Good evening everyone.
Being a Geriatrician, I am frequently asked many questions
regarding Geriatric medicine, the requirement and how senior citizens are
different from younger adults. Here I try to answer a few of them.
What is Geriatric Medicine?
Geriatric medicine is a branch of medicine concerned with
all aspects of health and illness in older adults (Individuals 60 years and
above)
Who is a Geriatrician?
A Geriatrician is a physician who specializes in treating
conditions that affect senior citizens. Geriatricians have an interesting and
varied job which includes providing comprehensive medical care to senior
citizens who may have several medical conditions (multimorbidity) and are often
taking multiple medications (polypharmacy).
Why do older people/senior citizens need specialized
care?
Older individuals differ from the younger ones in many ways.
A. Difference between person to person
increases with age
As people age, they become more and more
different from the standard population due to different health and medical
needs. Most adults aged 30 years don’t have a chronic disease, don’t need to
see doctors regularly and don’t take long term medications. But few, if not
many, people aged 60 years and above have one or two chronic medical conditions
(eg: Diabetes, Hypertension, chronic heart and lung diseases, joint pains,
memory complains etc), they are on multiple medications and may be dependent on
the young ones to perform their activities of daily living. The disease pattern and combination varies
drastically in this group making them different from the younger population.
B. Decreased reserve capacity
As people get older or develop chronic disease, there is a narrowing of their reserve capacity. This phenomenon has been called homeostenosis, a decreased ability to maintain homeostasis (balance) under stress. The stress can be in the form of infection, trauma, falls, pain, and even medications. A young person has a high capacity to maintain health and prevent the consequences of dehydration well. Whereas an older person is increasingly susceptible, a very short duration of decreased appetite can lead to dehydration which can, in turn, lead to kidney damage (termed as acute kidney injury). Being bedridden for even a few days can make an older person noticeably weaker.
C. Comorbidities
The recently released LASI (Longitudinal
Ageing Study in India) reports that a third (35%) of people aged 60 years and
above had diagnosed Cardiovascular diseases, 14% had diagnosed diabetes, 5.9%
had asthma, one in five (20%) had chronic bone and joint diseases. Hence, older
people don’t come to doctors with a single problem, they often have
multimorbidities (two or more medical conditions). And treatment of one
condition may interfere with another, or in some instances make it worse. A
specialist who works towards combining the treatments safely and effectively is
essential.
D. Atypical disease presentation
This was initially observed in children and
is now true for senior citizens as well. Unlike younger adults who have typical
presentations, senior citizens may not have similar features. For example, high-grade
fever, cough with sputum and shortness of breath are classical symptoms of
pneumonia. But this is not so for older people, they often present with no
fever, or low-grade fever, no to mild sputum production, altered mental status
(decreased speech, increased drowsiness, confusion etc) and loss of
appetite.
E. Polypharmacy
It is not uncommon to see an older person
take 5 or more medicines per day. As we go old, the number of diseases and disabilities
go on adding up. In many cases, it is necessary to take medicines for these
conditions. But at the same time, the function of our liver and kidneys deteriorates.
And these organs help remove these medicines from our blood. Also, the multiple
medicines taken together can interact with each other and cause harmful effects.
A Geriatrician ensures that the patient is receiving medications at optimum doses,
with minimal harmful effects, and eliminated the possibility of duplication of
medicine.
F. The attitude of the relatives
Most often the symptoms of older persons
are ignored by the person himself/herself and their relatives. Symptoms such as
urinary incontinence, decreased memory, decreased physical activity, reducing
vision, joint pains are considered as part of ageing and hence ignored. Hence,
these troubles increase and impair the daily activities of senior citizens. A Geriatrician
not only screens and treats an older person for these conditions, but he also
educates the patient as well as the family members regarding the preventive
measures.
G. Geriatric giants
These are major categories of impairment that
appear in older people. Traditionally these include immobility, instability,
incontinence (lack of control on urine and stool) and impaired intellect/memory.
More recently, four more syndromes of frailty (weakness), sarcopenia (loss of
muscles), anorexia (lack of appetite), and cognitive impairment (loss of memory
and mental function) have been termed as modern geriatric giants. A Geriatrician
who is trained in the care of older persons can properly assess all these
issues in totally and advise appropriate management to improve the functionality
and quality of life.
To conclude, senior citizens, differ not only from younger adults but also differ among people of the same age group. They need special attention and specialised care plans based on individual needs, and Geriatricians are trained to achieve this goal.
