Geriatrics, or geriatric medicine, is a medical specialty focused on providing care for the unique health needs of older adults. The term ''geriatrics'' originates from the
Greek
Greek may refer to:
Greece
Anything of, from, or related to Greece, a country in Southern Europe:
*Greeks, an ethnic group.
*Greek language, a branch of the Indo-European language family.
**Proto-Greek language, the assumed last common ancestor ...
γέρων ''geron'' meaning "old man", and ιατρός ''iatros'' meaning "healer". It aims to promote
health
Health, according to the World Health Organization, is "a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity".World Health Organization. (2006)''Constitution of the World Health Organiza ...
by
preventing, diagnosing and treating
disease
A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not immediately due to any external injury. Diseases are often known to be medical conditions that a ...
in
older adults
Old age refers to ages nearing or surpassing the life expectancy of human beings, and is thus the end of the human life cycle. Terms and euphemisms for people at this age include old people, the elderly (worldwide usage), OAPs (British usage ...
. There is no defined age at which patients may be under the care of a geriatrician, or geriatric physician, a physician who specializes in the care of elderly people. Rather, this decision is guided by individual patient need and the caregiving structures available to them. This care may benefit those who are managing multiple chronic conditions or experiencing significant age-related complications that threaten quality of daily life. Geriatric care may be indicated if caregiving responsibilities become increasingly stressful or medically complex for family and caregivers to manage independently.
There is a distinction between geriatrics and
gerontology
Gerontology ( ) is the study of the social, cultural, psychological, cognitive, and biological aspects of aging. The word was coined by Ilya Ilyich Mechnikov in 1903, from the Greek , ''geron'', "old man" and , ''-logia'', "study of". The fie ...
. Gerontology is the multidisciplinary study of the
aging
Ageing ( BE) or aging ( AE) is the process of becoming older. The term refers mainly to humans, many other animals, and fungi, whereas for example, bacteria, perennial plants and some simple animals are potentially biologically immortal. In ...
process, defined as the decline in organ function over time in the absence of injury, illness, environmental risks or behavioral risk factors. However, geriatrics is sometimes called medical gerontology.
Scope
Differences between adult and geriatric medicine
Geriatric providers receive specialized training in caring for elderly patients and promoting healthy aging. The care provided is one largely based on shared-decision making and is driven by patient goals and preferences, which can vary from preserving function, improving quality of life, or prolonging years of life. A guiding
mnemonic
A mnemonic ( ) device, or memory device, is any learning technique that aids information retention or retrieval (remembering) in the human memory for better understanding.
Mnemonics make use of elaborative encoding, retrieval cues, and imag ...
commonly used by geriatricians in the United States and Canada is the 5 M's of Geriatrics which describes mind, mobility, mentation,
medications
A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to diagnose, cure, treat, or prevent disease. Drug therapy (pharmacotherapy) is an important part of the medical field and rel ...
and matters most to elicit patient values.
It is common for elderly adults to be managing multiple medical conditions, or, multi-morbidity. Age-associated changes in physiology drive a compounded increase in susceptibility to illness, disease-associated morbidity, and death. Furthermore, common diseases may present atypically in elderly patients, adding further
diagnostic
Diagnosis is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different disciplines, with variations in the use of logic, analytics, and experience, to determine " cause and effect". In systems engine ...
and therapeutical complexity in patient care.
Geriatrics is highly interdisciplinary consisting of specialty providers from the fields of medicine, nursing, pharmacy, social work, physical and occupational therapy. Elderly patients can receive care related to medication management, pain management, psychiatric and memory care, rehabilitation, long-term nursing care, nutrition and different forms of therapy including physical, occupational and speech. Non-medical considerations include social services, transitional care, advanced directives, power of attorney and other legal considerations.
Increased complexity
The decline in physiological reserve in organs makes the elderly develop some kinds of diseases and have more complications from mild problems (such as
dehydration
In physiology, dehydration is a lack of total body water, with an accompanying disruption of metabolic processes. It occurs when free water loss exceeds free water intake, usually due to exercise, disease, or high environmental temperature. Mil ...
from a mild
gastroenteritis
Gastroenteritis, also known as infectious diarrhea and gastro, is an inflammation of the gastrointestinal tract including the stomach and intestine. Symptoms may include diarrhea, vomiting, and abdominal pain. Fever, lack of energy, and dehydra ...
). Multiple problems may compound: A mild
fever
Fever, also referred to as pyrexia, is defined as having a body temperature, temperature above the human body temperature, normal range due to an increase in the body's temperature Human body temperature#Fever, set point. There is not a single ...
in elderly persons may cause confusion, which may lead to a fall and to a fracture of the
neck of the femur
The femoral neck (femur neck or neck of the femur) is a flattened pyramidal process of bone, connecting the femoral head with the femoral shaft, and forming with the latter a wide angle opening medialward.
Structure
The neck is flattened from ...
("broken hip").
The presentation of disease in elderly persons may be vague and non-specific, or it may include
delirium
Delirium (also known as acute confusional state) is an organically caused decline from a previous baseline of mental function that develops over a short period of time, typically hours to days. Delirium is a syndrome encompassing disturbances in ...
or falls. (
Pneumonia
Pneumonia is an inflammatory condition of the lung primarily affecting the small air sacs known as alveoli. Symptoms typically include some combination of productive or dry cough, chest pain, fever, and difficulty breathing. The severity ...
, for example, may present with low-grade
fever
Fever, also referred to as pyrexia, is defined as having a body temperature, temperature above the human body temperature, normal range due to an increase in the body's temperature Human body temperature#Fever, set point. There is not a single ...
and confusion, rather than the high fever and cough seen in younger people.) Some elderly people may find it hard to describe their
symptoms
Signs and symptoms are the observed or detectable signs, and experienced symptoms of an disease, illness, injury, or condition. A sign for example may be a higher or lower temperature than normal, raised or lowered blood pressure or an abnormali ...
in words, especially if the disease is causing confusion, or if they have
cognitive impairment
Cognitive deficit is an inclusive term to describe any characteristic that acts as a barrier to the cognition process.
The term may describe
* deficits in overall intelligence (as with intellectual disabilities),
* specific and restricted defici ...
.
Delirium
Delirium (also known as acute confusional state) is an organically caused decline from a previous baseline of mental function that develops over a short period of time, typically hours to days. Delirium is a syndrome encompassing disturbances in ...
in the elderly may be caused by a minor problem such as
constipation
Constipation is a bowel dysfunction that makes bowel movements infrequent or hard to pass. The stool is often hard and dry. Other symptoms may include abdominal pain, bloating, and feeling as if one has not completely passed the bowel movement ...
or by something as serious and life-threatening as a
heart attack
A myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops to the coronary artery of the heart, causing damage to the heart muscle. The most common symptom is chest pain or discomfort which may tr ...
. Many of these problems are treatable, if the root cause can be discovered.
Geriatric Pharmacology
Elderly people require specific attention to
medications
A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to diagnose, cure, treat, or prevent disease. Drug therapy (pharmacotherapy) is an important part of the medical field and rel ...
. Elderly people particularly are subjected to
polypharmacy
Polypharmacy (polypragmasia) is the simultaneous use of multiple medicines by a patient for their conditions. Most commonly it is defined as regularly taking five or more medicines but definitions vary in where they draw the line for the minimum ...
(taking multiple medications) given their accumulation of multiple chronic diseases. Many of these individuals have also self-prescribed many
herbal medication
Herbal medicine (also herbalism) is the study of pharmacognosy and the use of medicinal plants, which are a basis of traditional medicine. With worldwide research into pharmacology, some herbal medicines have been translated into modern remedies ...
s and
over-the-counter drug
Over-the-counter (OTC) drugs are medicines sold directly to a consumer without a requirement for a prescription from a healthcare professional, as opposed to prescription drugs
A prescription drug (also prescription medication or prescripti ...
s. This polypharmacy, in combination with geriatric status, may increase the risk of
drug interaction
Drug interactions occur when a drug's mechanism of action is disturbed by the concomitant administration of substances such as foods, beverages, or other drugs. The cause is often the inhibition of the specific receptors available to the drug, ...
s or
adverse drug reaction
An adverse drug reaction (ADR) is a harmful, unintended result caused by taking medication. ADRs may occur following a single dose or prolonged administration of a drug or result from the combination of two or more drugs. The meaning of this term ...
s.
Pharmacokinetic
Pharmacokinetics (from Ancient Greek ''pharmakon'' "drug" and ''kinetikos'' "moving, putting in motion"; see chemical kinetics), sometimes abbreviated as PK, is a branch of pharmacology dedicated to determining the fate of substances administered ...
and
pharmacodynamic
Pharmacodynamics (PD) is the study of the biochemical and physiologic effects of drugs (especially pharmaceutical drugs). The effects can include those manifested within animals (including humans), microorganisms, or combinations of organisms (for ...
changes arise with older age, impairing their ability to metabolize and respond to drugs. Each of the four pharmacokinetic mechanisms (absorption, distribution, metabolism, excretion) are disrupted by age-related physiologic changes. For example, overall decreased hepatic function can interfere with clearance or metabolism of drugs and reductions in kidney function can affect renal elimination. Pharmacodynamic changes lead altered sensitivity to drugs in geriatric patients, such as increased pain relief with
morphine
Morphine is a strong opiate that is found naturally in opium, a dark brown resin in poppies (''Papaver somniferum''). It is mainly used as a analgesic, pain medication, and is also commonly used recreational drug, recreationally, or to make ...
use. Therefore, geriatric individuals require specialized pharmacological care that is informed by these age-related changes.
Geriatric syndromes
Geriatric syndromes is a term used to describe a group of clinical conditions that are highly prevalent in elderly people. These syndromes are not caused by specific pathology or disease, rather, are a manifestation of multifactorial conditions affecting several organ systems. Common conditions include frailty, functional decline, falls, loss in continence and malnutrition, amongst others.
Frailty
Frailty is marked by a decline in physiological reserve, increased vulnerability to physiological and emotional stressors, and loss of function. This may present as progressive and unintentional weight loss, fatigue, muscular weakness and decreased mobility. It is associated with increased injuries, hospitalization and adverse clinical outcomes.
Functional decline
Functional disability can arise from a decline in physical function and/or cognitive function. It is associated with an acquired difficulty in performing basic everyday tasks resulting in an increased dependence of other individuals and/or medical devices.
These tasks are sub-divided into basic activities of daily living (ADL) and instrumental activities of daily living (IADL) and are commonly used as an indicator of a person's functional status.
Activities of daily living (ADL) are fundamental skills needed to care for oneself, including feeding, personal hygiene, toileting, transferring and ambulating. Instrumental activities of daily living (IADL) describe more complex skills needed to allow oneself to live independently in a community, including cooking, housekeeping, managing one's finances and medications. Routine monitoring of ADL and IADL is an important functional assessment used by clinicians to determine the extent of support and care to provide to elderly adults and their caregivers. It serves as a qualitative measurement of function over time and predicts the need for alternative living arrangements or models of care, including senior housing apartments, skilled nursing facilities, palliative, hospice or home-based care.
Falls
Falls are the leading cause of emergency department admissions and hospitalizations in adults age 65 and older, many of which result in significant injury and permanent disability. As certain risk factors can be modifiable for the purpose of reducing falls, this highlights an opportunity for intervention and risk reduction. Modifiable factors include:
* Improving balance and muscle strength.
* Removing environmental hazards.
* Encouraging use of assistive devices.
* Treating chronic conditions.
* Adjusting medication.
Urinary incontinence
Urinary incontinence or overactive bladder symptoms is defined as unintentionally urinating oneself. These symptoms can be caused by medications that increase urine output and frequency (e.g. anti-hypertensives and diuretics), urinary tract infections, pelvic organ prolapse, pelvic floor dysfunction, and diseases that damage the nerves that regulate
bladder
The urinary bladder, or simply bladder, is a hollow organ in humans and other vertebrates that stores urine from the kidneys before disposal by urination. In humans the bladder is a distensible organ that sits on the pelvic floor. Urine enters ...
emptying. Other
musculoskeletal
The human musculoskeletal system (also known as the human locomotor system, and previously the activity system) is an organ system that gives humans the ability to move using their muscular and skeletal systems. The musculoskeletal system prov ...
conditions affecting mobility should be considered, as these can make accessing bathrooms difficult.
Malnutrition
Malnutrition
Malnutrition occurs when an organism gets too few or too many nutrients, resulting in health problems. Specifically, it is "a deficiency, excess, or imbalance of energy, protein and other nutrients" which adversely affects the body's tissues a ...
and poor nutritional status is an area of concern, affecting 12% to 50% of hospitalized elderly patients and 23% to 50% of institutionalized elderly patients living in long-term care facilities such as assisted living communities and skilled nursing facilities.
As malnutrition can occur due to a combination of physiologic, pathologic, psychologic and socioeconomic factors, it can be difficult to identify effective interventions. Physiologic factors include reduced smell and taste, and a decreased metabolic rate affecting nutritional food intake. Unintentional weight loss can result from pathologic factors, including a wide range of chronic diseases that affect cognitive function, directly impact digestion (e.g. poor dentition,
gastrointestinal cancers,
gastroesophageal reflux disease) or may be managed with dietary restrictions (e.g. congestive heart failure, diabetes mellitus,
hypertension
Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long-term medical condition in which the blood pressure in the arteries is persistently elevated. High blood pressure usually does not cause symptoms. Long-term high bl ...
). Psychologic factors include conditions including depression, anorexia, and grief.
Practical concerns
Functional abilities, independence and
quality of life
Quality of life (QOL) is defined by the World Health Organization as "an individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards ...
issues are of great concern to geriatricians and their patients. Elderly people generally want to live independently as long as possible, which requires them to be able to engage in
self-care
Self-care has been defined as the process of establishing behaviors to ensure holistic well-being of oneself, to promote health, and to actively management of illness when it occurs. Individuals engage in some form of self-care daily with food ...
and other
activities of daily living
Activity may refer to:
* Action (philosophy), in general
* Human activity: human behavior, in sociology behavior may refer to all basic human actions, economics may study human economic activities and along with cybernetics and psychology may st ...
. A geriatrician may be able to provide information about
elder care
Elderly care, or simply eldercare (also known in parts of the English-speaking world as aged care), serves the needs and requirements of senior citizens. It encompasses assisted living, adult daycare, long-term care, nursing homes (often call ...
options, and refers people to
home care Homecare (also spelled as home care) is health care or supportive care provided by a professional caregiver in the individual home where the patient or client is living, as opposed to care provided in group accommodations like clinics or nursing ho ...
services,
skilled nursing facilities
A nursing home is a facility for the residential care of elderly or disabled people. Nursing homes may also be referred to as skilled nursing facility (SNF) or long-term care facilities. Often, these terms have slightly different meanings to in ...
,
assisted living facilities
An assisted living residence or assisted living facility (ALF) is a housing facility for people with Disability, disabilities or for adults who cannot or who choose not to live independent living, independently. The term is popular in the Unite ...
, and
hospice
Hospice care is a type of health care that focuses on the palliation of a terminally ill patient's pain and symptoms and attending to their emotional and spiritual needs at the end of life. Hospice care prioritizes comfort and quality of life by ...
as appropriate.
Frail elderly people may choose to decline some kinds of medical care, because the risk-benefit ratio is different. For example, frail elderly women routinely stop
screening mammograms, because
breast cancer
Breast cancer is cancer that develops from breast tissue. Signs of breast cancer may include a lump in the breast, a change in breast shape, dimpling of the skin, milk rejection, fluid coming from the nipple, a newly inverted nipple, or a re ...
is typically a slowly growing disease that would cause them no pain, impairment, or loss of life before they would die of other causes. Frail people are also at significant risk of post-surgical complications and the need for extended care, and an accurate prediction—based on validated measures, rather than how old the patient's face looks—can help older patients make fully informed choices about their options. Assessment of older patients before elective surgeries can accurately predict the patients' recovery trajectories.
One frailty scale uses five items: unintentional weight loss,
muscle weakness
Muscle weakness is a lack of muscle strength. Its causes are many and can be divided into conditions that have either true or perceived muscle weakness. True muscle weakness is a primary symptom of a variety of skeletal muscle diseases, includi ...
, exhaustion, low physical activity, and slowed walking speed. A healthy person scores 0; a very frail person scores 5. Compared to non-frail elderly people, people with intermediate frailty scores (2 or 3) are twice as likely to have post-surgical complications, spend 50% more time in the hospital, and are three times as likely to be discharged to a skilled nursing facility instead of to their own homes.
Frail elderly patients (score of 4 or 5) who were living at home before the surgery have even worse outcomes, with the risk of being discharged to a nursing home rising to twenty times the rate for non-frail elderly people.
Subspecialties and related services
Some diseases commonly seen in elderly are rare in adults, e.g., dementia, delirium, falls. As societies aged, many specialized geriatric- and geriatrics-related services emerged
including:
Medical
*
Geriatric cardiology
Cardiogeriatrics, or geriatric cardiology, is the branch of cardiology and geriatric medicine that deals with the cardiovascular disorders in elderly people.
Cardiac disorders such as coronary heart disease, including myocardial infarction, heart ...
or
cardiogeriatrics
Cardiogeriatrics, or geriatric cardiology, is the branch of cardiology and geriatric medicine that deals with the cardiovascular disorders in elderly people.
Cardiac disorders such as coronary heart disease, including myocardial infarction, heart ...
.
*
Geriatric dentistry
Geriatric dentistry is the delivery of dental care to older adults involving diagnosis, prevention, management and treatment of problems associated with age related diseases. The mouth is referred to as a mirror of overall health, reinforcing that ...
.
*
Geriatric dermatology
Dermatology is the branch of medicine dealing with the skin.''Random House Webster's Unabridged Dictionary.'' Random House, Inc. 2001. Page 537. . It is a speciality with both medical and surgical aspects. A List of dermatologists, dermatologist ...
.
* Geriatric diagnostic imaging.
* Geriatric emergency medicine.
*
Geriatric nephrology.
*
Geriatric neurology
Geriatric neurology is the branch of medicine that studies neurologic disorders in elderly.
Origin
In 1991 Advanced Fellowship Program in Geriatric Neurology was started by the Department of Veterans Affairs. Many veterans suffered from neurodeg ...
.
*
Geriatric oncology
Geriatric oncology is a branch of medicine that is concerned with the diagnosis and treatment of cancer in the elderly, usually defined as aged 65 and older. This fairly young but increasingly important subspecialty incorporates the special needs ...
.
* Geriatric physical examination of interest especially to physicians & physician assistants.
*
Geriatric psychiatry
Geriatric psychiatry, also known as geropsychiatry, psychogeriatrics or psychiatry of old age, is a branch of medicine and a subspecialty of psychiatry dealing with the study, prevention, and treatment of neurodegenerative, cognitive impairment, ...
or
psychogeriatrics (focus on
dementia
Dementia is a disorder which manifests as a set of related symptoms, which usually surfaces when the brain is damaged by injury or disease. The symptoms involve progressive impairments in memory, thinking, and behavior, which negatively affe ...
,
delirium
Delirium (also known as acute confusional state) is an organically caused decline from a previous baseline of mental function that develops over a short period of time, typically hours to days. Delirium is a syndrome encompassing disturbances in ...
,
depression and other psychiatric disorders).
* Geriatric public health or preventive geriatrics
*
Geriatric rehabilitation
Geriatric rehabilitation or geriatric physical therapy is the branch of medicine that studies rehabilitation and physical therapy issues in elderly.
Origins
Geriatric rehabilitation covers three areas – normal aging due to disuse and deco ...
.
*
Geriatric rheumatology Geriatric rheumatology is the branch of medicine that studies rheumatologic disorders in elderly (joints, muscles & other structures around the joints). Sometimes it is called Gerontorheumatology.
Origin
The geriatric rheumatology clinic provides ...
(focus on joints and soft tissue disorders in elderly).
*
Geriatric sexology
Sexuality in older age concerns the sexual drive, sexual activity, interests, orientation, intimacy, self-esteem, behaviors, and overall Human sexuality, sexuality of people in middle age and old age, and the social perceptions concerning sexualit ...
(focus on sexuality in aged people).
* Geriatric subspeciality medical clinics (such as geriatric anticoagulation clinic, geriatric assessment clinic, falls and balance clinic, continence clinic, palliative care clinic, elderly pain clinic, cognition and memory disorders clinic).
Surgical
* Geriatric orthopaedics or orthogeriatrics (close cooperation with
orthopedic surgery
Orthopedic surgery or orthopedics ( alternatively spelt orthopaedics), is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal ...
and a focus on
osteoporosis
Osteoporosis is a systemic skeletal disorder characterized by low bone mass, micro-architectural deterioration of bone tissue leading to bone fragility, and consequent increase in fracture risk. It is the most common reason for a broken bone ...
and rehabilitation).
* Geriatric cardiothoracic surgery.
* Geriatric urology.
* Geriatric otolaryngology.
* Geriatric general surgery.
*
Geriatric trauma
Geriatric trauma refers to a traumatic injury that occurs to an elderly person. People around the world are living longer than ever. In developed and underdeveloped countries, the pace of population aging is increasing. By 2050, the world's popul ...
.
* Geriatric gynecology.
* Geriatric ophthalmology.
Other geriatrics subspecialties
*
Geriatric anesthesia
Geriatric anesthesia (or geriatric anaesthesia) is the branch of medicine that studies anesthesia approach in elderly.
Origin
The perioperative care of elderly patients differs from that of younger patients for a number of reasons. Some of these ...
(focuses on
anesthesia
Anesthesia is a state of controlled, temporary loss of sensation or awareness that is induced for medical or veterinary purposes. It may include some or all of analgesia (relief from or prevention of pain), paralysis (muscle relaxation), ...
& perioperative care of elderly).
*
Geriatric intensive-care unit
Geriatric intensive care unit is a special intensive care unit dedicated to management of critically ill elderly.
Origin
Geriatric intensive care units began because the world population is aging. Geriatric medicine is distinct from adult or ped ...
: (a special type of
intensive care unit
220px, Intensive care unit
An intensive care unit (ICU), also known as an intensive therapy unit or intensive treatment unit (ITU) or critical care unit (CCU), is a special department of a hospital or health care facility that provides intensiv ...
dedicated to critically ill elderly).
*
Geriatric nursing
Gerontological nursing is the specialty of nursing pertaining to older adults. Gerontological nurses work in collaboration with older adults, their families, and communities to support healthy aging, maximum functioning, and quality of life. The ...
(focuses on nursing of elderly patients and the aged).
* Geriatric nutrition.
* Geriatric occupational therapy.
* Geriatric pain management.
* Geriatric pharmacy.
* Geriatric
optometry
Optometry is a specialized health care profession that involves examining the eyes and related structures for defects or abnormalities. Optometrists are health care professionals who typically provide comprehensive primary eye care.
In the Uni ...
.
* Geriatric physical therapy.
* Geriatric
podiatry
Podiatry () or podiatric medicine () is a branch of medicine devoted to the study, diagnosis, medical and surgical treatment of disorders of the foot, ankle, and leg.
A Doctor of Podiatric Medicine (DPM), or a podiatrist, is a healthcare p ...
.
*
Geriatric psychology Geriatric psychology is a subfield of psychology that specializes in the mental and physical health of individuals in the later stages of life. These specialized psychologists study a variety of psychological abilities that deplete as aging occurs ...
.
* Geriatric speech-language
pathology
Pathology is the study of the causes and effects of disease or injury. The word ''pathology'' also refers to the study of disease in general, incorporating a wide range of biology research fields and medical practices. However, when used in ...
(focuses on neurological disorders such as dysphagia, stroke, aphasia, and traumatic brain injury).
* Geriatric mental health counselor/specialist (focuses on treatment more so than assessment).
* Geriatric audiology.
History
One of the eight branches of the traditional Indian system of medicine,
Ayurveda
Ayurveda () is an alternative medicine system with historical roots in the Indian subcontinent. The theory and practice of Ayurveda is pseudoscientific. Ayurveda is heavily practiced in India and Nepal, where around 80% of the population repo ...
, is ''jara'' or ''rasayana'', similar to geriatrics.
Charaka
Charaka was one of the principal contributors to Ayurveda, a system of medicine and lifestyle developed in Ancient India. He is known as an editor of the medical treatise entitled ''Charaka Samhita'', one of the foundational texts of classical ...
described the fatigue and physical exhaustion caused by premature aging as the result of a poor diet. The ''
Charaka Samhita
The ''Charaka Samhita'' (, “Compendium of ''Charaka''”) is a Sanskrit text on Ayurveda (Indian traditional medicine). Along with the ''Sushruta Samhita'', it is one of the two foundational texts of this field that have survived from ancien ...
'' recommends that elderly patients avoid excessive physical or mental strain and consume a light but nutritious diet.
A number of physicians in the
Byzantine Empire
The Byzantine Empire, also referred to as the Eastern Roman Empire or Byzantium, was the continuation of the Roman Empire primarily in its eastern provinces during Late Antiquity and the Middle Ages, when its capital city was Constantinopl ...
studied geriatrics, with doctors like
Aëtius of Amida
Aëtius of Amida (; grc-gre, Ἀέτιος Ἀμιδηνός; Latin: ''Aëtius Amidenus''; fl. mid-5th century to mid-6th century) was a Byzantine Greek physician and medical writer, particularly distinguished by the extent of his erudition. His ...
evidently specializing in the field.
Alexander of Tralles
Alexander of Tralles ( grc-x-byzant, Ἀλέξανδρος ὁ Τραλλιανός; ca. 525– ca. 605) was one of the most eminent physicians in the Byzantine Empire. His birth date may safely be put in the 6th century AD, for he mentions Aëtiu ...
viewed the process of aging as a natural and inevitable form of
marasmus
Marasmus is a form of severe malnutrition characterized by energy deficiency. It can occur in anyone with severe malnutrition but usually occurs in children. Body weight is reduced to less than 62% of the normal (expected) body weight for the a ...
, caused by the loss of moisture in body tissue. The works of Aëtius describe the mental and physical symptoms of aging.
Theophilus Protospatharius
Theophilus Protospatharius ( el, Θεόφιλος Πρωτοσπαθάριος; ca. 7th century) was the author of several extant Greek medical works of uncertain status, either from Philaretus or Philotheus. Nothing is known of his life or the ti ...
and
Joannes Actuarius
Johannes Zacharias Actuarius ( el, Ἰωάννης Ζαχαρίου Ἀκτουάριος; – c. 1328
), son of Zacharias ( el, Ζαχαρίας), was a Byzantine physician in Constantinople. He is given the title of '' Actuarius'', a dignity fr ...
also discussed the topic in their medical works. Byzantine physicians typically drew on the works of
Oribasius
Oribasius or Oreibasius ( el, Ὀρειβάσιος; c. 320 – 403) was a Greek medical writer and the personal physician of the Roman emperor Julian. He studied at Alexandria under physician Zeno of Cyprus before joining Julian's retinue. He ...
and recommended that elderly patients consume a diet rich in foods that provide "heat and moisture". They also recommended frequent bathing, massaging, rest, and low-intensity exercise regimens.
In ''
The Canon of Medicine
''The Canon of Medicine'' ( ar, القانون في الطب, italic=yes ''al-Qānūn fī al-Ṭibb''; fa, قانون در طب, italic=yes, ''Qanun-e dâr Tâb'') is an encyclopedia of medicine in five books compiled by Persian physician-phi ...
'', written by
Avicenna
Ibn Sina ( fa, ابن سینا; 980 – June 1037 CE), commonly known in the West as Avicenna (), was a Persian polymath who is regarded as one of the most significant physicians, astronomers, philosophers, and writers of the Islamic G ...
in 1025, the author was concerned with how "old folk need plenty of sleep" and how their bodies should be
anointed
Anointing is the ritual act of pouring aromatic oil over a person's head or entire body.
By extension, the term is also applied to related acts of sprinkling, dousing, or smearing a person or object with any perfumed oil, milk, butter, or oth ...
with
oil
An oil is any nonpolar chemical substance that is composed primarily of hydrocarbons and is hydrophobic (does not mix with water) & lipophilic (mixes with other oils). Oils are usually flammable and surface active. Most oils are unsaturated ...
, and recommended
exercise
Exercise is a body activity that enhances or maintains physical fitness and overall health and wellness.
It is performed for various reasons, to aid growth and improve strength, develop muscles and the cardiovascular system, hone athletic ...
s such as
walking
Walking (also known as ambulation) is one of the main gaits of terrestrial locomotion among legged animals. Walking is typically slower than running and other gaits. Walking is defined by an 'inverted pendulum' gait in which the body vaults o ...
or
horse-riding
Equestrianism (from Latin , , , 'horseman', 'horse'), commonly known as horse riding (Commonwealth English) or horseback riding (American English), includes the disciplines of riding, driving, and vaulting. This broad description includes the ...
. Thesis III of the ''Canon'' discussed the
diet
Diet may refer to:
Food
* Diet (nutrition), the sum of the food consumed by an organism or group
* Dieting, the deliberate selection of food to control body weight or nutrient intake
** Diet food, foods that aid in creating a diet for weight loss ...
suitable for
old people
Old age refers to ages nearing or surpassing the life expectancy of human beings, and is thus the end of the human life cycle. Terms and euphemisms for people at this age include old people, the elderly (worldwide usage), OAPs (British usage ...
, and dedicated several sections to elderly patients who become
constipated
Constipation is a bowel dysfunction that makes bowel movements infrequent or hard to pass. The Human feces, stool is often hard and dry. Other symptoms may include abdominal pain, bloating, and feeling as if one has not completely passed the bo ...
.
The
Arab
The Arabs (singular: Arab; singular ar, عَرَبِيٌّ, DIN 31635: , , plural ar, عَرَب, DIN 31635: , Arabic pronunciation: ), also known as the Arab people, are an ethnic group mainly inhabiting the Arab world in Western Asia, ...
physician
Algizar (–980) wrote a book on the medicine and health of the elderly.
He also wrote a book on
sleep disorder
A sleep disorder, or somnipathy, is a medical disorder of an individual's sleep patterns. Some sleep disorders are severe enough to interfere with normal physical, mental, social and emotional functioning. Polysomnography and actigraphy are test ...
s and another one on
forgetfulness
Forgetting or disremembering is the apparent loss or modification of information already encoded and stored in an individual's short or long-term memory. It is a spontaneous or gradual process in which old memories are unable to be recalled from ...
and how to strengthen
memory
Memory is the faculty of the mind by which data or information is encoded, stored, and retrieved when needed. It is the retention of information over time for the purpose of influencing future action. If past events could not be remembered, ...
, and a treatise on causes of
mortality
Mortality is the state of being mortal, or susceptible to death; the opposite of immortality.
Mortality may also refer to:
* Fish mortality, a parameter used in fisheries population dynamics to account for the loss of fish in a fish stock throug ...
.
Another Arab physician in the 9th century,
Ishaq ibn Hunayn
Abū Yaʿqūb Isḥāq ibn Ḥunayn ( ar, إسحاق بن حنين) (c. 830 Baghdad, – c. 910-1) was an influential Arab physician and translator, known for writing the first biography of physicians in the Arabic language. He is also known for ...
(died 910), the son of Nestorian Christian scholar
Hunayn Ibn Ishaq
Hunayn ibn Ishaq al-Ibadi (also Hunain or Hunein) ( ar, أبو زيد حنين بن إسحاق العبادي; (809–873) was an influential Nestorian Christian translator, scholar, physician, and scientist. During the apex of the Islamic ...
, wrote a ''Treatise on Drugs for Forgetfulness''.
George Day published the ''Diseases of Advanced Life'' in 1849, one of the first publications on the subject of geriatric medicine.
The first modern geriatric hospital was founded in Belgrade, Serbia, in 1881 by doctor
Laza Lazarević
Lazar "Laza" Lazarević ( sr-cyr, Лазаp Лаза Лазаревић, 13 May 1851 – 10 January 1891) was a Serbian writer, psychiatrist, and neurologist.
Medical career
Lazarević was born in Šabac in 1851. He studied medicine at the U ...
.
The term ''geriatrics'' was proposed in
1908 by Ilya Ilyich Mechnikov, Laurate of the Nobel Prize for Medicine and later by 1909 by Dr.
Ignatz Leo Nascher
Ignatz Leo Nascher (11 October 1863 – 25 December 1944) an Austrian Americans, Austrian-American doctor and Gerontology, gerontologist. He coined the term "geriatrics" in 1909. Born in Vienna, Nascher immigrated to the United States at a young a ...
, 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 began with the "mother"
of geriatrics, Dr.
Marjory Warren
Marjory Winsome Warren ( 28 October 1897 – 5 September 1960) is one of the first geriatricians and considered the mother of modern geriatric medicine.
Early life and career
Warren was born in London, to Walter Richard Warren (a barrister) and hi ...
.
Warren emphasized that rehabilitation was essential to the care of older people. Using her experiences as a physician in a London Workhouse infirmary, she believed 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 multidisciplinary history. It values all the professions, not just medicine, for their contributions in optimizing the well-being and independence of older people.
Another innovator of British geriatrics is Bernard Isaacs, who described the "giants" of geriatrics mentioned above: immobility and instability,
incontinence
Incontinence or Incontinent may refer to:
*Fecal incontinence, the involuntary excretion of bowel contents
*Urinary incontinence, the involuntary excretion of urine
* Lack of moderation or self-control, especially related to sexual desire - see I ...
, and
impaired intellect. Isaacs asserted that, if examined closely enough, all common problems with older people relate to one or more of these giants.
The care of older people in the UK has been advanced by the implementation of the National Service Frameworks for Older People, which outlines key areas for attention.
Geriatrician training
United States
In the
United States
The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country primarily located in North America. It consists of 50 states, a federal district, five major unincorporated territorie ...
, geriatricians are
primary-care physician
A primary care physician (PCP) is a physician who provides both the first contact for a person with an undiagnosed health concern as well as continuing care of varied medical conditions, not limited by cause, organ system, or diagnosis. The term ...
s (
D.O. or
M.D.
Doctor of Medicine (abbreviated M.D., from the Latin ''Medicinae Doctor'') is a medical degree, the meaning of which varies between different jurisdictions. In the United States, and some other countries, the M.D. denotes a professional degree. T ...
) who are board-certified in either
family medicine
Family medicine is a medical specialty within primary care that provides continuing and comprehensive health care for the individual and family across all ages, genders, diseases, and parts of the body. The specialist, who is usually a primary ...
or
internal medicine and who have also acquired the additional training necessary to obtain the Certificate of Added Qualifications (CAQ) in geriatric medicine. Geriatricians have developed an expanded expertise in the aging process, the impact of aging on illness patterns, drug therapy in seniors, health maintenance, and
rehabilitation
Rehabilitation or Rehab may refer to:
Health
* Rehabilitation (neuropsychology), therapy to regain or improve neurocognitive function that has been lost or diminished
* Rehabilitation (wildlife), treatment of injured wildlife so they can be retur ...
. They serve in a variety of roles including hospital care, long-term care, home care, and terminal care. They are frequently involved in ethics consultations to represent the unique health and diseases patterns seen in seniors. The model of care practiced by geriatricians is heavily focused on working closely with other disciplines such as nurses,
pharmacists
A pharmacist, also known as a chemist (Commonwealth English) or a druggist (North American and, archaically, Commonwealth English), is a healthcare professional who prepares, controls and distributes medicines and provides advice and instructi ...
, therapists, and social workers.
United Kingdom
In the United Kingdom, most geriatricians are hospital physicians, whereas others focus on community geriatrics in particular. Although originally a distinct clinical specialty, it has been integrated as a specialization of general medicine since the late 1970s. Most geriatricians are, therefore, accredited for both. Unlike in the United States, geriatric medicine is a major specialty in the United Kingdom and are the single most numerous internal medicine specialists.
Canada
In
Canada
Canada is a country in North America. Its ten provinces and three territories extend from the Atlantic Ocean to the Pacific Ocean and northward into the Arctic Ocean, covering over , making it the world's second-largest country by tot ...
, there are two pathways that can be followed in order to work as a physician in a geriatric setting.
#Doctors of Medicine (M.D.) can complete a three-year core internal medicine residency program, followed by two years of specialized geriatrics residency training. This pathway leads to certification, and possibly fellowship after several years of supplementary academic training, by the
Royal College of Physicians and Surgeons of Canada
The Royal College of Physicians and Surgeons of Canada (french: Collège royal des médecins et chirurgiens du Canada) is a regulatory college which acts as a national, nonprofit organization established in 1929 by a special Act of Parliament to o ...
.
# Doctors of Medicine (M.D.) can opt for a two-year residency program in family medicine and complete a one-year enhanced skills program in
care of the elderly
Elderly care, or simply eldercare (also known in parts of the English-speaking world as aged care), serves the needs and requirements of senior citizens. It encompasses assisted living, adult daycare, long-term care, nursing homes (often called re ...
. This post-doctoral pathway is accredited by the
College of Family Physicians of Canada
The College of Family Physicians of Canada (CFPC; French: ''Collège des médecins de famille du Canada'', ''CMFC'') is a professional association and the legal certifying body for the practice of family medicine in Canada. This national organiz ...
.
Many universities across Canada also offer gerontology training programs for the general public, such that
nurses
Nursing is a profession within the health care sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life. Nurses may be differentiated from other health ca ...
and other health care professionals can pursue further education in the discipline in order to better understand the process of aging and their role in the presence of older patients and residents.
India
In India, Geriatrics is a relatively new speciality offering. A three-year post graduate residency (M.D) training can be joined for after completing the 5.5-year undergraduate training of
MBBS
Bachelor of Medicine, Bachelor of Surgery ( la, Medicinae Baccalaureus, Baccalaureus Chirurgiae; abbreviated most commonly MBBS), is the primary medical degree awarded by medical schools in countries that follow the tradition of the United King ...
(Bachelor of Medicine and Bachelor of Surgery). Unfortunately, only eight major institutes provide M.D in Geriatric Medicine and subsequent training. Training in some institutes are exclusive in the Department of Geriatric Medicine, with rotations in Internal medicine, medical subspecialties etc. but in certain institutions, are limited to 2-year training in Internal medicine and subspecialities followed by one year of exclusive training in Geriatric Medicine.
Minimum geriatric competencies
In July 2007, the
Association of American Medical Colleges
The Association of American Medical Colleges (AAMC) is a nonprofit organization based in Washington, D.C. that was established in 1876. It represents medical schools, teaching hospitals, and academic and scientific societies, while providing serv ...
(AAMC) and the
John A. Hartford Foundation
The John A. Hartford Foundation (JAHF or the Hartford Foundation) is a private United States-based philanthropy whose current mission is to improve the care of older adults. For many years, it made grants for research and education in geriatric me ...
hosted a National Consensus Conference on Competencies in Geriatric Education where a consensus was reached on minimum competencies (learning outcomes) that graduating medical students needed to assure competent care by new interns to older patients. Twenty-six (26) Minimum Geriatric Competencies in eight content domains were endorsed by the
American Geriatrics Society
The American Geriatrics Society (AGS) is a non-profit professional society founded on June 11, 1942, for health care professionals practicing geriatric medicine. Among the founding physicians were Dr. Ignatz Leo Nascher, who coined the term "geri ...
(AGS), the
American Medical Association
The American Medical Association (AMA) is a professional association and lobbying group of physicians and medical students. Founded in 1847, it is headquartered in Chicago, Illinois. Membership was approximately 240,000 in 2016.
The AMA's state ...
(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.
Research
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
Adipose tissue, body fat, or simply fat is a loose connective tissue composed mostly of adipocytes. In addition to adipocytes, adipose tissue contains the stromal vascular fraction (SVF) of cells including preadipocytes, fibroblasts, vascular en ...
and muscle and drug elimination.
Psychological considerations include the fact that elderly persons (in particular, those experiencing substantial memory loss or other types of cognitive impairment) are unlikely to be able to adequately monitor and adhere to their own scheduled
pharmacological
Pharmacology is a branch of medicine, biology and pharmaceutical sciences concerned with drug or medication action, where a drug may be defined as any artificial, natural, or endogenous (from within the body) molecule which exerts a biochemica ...
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 a medication schedule was reported by a striking one-third of the participants. Further development of methods that might possibly help monitor and regulate dosage administration and scheduling is an area that deserves attention.
Another important area is the potential for improper administration and use of potentially inappropriate medications, and the possibility of errors that could 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 medico-legal issues
Elderly persons sometimes cannot make decisions for themselves. They may have previously prepared a
power of attorney
A power of attorney (POA) or letter of attorney is a written authorization to represent or act on another's behalf in private affairs (which may be financial or regarding health and welfare), business, or some other legal matter. The person auth ...
and
advance directives
An advance healthcare directive, also known as living will, personal directive, advance directive, medical directive or advance decision, is a legal document in which a person specifies what actions should be taken for their health if they are no ...
to provide guidance if they are unable to understand what is happening to them, whether this is due to long-term dementia or to a short-term, correctable problem, such as
delirium
Delirium (also known as acute confusional state) is an organically caused decline from a previous baseline of mental function that develops over a short period of time, typically hours to days. Delirium is a syndrome encompassing disturbances in ...
from a fever.
Geriatricians
Geriatrics, or geriatric medicine, is a medical specialty focused on providing care for the unique health needs of older adults. The term ''geriatrics'' originates from the Greek language, Greek γέρων ''geron'' meaning "old man", and ιατ ...
must respect the patients' privacy while seeing that they receive appropriate and necessary services. More than most specialties, they must consider whether the patient has the legal
responsibility and
competence to understand the facts and make decisions. They must support
informed consent
Informed consent is a principle in medical ethics and medical law, that a patient must have sufficient information and understanding before making decisions about their medical care. Pertinent information may include risks and benefits of treatme ...
and resist the temptation to manipulate the patient by withholding information, such as the dismal
prognosis
Prognosis (Greek: πρόγνωσις "fore-knowing, foreseeing") is a medical term for predicting the likely or expected development of a disease, including whether the signs and symptoms will improve or worsen (and how quickly) or remain stabl ...
for a condition or the likelihood of recovering from surgery at home.
Elder abuse
Elder abuse (also called "elder mistreatment", "senior abuse", "abuse in later life", "abuse of older adults", "abuse of older women", and "abuse of older men") is "a single, or repeated act, or lack of appropriate action, occurring within any rela ...
is the physical, financial, emotional, sexual, or other type of abuse of an older dependent. Adequate training, services, and support can reduce the likelihood of elder abuse, and proper attention can often identify it. For elderly people who are unable to care for themselves, geriatricians may recommend
legal guardianship
A legal guardian is a person who has been appointed by a court or otherwise has the legal authority (and the corresponding duty) to make decisions relevant to the personal and property interests of another person who is deemed incompetent, calle ...
or
conservatorship
Under U.S. law, conservatorship is the appointment of a guardian or a protector by a judge to manage the financial affairs and/or daily life of another person due to old age or physical or mental limitations. A person under conservatorship is a " ...
to care for the person or the estate.
Elder abuse occurs increasingly when caregivers of elderly relatives have a mental illness. These instances of abuse can be prevented by engaging these individuals with mental illness in mental health treatment. Additionally, interventions aimed at decreasing elder reliance on relatives may help decrease conflict and abuse. Family education and support programs conducted by mental health professionals may also be beneficial for elderly patients to learn how to set limits with relatives with psychiatric disorders without causing conflict that leads to abuse.
See also
*
Aging in Place
The U.S. Centers for Disease Control and Prevention defines aging in place as "the ability to live in one's own home and community safely, independently, and comfortably, regardless of age, income, or ability level".
Environmental gerontology
Re ...
*
Aging-associated diseases
An aging-associated disease (commonly termed age-related disease, ARD) is a disease that is most often seen with increasing frequency with increasing senescence. They are essentially complications of senescence, distinguished from the aging pr ...
*
Alliance for Aging Research
*
Commission for Certification in Geriatric Pharmacy
The Commission for Certification in Geriatric Pharmacy (CCGP) is a non-profit organization which has established a voluntary professional certification program for pharmacists. Pharmacists must pass a written examination to become certified and mus ...
*
Elderly care
Elderly care, or simply eldercare (also known in parts of the English-speaking world as aged care), serves the needs and requirements of senior citizens. It encompasses assisted living, adult daycare, long-term care, nursing homes (often called re ...
*
Gero-Informatics
Health informatics is the field of science and engineering that aims at developing methods and technologies for the acquisition, processing, and study of patient data, which can come from different sources and modalities, such as electronic hea ...
*
GERRI
Gerri may refer to:
*Gerri, a feminine given name:
**Gerri Elliott (21st century), American businesswoman
**Gerri Green (born 1995), American football player
**Gerri Lawlor (21st century), American actress
**Gerri Peev (21st century), Bulgarian-Br ...
*
Nosokinetics Nosokinetics is the science/subject of measuring and modelling the process of care in health and social care systems.'' Nosokinetics'' brings together the Greek words for ''noso'': disease and ''kinetics'': movement.
Black box models are currently ...
*
Life extension
Life extension is the concept of extending the human life expectancy, lifespan, either modestly through improvements in medicine or dramatically by increasing the maximum lifespan beyond its generally-settled oldest people, limit of 125 years.
S ...
*
Geriatric medicine in Egypt
*
Transgenerational design
Transgenerational design is the practice of making products and environments compatible with those physical and sensory impairments associated with human aging and which limit major activities of daily living. The term ''transgenerational design ...
* ''
Physical & Occupational Therapy in Geriatrics'' (journal)
*
Gerontological nursing
Gerontological nursing is the specialty of nursing pertaining to older adults. Gerontological nurses work in collaboration with older adults, their families, and communities to support healthy aging, maximum functioning, and quality of life. The ...
References
Further reading
*
*
*
*
External links
Merck Manual of GeriatricsMinimum Geriatric Competencies - Portal of Geriatric Online EducationCare for the elderly in the EU
American Geriatrics Society
{{Authority control
Ageing