English Articles
Why geriatric medicine
Elderly patients are different from young in their health profile as follows;
1- Commonly the diseases affects
more than one body system like heart failure in circulatory system and
parkinsonism in nervous system, cataract in the eyes etc.
2- The psychological state has a direct impact on quality of life of elderly.
For example, depression kills motivation and the hope and enthusiasm for
recovery.
3- The reserve in all body systems gradually decreases by aging, so all body
systems are prone to be more readily affected by illnesses compared with young.
4- Elderly are more prone to side effects of medications. For example some
medications can cause falls, intellectual deterioration, swelling of feet, etc.
5- The need to consult more than 1 or 2 specialties for 2 or more affected body
systems.
6- Many prescription from many physicians creates suffering from side effects
that can be mistakenly treated by adding more medicines.
7- There are health problems affect only elderly like dementia, urinary
incontinence, falls, and delirium or confusion.
8- Some disabilities (that can be easily treated) can be mistakenly considered
as part of normal aging by the elderly himself or his relatives or even by the
treating doctor. These misinterpretation wastes excellent chances for treatment
and improvements in quality of life.
9- The social life has direct impact on the quality of life of patients like
isolation and poor income.
10- The rapid deterioration of endurance if stay on bed for a few days.
11- The elderly illness creates a burden on the caregiver. This burden can lead
to development of multiple health problems in the caregiver.
Geriatric medicine is different
It manipulate all the factors that can lead to independence (ability of elderly
to take care of himself)
These factors are 1- physical illnesses 2- psychological or mental illnesses 3-
social and environmental factors.
The approach is different
In geriatric medicine, the doctors
approach the problems of the patients not a disease by itself. For example losing
ability to walk is a problem that could be due to many diseases like arthritis,
Parkinsonism, neuropathy, reduced vision, loss of motivation and fear of fall.
All of them together and in the same time can affect the ability of the elderly
to walk. In other words, one problem can be due to interaction of several
diseases. Geriatric medicine also consider the caregiver burden and helps to
reduce it.
The expected outcome is also different.
Cure from one disease is not the actual target in geriatric medicine but the
actual target is the resolution of a problem affecting function (independence).
The aim of geriatric medicine is different;
So it is not only to cure a disease but curing a disease is one circle in a
long chain.
The common problems that geriatrician assess routinely to find ways to resolve them are;
1- Instability in walking.
2- Immobility
3- incontinence of urine.
4- Isolation, loss of motivation.
5- Intellectual impairment.
6- Undernutrition.
7- Impotence.
8- Iatrogenesis (side effects of inappropriate prescribing of medications).
9- Insomnia (inability to sleep at night.
10- Impairment of vision or hearing.
Each one of the above problems can
be due to interaction of many illnesses including the psychological and also
the effects of social and environmental conditions.
How the geriatrician do his job;
1- Doctor starts by identifying the
problems and in the same time evaluating the functional level of the patient
and the role of this problems in functional deterioration.
2- Then he search for the causes that may lead to these problems.
3- Identifies priorities in treatment, starting with problems with most serious
consequences.
4- Creates a plan of management
5- Working in a team consists of physiotherapist, social worker, nurse and
occupational system. All share in the implementation of the plan.
33 warning signs of elderly diseases
The sign ------- (The cause)
Notics 1 All the causes are managable
Notice 2 The causes mentioned are the most appropriate for the age and need to be excluded before considering other causes.
1. Inability to sleep at night (depression)
2. Get lost in the street (dementia).
3. Repeating the same talk or repeat asking same question ie, forgetfulness observed by others (dementia).
4. Feeling pains specially at night (depression).
5. Sudden pain in the back (fracture due to osteoporosis).
6. Gradual development of severe back pain (myeloma blood cancer).
7. Difficulty sitting from lying position, or standing from sitting position (prolonged stay in bed during illness ,vitamin D deficiency, decrease or increase thyroid activity, decrease potassium or sodium in blood, increased calcium, depression, parkinsonism, obesity, osteoarthrit
8. Tearing on trivials observed by others (depression)
9. Sudden increase in breathing rate (blood clot closed s lung vessel).
10. Rapid increase in breathing rate (breathless) during rest (pneumonia).
11. Sudden disturbance of consciousness (epilepsy without convulsions or stroke).
12. Wishes of death (severe depression).
13. Self blame (depression).
14. Sudden agitation or sudden restlessness (retention of urine).
15. Slowness of gait (Parkinsonism).
16. Gradual increase in frequency in passing small amounts of urine at night (benign prostate tumor)
17. Rapidly progressive increase in difficulty passing urine (cancer prostate).
18. Sudden increase in frequency in passing urine (urine infection)
19. Increase frequency of passing urine large amounts (uncontrolled diabetes).
20. Inability to hold urine till reaching toilet (urgency incontinence has many causes).
21. Coughing during drinking or eating (Shocking leads to recurrent chest infections and lung fibrosis)
22. Anemia due to loss of iron (cancer stomach, stomach ulcer, cancer colon, poor nutrition. Endoscopy is necessary).
23- Prefer siting alone and talking less (depression or early dementia)
24. New headache in one side of the head (Blood between brain and skull called subdural hematoma).
25. Pain and swelling in one leg (blood cloting in the veins of the leg).
26. Difficulty breathing during walking (heart failure or lung fibrosis)
27. Urine leak in women during movement, cough or sneezing (Stress incontinence)
28. Sudden clouding of consciousness (medicine, epilepsy, infections, urine retension, menengitis, silent heat attack, sodium and potassium problem, low O2 in blood). ;
29. Easy to go into bad temper and became or used to be aggressive (depression).
30. Elderly complain that he or she became forgetful (depression).
31. Body aches (depression, vitamin D deficiency)
32. Severe pain in shoulders and pelvic girdle prevents movement (rheumatic disease called polymyalgia rehumatica).
33- (Hallucination) seeing things or people not there (medicine, lewi body dementia).