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Geriatrics is the branch of medicine that focuses on health care of the elderly. It aims to promote health and to prevent and treat diseases and disabilities in older adults.

Geriatrics was separated from internal medicine as a separate entity as pediatrics separation from adult internal medicine and the same as neonatology separation from pediatrics.[1]


There is no set age at which patients may be under the care of a geriatrician. Rather, this is determined by a profile of the typical problems that geriatrics focuses on.

The term geriatrics differs from gerontology. This is the study of the aging process itself. The term comes from the Greek geron meaning "old man" and iatros meaning "healer". However "Geriatrics" is considered by some as "Medical Gerontology".


Scope Edit

Differences between adult and geriatric medicine Edit

Geriatrics differs from adult medicine in many respects. The body of an elderly person is substantially different physiologically from that of an adult. Old age is the period of manifestation of decline of the various organ systems in the body. This varies according to various reserve in the organs (e.g. Smokers consume their respiratory system reserve early and rapidly).

Many people cannot differentiate between Disease and Aging effects (e.g. renal impairment may be a part of aging but renal failure is not also urinary incontinence is not part of normal aging)needs clarification. Geriatricians aim at treating the disease and decreasing the effect of aging on the elderly life. Years of training and experience (above and beyond basic medical training) goes into recognizing the difference between normal aging and what is actually pathological.

The decline in physiological reserve in organs make elderly persons very vulnerable to have diseases (such as dehydration from a mild gastroenteritis) and liable to have complications from mild problems (Fever in elderly persons may cause confusion leading to a fall and fracture of neck of femur).

Functional ability, dependence and quality of life issues are of greater concern to geriatricians perhaps than to adult physicians.

Treating an elderly person is not like treating an adult. A major difference between geriatrics and adult medicine is that elderly persons sometimes cannot make decisions for themselves. The issues of power of attorney, privacy, legal responsibility, advance directives and informed consent must always be considered geriatric procedure. Elder abuse is also a major concern in this age group. In a sense, geriatricians often have to "treat" the caregivers and sometimes, the family, rather than just the elder.

Elderly people have specific issues as regard medications. Elderly people particularly are subjected to polypharmacy due to many causes. Some elderly people have multiple medical disorders; some use many herb & OTCs; some adult physicians just prescribe medications to their specific specialty without reviewing other medications used by the elder patient. The polypharmacy may result in many drug interactions and may be some drug adverse reactions. Drugs are excreted mostly by kidneys or liver which maybe impaired in elderly and medication might need adjustment (Renal or Hepatic).

Also presentations of diseases in elderly persons may be vague and non-specific or present with delirium of falls (Pneumonia may present with fever, low grade fever, dehydration, confusion or falls) . Also some elderly people may find difficulty verbally describing expressing their symptoms, especially if the disease is active and causing confusion or if they have cognitive impairment. Delirium in elderly may be caused from a minor problem as constipation to a serious life threatening problem as myocardial infarction.

Geriatrics giants and elderly diseases Edit

'Geriatric giants' are immobility, instability, incontinence and impaired intellect/memory. Health issues in older adults may also include elderly care, delirium, use of multiple medications, impaired vision and hearing.

Geriatrics subspecialties and related specialties Edit

Some diseases commonly seen in elderly are rare in adults (as Dementia, delirium, falls....etc). With the surfacing of the aging phenomenon of societies many specialized geriatrics and geriatrics related services emerged[2] [3] including:

Medical Edit

Surgical Edit

Other geriatrics subspecialities. Edit

HistoryEdit

The Canon of Medicine,[53] written by Abu Ali Ibn Sina (Avicenna) in 1025, was the first book to offer instruction for the care of the aged, foreshadowing modern gerontology and geriatrics. In a chapter entitled "Regimen of Old Age", Avicenna was concerned with how "old folk need plenty of sleep", how their bodies should be anointed with oil, and recommended exercises such as walking or horse-riding. Thesis III of the Canon discussed the diet suitable for old people, and dedicated several sections to elderly patients who become constipated.[54][55][56]

The famous Arabic physician, Ibn Al-Jazzar Al-Qayrawani (Algizar, circa 898-980), also wrote a special book on the medicine and health of the elderly, entitled Kitab Tibb al-Machayikh[57] or Teb al-Mashaikh wa hefz sehatahom.[58] He also wrote a book on sleep disorders and another one on forgetfulness and how to strengthen memory, entitled Kitab al-Nissian wa Toroq Taqwiati Adhakira,[59][60][61] and a treatise on causes of mortality entitled Rissala Fi Asbab al-Wafah.[62] Another Arabic physician in the 9th century, Ishaq ibn Hunayn (died 910), the son of Hunayn Ibn Ishaq, wrote a Treatise on Drugs for Forgetfulness (Risalah al-Shafiyah fi adwiyat al-nisyan).[63]

The term geriatrics was proposed in 1909 by Dr. Ignatz Leo Nascher, former Chief of Clinic in the Mount Sinai Hospital Outpatient Department (New York City) and a "Father" of geriatrics in the United States.

Modern geriatrics in the United Kingdom really began with the "Mother" of Geriatrics, Dr. Marjorie Warren. Warren emphasized 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 multidisciplinary working, valuing all the professions, not just medicine, for their contributions in optimizing the well-being and independence of older people.

Another "hero" of British Geriatrics is Bernard Isaacs, who described the "giants" of geriatrics: immobility and instability, incontinence and impaired intellect.[64] Isaacs asserted that if you look closely enough, all common problems with older people relate back to one of these giants.

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.[65]

Geriatricians training Edit

In the United States, geriatricians are primary care physicians who are board-certified in either family medicine or internal medicine and have also acquired the additional training necessary to obtain the Certificate of Added Qualifications (CAQ) in geriatric medicine.

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.[66] Most geriatricians are therefore accredited for both. In contrast to the United States, geriatric medicine is a major specialty in the United Kingdom; geriatricians are the single most numerous internal medicine specialists.

Geriatrics organizations Edit

  • American geriatrics society
  • British geriatrics society

Research Edit

Hospital Elder Life ProgramEdit

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 delirium 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.

In July 2007 the American Association of Medical Colleges (AAMC) and the Hartford Foundation hosted a National Consensus Conference on Competencies in Geriatric Education where a consensus was reached on minimum competencies (learning outcomes) that graduating medical student needed to assure competent care to older patients by new interns. There are 26 competencies in eight content domains, endorsed 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; medication management; self-care capacity; falls, balance, gait disorders; atypical presentation of disease; palliative care; hospital care for elders, and health care planning and promotion. Each content domain specifies three or more observable, measurable competencies. The entire list is available on the Portal of Geriatric Online Education.

PharmacologyEdit

Pharmacological constitution and regimen for older people is an important topic, one which is related to changing and differing physiology and psychology.

Changes in physiology with aging may alter the absorption, the effectiveness and the side effect profile of many drugs. These changes may occur in oral protective reflexes (dryness of the mouth caused by diminished salivary glands), in the gastrointestinal system (such as with delayed emptying of solids and liquids possibly restricting speed of absorption), and in the distribution of drugs with changes in body fat and muscle and drug elimination.

Psychological 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. One study (Hutchinson et al, 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.

Another area of importance is the potential for improper administration and usage of potentially inappropriate medications, and possibility of errors which result in dangerous drug interactions. Polypharmacy is often a predictive factor (Cannon et al, 2006). Research done on home/community health care found that "nearly 1 of 3 medical regimens contain a potential medication error" (Choi et al, 2006).


Ethical and medicolegal issues Edit

See alsoEdit

ReferencesEdit

  1. Geriatrics separation from internal medicine
  2. GERIATRICSFOR-SPECIALISTS INITIATIVE (GSI)
  3. Increasing Geriatrics Expertise in Surgical and Medical Specialties
  4. Textbook of Diagnostic Imaging in the Elderly book
  5. GERIATRIC IMAGING - Radiology ebook CT MRI Xrays
  6. Imaging of the Geriatric Patient, Radiologic Clinics of North America
  7. Geriatric Anticoagulation Clinic
  8. Geriatric subspecialty clincs, Singapore
  9. Geriatric Emergency Medicine Resources
  10. Quality Geriatric Emergency Care
  11. THE AMERICAN JOURNAL OF GERIATRIC PHARMACOTHERAPY
  12. geriatric pharmacy review
  13. Geriatric Pharmacotherapy: A Guide For The Helping Professional
  14. AMA, Improving the Quality of Geriatric Pharmacotherapy
  15. Geriatric Pharmacotherapy
  16. Geriatric Pharmacotherapy Program
  17. Geriatric Pharmacotherapy Cases Studies
  18. geriatric_pharmacology presentation
  19. online resources
  20. GERIATRIC PHARMACY PRACTICE RESIDENCY
  21. Knowledge of Pharmacy Graduates of Consultant Pharmacy Practice
  22. geriatric pharmacy curriculum
  23. Beers lis
  24. Geriatric Pharmacotherapy Blog
  25. medication related problems in elderly
  26. Geriatric Pharmacology NEJM
  27. Geriatric Pharmacology book
  28. Geriatric clinical pharmacology book
  29. Geriatric Drug Therapy Interventions
  30. Orthopedic-Geriatric Unit
  31. Geriatric Orthopaedic Surgery Resources
  32. Geriatric Cardiothoracic Surgery Resources
  33. GERIATRIC GENERAL THORACIC SURGERY
  34. Geriatric Urology Resources
  35. Geriatric Otolaryngology Resources
  36. Geriatric General Surgery Resources
  37. Geriatric Gynecology Resources
  38. Geriatric Ophthalmology Resources
  39. Geriatric Psychology
  40. geriatric psychology archives
  41. GERIATRICPSYCH.COM
  42. geriatric-psychology
  43. TRAINING PROGRAMS IN GERIATRIC PSYCHIATRY AND GERIATRIC PSYCHOLOGY
  44. Geriatric Psychologists
  45. Florida geriatric psychologists
  46. Faculty Training Program in Geriatric Psychology
  47. A Guide to Psychological Practice in Geriatric Long-Term Care book
  48. Geriatric Psychology resources
  49. Geriatric Psychology section of Am board of psychology
  50. Aging Gracefully and the Importance of Geriatric Nutrition
  51. Geriatric Nutrition Health Article
  52. Geriatric Nutrition: The Health Professional's Handbook
  53. Al-Canon scanned photos
  54. Howell, Trevor H. (1987), "Avicenna and His Regimen of Old Age", Age and Ageing 16: 58–59, doi:10.1093/ageing/16.1.58 
  55. Avicenna and the care of the aged by TH Howell Gerontologist 1972 12: 424-426.
  56. Gerontology and geriatrics in the works of Abu Ali Ibn Sina in Sovetskoe zdravookhranenie
  57. Al Jazzar
  58. Vesalius Official journal of the International Society for the History of Medicine
  59. Algizar a web page in french
  60. Ibn Jazzar
  61. [Geritt Bos, Ibn al-Jazzar, Risala fi l-isyan (Treatise on forgetfulness), London, 1995 ]
  62. Al Jazzar
  63. Islamic culture and medical arts
  64. Isaacs 1965
  65. Department of Health Older People's information
  66. Barton & Mulley 2003

Further reading Edit

  • 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.

External linksEdit

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