What is Geriatric Medicine?
Geriatric Medicine is a specialty of Medicine that deals exclusively with the “healthcare of elderly” (Senior Citizens of 60+ age)
Who is a Geriatrician?
A Geriatrician is a trained medical doctor who specializes in treating senior citizens (60+ year old people) and practices geriatric medicine
How Elderly/Senior citizens are different from their younger counterparts?
There are a lot of differences when we compare the elderly people with those who are younger or in their middle-ages. Let us try to understand how:
1) Difference between person to person increases with age
As people age, they become more and more different from standard population due to different health and medical needs. Let’s say a group of 20 men and women, all 30 years old. Most have no chronic diseases, don’t need to see doctors on a regular basis, and don’t take any long-term medication. Compare this to a group of 20 men and women who are 60 years or 70 years or 80 years old. Many of them have chronic heart and lung diseases, memory impairment, are frail, wheel-chair bound and on long term medications. Many will have some form of restriction in their independence in the activities of their daily living like bathing, going to toilet and dressing. The disease pattern and combination varies drastically in this group and this makes them very different from the younger population
2) Homeostenosis
As we grow older, our bodies become increasingly more susceptible to any stressors, called Homeostenosis. It can be related to any infection, trauma or even medications. For example, a common cold, in a younger individual may cause fever, body ache and appetite loss, which can be treated with most of the cold remedies. But same illness in an elderly person may cause havoc. Poor appetite may cause significant dehydration and lead to dizziness and falls, especially if on blood pressure medications. Being bedridden even for a day or two will make an elderly noticeably weaker, again leading to falls. So again, this leads to a requirement of a person who specializes in knowing the impact
3) Multimorbidity
Another important difference is multimorbidity, that is the number of multiple ailments or medical conditions present at the same time. Elderly typically don’t come to doctors with one single condition. Instead they have a variety of concerns and illnesses such as hypertension, diabetes, obesity, arthritis, etc. Sometimes, treatment for one condition may interfere with another or in some instances make it worse. So a specialty that works towards combining the treatments together in a safe and effective manner is essential.
4) Atypical disease presentations
Similar to how diseases have different presentation in the pediatric (child) age group, diseases may have different presentations in the elderly. To give a few examples; classic symptoms of heart attack such as chest pain and sense of impending doom are rarely present in elderly. Instead, they may complain of stomach ache, nausea or simply feeling tired. Cough, breathlessness and fever - the hallmarks of pneumonia may not be presenting features in elderly. They may manifest as poor appetite, fatigability and confusion.
5) Polypharmacy
It is not uncommon to see an elderly individual take 5 or more medicines per day. As we grow old, the number of diseases and disabilities go on adding up. In many cases, it is necessary to take multiple medicines for these conditions. But, as we grow old, the functioning of our organ systems, especially the liver and kidney, decreases. They are not able to metabolize medicines, as compared to a younger age group. Also, multiple drugs when taken together may cause major side-effects. Consider a typical 70 years elderly gentleman with diabetes, high blood pressure, cholesterol problems, with heart failure. How many medicines will he be taking per day for all of his health issues? Geriatric Medicine specialist doctor ensures that the medicines are optimally consumed and have minimal side effects.
6) Attitude of the Relatives
In many cases, when the elderly people complain of any physical discomfort, it is not taken seriously by other members in the family. They tend to ignore it, thinking it to be an inevitable part of the ageing process. Consider a similar situation in a small child. When a child has even a minor problem, he/she is immediately taken to the doctor for treatment; but when an elderly person suffers from similar issues, most of the times it is ignored by the family without any further action taken. A geriatric medicine specialist doctor not only counsels the patient but also provides a support system for the attendants.
7) Social problems
Many senior citizens suffer from socioeconomic problems like isolation, dependence on others for their daily activities, poverty and so on. These problems may aggravate or precipitate the already existing medical problems.
8) Geriatric giants
These are major categories of impairment that appear in elderly people. Traditionally these included immobility, instability, incontinence (lack of control on urine and stool) and impaired intellect / memory. More recently, four new syndromes of frailty (weakness), sarcopenia (loss of muscles), anorexia (lack of appetite) and cognitive impairment (loss of memory and mental functions) have been termed as the modern geriatric giants. Impaired vision and hearing impairment are common chronic problems in senior citizens. A Geriatrician, who is exclusively trained in the elderly care, can properly assess all these issues in totality and advise appropriate management to improve the functionality and quality of life in the elderly.
What do Geriatricians do differently?
1. Add life to years and not years to life
2. Care for the full spectrum of diseases seen in elderly individuals
3. Recognize the importance of maintaining functional independence in older people and focus on providing targeted preventive interventions
4. Specifically trained in the normal and abnormal physiological and psychological changes associated with ageing and recognize the differences in presentation of disease relative to normal ageing
5. Provide “Comprehensive Medical Care to all the health issues in the elderly”; whether it is poorly controlled diabetes or blood pressure problems or bone and joint problems/arthritis or dementia or dizziness and balance problems or Parkinson disease or urinary problems, to name a few
6. Evaluate and optimize the elderly person’s medical state, who are to undergo surgery by performing a pre-operative comprehensive geriatric assessment and at the same time take care of any post-operative medical problems that may arise in such patients. Geriatricians play a big role in early rehabilitation and discharge in such cases
7. Experts in optimizing or decreasing the number of medicines taken by the elderly and thereby prevent side-effects
When to consult a Geriatrician?
Each and every individual who is 60 years of age and above is unique and has different degrees of health, illness and disability. A geriatrician should be consulted, if you or your relatives are 60 years of age and above and if answer to any of the below questions is yes:
1) Are you suffering from any of the medical conditions like diabetes, high or low blood pressure, joint problems or arthritis, heart disease, Parkinson disease, respiratory problems or any other health issue or have multiple of these conditions at the same time?
2) Did you get frequently hospitalized in the previous 1 year?
3) Are you forgetting things more often than in the past or suffering from dementia?
4) Did you have a fall while getting up from bed or in the bathroom or in your home or outside in the previous 1 year?
5) Are you having difficulty walking or feeling dizzy/giddy on a frequent basis?
6) Are you having unintended weight loss or have lost your appetite for unknown reasons?
7) Are you taking 5 or more medicines (allopathic and alternative) every day or have difficulty in managing them?
8) Are you suffering from chronic constipation or loose motions or have recent alteration in your bowel habits?
9) Are you having urinary problems like increase in urine frequency or difficulty in passing urine or have to frequently get up in the night to pass urine?
10) Are you experiencing a decrease in your functionality or wheel-chair bound or bed-ridden and have increasing dependence on others for your daily activities?
11) Are your family members or care-givers being overburdened in the care process of your or your known-to person?
12) Do you need palliative care for terminal diseases or cancer?
13) Do you want vaccination for your age?