Common Geriatric Disorders and Their Management

The geriatric patient population is rapidly increasing. This group is at risk for hospital complications including functional decline and iatrogenic infections.

Geriatrics focuses on the unique changes that occur as people age. It also addresses common diseases and syndromes that are found in this population. This article will explore some of the most common geriatric disorders and their management.

Frailty

Frailty is a relatively new concept in the geriatric medical community and there has been a lot of research around it. It is defined as a syndrome with age-related deficits involving several body systems and can be measured by symptoms like weakness, slowness of movement, exhaustion easily and weight loss.





One emerging theory of frailty is that it is caused by a state of chronic inflammation that results in a proinflammatory milieu, loss of muscle mass (sarcopenia) and decreased activity in several bodily systems. Other mechanisms that contribute to frailty include lowered anabolic hormones like testosterone and estrogen, imbalanced micronutrients and oxidative stress.

It is estimated that a quarter of those over 85 are frail and this is a significant group because they have poorer outcomes. They are more likely to fall, have prolonged hospital stays and have subpar surgical outcomes. They also have a greater susceptibility to adverse events from even mild stresses like surgery, hospital admission for flu or a new medication. Identifying frailty can help with a targeted approach to care and incorporating the components of care such as care and support planning, exercise, dietary intervention, structured medication review and strengthening social networks.

Delirium

Delirium is a sudden change in mental functioning that causes confusion, trouble paying attention and changes in behavior. It is often mistaken for dementia or depression, and it can lead to long hospital stays and poor health outcomes after a person leaves the hospital.

Delirium can be triggered by severe illness, surgery and anesthesia, or medications. It is more common in people with preexisting dementia, and it can increase the rate of cognitive decline after a hospital stay. It is also a common side effect of sepsis and is called "ICU psychosis."

A person in delirium may appear more withdrawn or quiet, but can also become restless or agitated. Physical restraints should be avoided, as they can worsen delirium. Instead, the care team should work to identify and reverse any illness or medication causing the delirium, manage pain and other symptoms such as constipation, and provide a reassuring presence. Studies have shown that the reassuring presence of family members is especially helpful in reducing delirium. It can help to know about delirium in advance, so you can talk with your loved one's doctor and be prepared to ask questions during visits.

Vision and Hearing Issues

Many elderly people have vision and hearing problems, which can interfere with their daily activities. Some of these are caused by normal age-related changes, while others are a result of pathology of the ear and eye.

It is common for both vision and hearing to decline with aging, but severe loss of these senses can have profound negative consequences on an individual’s quality of life. It can also have a direct impact on their mental health and social interaction.

The development of geriatric syndromes is usually the consequence of an accumulation of impairments across multiple systems. This may be exacerbated by physiologic stressors, such as cancer therapy and its associated fatigue or toxicity, depression, and polypharmacy. Therefore, it is important that oncologists identify geriatric syndromes and develop supportive care interventions to improve the quality of life of their patients. Moreover, early identification of these conditions can help prevent functional deterioration and escalation of risk factors (e.g., falls, delirium, and drug-drug interactions) in the aging population. This can reduce the need for rehospitalization and hospital length of stay, as well as reduce complications of ACS treatment.

Osteoporosis

Bones are living tissue that are constantly being broken down and rebuilt. As we age, break down exceeds formation, resulting in the weakening of bones (osteoporosis).

Symptoms are usually not present until a bone fracture occurs. These often happen in the hip, wrist or spine. Osteoporotic fractures are often painful and may result in a stooped or bent forward posture.

A bone density scan can detect osteoporosis or the earlier stage called osteopenia. The test measures the amount of bone mass, and doctors use a T score or Z score to compare against people of a similar age and gender.

A diet high in calcium and vitamin D helps prevent osteoporosis. Exercise that includes strength training (where resistance is applied to a muscle to develop and maintain muscular strength, endurance and muscle mass) can also help. Talk to a health or fitness professional about the best exercises for you if you have joint problems or another medical condition that limits your exercise options. Also, avoid gastrointestinal surgeries that reduce the size of your stomach or remove parts of your intestines – this can decrease how well your body absorbs nutrients including calcium.

Cancer

Cancer is a disease of older people that occurs when cells in the body develop rapidly and grow out of control, leading to uncontrolled growth of tumors that eventually destroy the body. It is one of the most common diseases that affects aging adults and can lead to death, but it is also treatable with modern medicine.

Other health issues that afflict the elderly population include hearing and vision loss, increased blood pressure (hypertension), generalized muscle weakness, ocular changes, and delirium. These conditions can be treated with home healthcare, and regular visits to a geriatrician can help them keep up with their health.

The number of Americans over age 85 is expected to triple by 2050, and it is important that clinicians understand the health issues that are associated with this demographic. Certain age-related changes are normal, but others are not and can cause complications such as falls, iatrogenic infections, functional decline, and hospital readmissions. Identifying these problems early and implementing appropriate treatments can help the elderly population live independently in their homes.