrointestinal system (such as discharge of suspended solids and fluids may limit the rate of absorption), and in drug distribution with changes in body fat and muscle and drug removal treatment.
Psychological considerations include the fact that the elderly (in particular, those who experience substantial memory loss or other types of cognitive impairment) may not be able to adequately monitor and adhere to their scheduled pharmacological administration. One study (Hutchinson et al., 2006) found that 25% of those surveyed admitted skipping doses or cutting them in half. Non-compliance self-reported compliance with treatment schedules was reported by a third of the conspicuous participants. Further development of possible methods can help monitor and regulate dosage administration and scheduling are areas that deserve attention.
Other important areas are improper administration potential and potentially inappropriate use of drugs, and possible errors that may cause harmful drug interactions. Polypharmacy is often a predictive factor (Cannon et al., 2006). Studies conducted on home/community health care found that "almost 1 of 3 medical regimens contain potential treatment errors" (Choi et al., 2006).
Ethical issues and laws
Parents sometimes can not make decisions for themselves. They may have previously prepared a power of attorney and follow-up directions to provide guidance if they can not understand what is happening to them, whether this is due to long-term dementia or short-term problems that can be corrected, such as delirium from fever.
Geriatricians should respect the privacy of patients while seeing that they receive appropriate and necessary services. More than most specializations, they should consider whether the patient has the legal and competence responsibilities to understand the facts and make decisions. They should support informed consent and resist the temptation to manipulate the patient by withholding information, such as a grim prognosis for a condition or the possibility of recovering from home surgery.
Parental violence is physical, financial, emotional, sexual, or other kinds of older dependence. Adequate training, services and support can reduce the likelihood of parental abuse, and proper attention can often identify it. For the elderly who can not take care of themselves, geriatric can recommend a legal guardianship or conservatory to care for people or property.
Source of the article : Wikipedia
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