Geriatrics or Geriatric medicine is a word that has stared gaining popularity in recent times. It is used in connection to older people or the elderly and deals with caring for them. This word became popular as the need to address the special needs of the older people arose. The age cut off for defining a person as elderly or an older person is generally accepted as 65 years, however, the World Health Organisation, WHO recognizes 60 years as a better cut off age. This is because in most societies, especially the low and middle-income countries, most adults begin to encounter issues related to aging at 60 years. The word Geriatrics is used interchangeably with Geriatric medicine. It refers to the medical care given to the elderly adults. Its main purpose is to promote the health of the elderly by preventing and treating diseases in the elderly while managing disabilities among them as a result of these diseases. However, in reality, the average age of most patients that attend geriatric centres is around 70 years. Geriatric medicine or geriatrics is often confused with Gerontology. While Geriatrics deals with medical problems of elderly/older people, Gerontology deals with all the issues associated with aging. This goes beyond medical care to include other occupational and social aspects of aging.
Why is there a need for geriatrics?
Because of advances in technology, medicine, and with diagnostic breakthroughs, the life span of individuals worldwide has gradually increased. Thus, there are more ‘older people ‘or Elderly ones among us now. According to the WHO, there are about 1 billion people worldwide aged 60 years and above and this number is expected to increase to 2 billion people by 2050. This fact has made it necessary to pay more attention to the unique health needs of the elderly.
What is unique about Geriatrics and how is it different from ‘normal’ adult medicine?
Ageing is a complex process which occurs in every individual. It often occurs differently for different individuals but is characterized by the same processes of cellular and organ aging. This means that all the body organs are aging at the same time. Things such as lifestyle habits, diet, genes and the environment of an individual also affect this process. The process of aging leads to organ changes in all the systems. Some of these changes may either be caused by disease processes, which are more prevalent in the older age group, or are caused by the process of ageing itself. Issues like stiff, unstable joints, leading to reduced mobility, weak muscles, poor vision, can predispose to falls which can have serious consequences. Other issues commonly seen in Geriatrics are poor appetite, loss of teeth, constipation, non-communicable diseases like hypertension and diabetes mellitus, obesity, and some cancers. Geriatric medicine therefore pays special attention to both the prevention and management of these issues as they mostly do not occur in isolation, and one person may have more than one of these health issues. The manifestation and experience of these health problems can also be greatly influenced by the process of aging itself. This therefore makes geriatric different from the ‘normal’ adult medicine.
What are the Geriatric giants?
The word ‘geriatric giants’ was formed by Bernard Isaacs in 1965, he was one of the fathers of geriatrics. These giants are special issues to pay attention to in the geriatric patient. They are:
- incontinence, and
- impaired intellect/memory.
Later on, a fifth giant, iatrogenesis which deals with the many drug interactions in the elderly was added.
Newer researches and study into the fundamental cause of most of the problems of the elderly evolved over the past 50 years and these giants were further summarized and the ‘modern geriatric giants’ were described as:
- the anorexia of aging,
- and cognitive impairment.
What are the Special issues in Geriatrics?
Based on the traditional and modern geriatric giants, the special issues a geriatric care team should take note of and actively try to prevent or minimize the complications in the elderly are:
- Risk of falls
- Risk of malnutrition due to poor appetite, poor dentition, poor digestion, limited dietary choices, constipation.
- Poor memory/reduced intellect
- Poor vision
- Poor hearing
- Reduced independence/more need for dependence
- Elder abuse
- Risk of psychological issues like depression
- Chronic pain from various illnesses
- Death and dying
What are the branches of Geriatrics?
Even though there are no formal demarcations of geriatrics, it can be sub-divided into branches based on the identified special needs of the patients and the services they require. According to Wikipedia, the branches can be broadly divided into medical or surgical geriatrics and they include:
• Geriatric dentistry
• Geriatric dermatology
• Geriatric diagnostic imaging
• Geriatric emergency medicine
• Geriatric nephrology
• Geriatric neurology
• Geriatric oncology
• Geriatric physical examination of interest especially to physicians & physician assistants.
• Geriatric psychiatry or psychogeriatrics (focus on dementia, delirium, depression and other psychiatric disorders)
• Geriatric public health or preventive geriatrics
• Geriatric rehabilitation
• Geriatric rheumatology (focus on joints and soft tissue disorders in elderly)
• Geriatric sexology (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)
• Orthogeriatrics (close cooperation with orthopedic surgery and a focus on osteoporosis and rehabilitation).
• Geriatric cardiothoracic surgery
• Geriatric urology
• Geriatric otolaryngology
• Geriatric general surgery
• Geriatric trauma
• Geriatric gynecology
• Geriatric ophthalmology
Other geriatrics subspecialties
• Geriatric anesthesia (focuses on anesthesia & perioperative care of elderly)
• Geriatric intensive-care unit: (a special type of intensive care unit dedicated to critically ill elderly)
• Geriatric nursing (focuses on nursing of elderly patients and the aged).
• Geriatric nutrition
• Geriatric Occupational Therapy
• Geriatric Pain Management
• Geriatric Pharmacy
• Geriatric Physical Therapy
• Geriatric podiatry
• Geriatric psychology
• Geriatric Speech-Language Pathology (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
Who are the members of the geriatric team?
Geriatrics is a multidisciplinary field. A good geriatric practice works with a well-coordinated team of geriatric health professional. They are:
- Geriatric nurses,
- Nurse practitioners,
- Palliative care or hospice physician.
- Physical and occupational therapists, and a
- Physician assistants,
- Physicians (doctors (internal physicians or family physicians) trained in geriatric care),
- Social workers,