GERIATRICS
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Transcript of GERIATRICS
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GERIATRICSDr. Meg-angela Christi Amores
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AGING defined progressive, universal decline first in
functional reserve and then in function that occurs in organisms over time
Heterogeneous varies widely in different individuals and
in different organs within a particular individual
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Aging defined is not a disease however, the risk of developing disease
is increased, often dramatically, as a function of age
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AGING biochemical composition of tissues
changes physiologic capacity decreases ability to maintain homeostasis in
adapting to stressors declines vulnerability to disease processes
increases mortality rate increases exponentially with age
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Epidemiology Between 2000 and 2030, the number of
older adults worldwide is expected to increase from 420 to 974 million
Only 13% of those 80 years live in the United States; over 40% of those 80 years live in Asia.
WOMEN outlive MEN only 15% of centenarians are men older women are frequently single and live
alone
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Biology of Aging As we age, we become increasingly unlike
one another homeostatic mechanisms are slower to
respond to stressors take longer to restore normal function Allostasis - ability to maintain stable
function in the face of a change in the environment Decreases with age
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75-year-old with a blood pressure of 170/90 mmHg might have been considered to have an age-related increase in systolic blood pressure
we now know that such a reading is a reflection of increased vascular stiffness
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Gerontology – study of aging aimed at understanding the cellular and
molecular basis of age-related changes preserving function as long as possible and
extending life span
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Aging studies Alteration of genes involved in DNA
repair often leads to premature aging Alteration of genes involved in insulin
signaling often leads to life extension Calorie restriction (at least 30% lower
than an ad lib diet) increases both average and maximal life span in a wide range of species
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Theories of agingHypothesis How it may workGenetic Aging is a genetic program activated in post-reproductive
life when an individual's evolutionary mission is accomplished
Oxidative stress Accumulation of oxidative damage to DNA, proteins, and lipids interferes with normal function and produces a decrease in stress responses
Mitochondrial dysfunction
A common deletion in mitochondrial DNA with age compromises function and alters cell metabolic processes and adaptability to environmental change
Hormonal changes The decline and loss of circadian rhythm in secretion of some hormones produces a functional hormone deficiency state
Telomere shortening Aging is related to a decline in the ability of cells to replicate
Defective host defenses
The failure of the immune system to respond to infectious agents and the overactivity of natural immunity create vulnerability to environmental stresses
Accumulation of senescent cells
Renewing tissues become dysfunctional through loss of ability to renew
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Approach to the Geriatric Patient functional status is the best indicator of
prognosis and longevity how well a person is able to provide for
his or her own daily needs
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Approach to the Geriatric patient First opportunity: when HE is greeted,
and taken to exam room: what way is the greeting received Does the patient need assistance in getting
out of a chair use of an assistive device, such as a cane
or walker The patient's gait speed and stability Is the patient fatigued after a short walk
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Approach to the Geriatric Patient ADL (activities of daily living)
dressing, bathing, feeding, toileting, transferring, and ambulating
IADL (instrumental activities of daily living) money management, medication
administration, using transportation, using the telephone, shopping, housekeeping, and meal preparation
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Approach to the Geriatric Patient gait and balance, cognition, vision and
hearing, dental and nutritional health, and driving ability
Timed Get Up and Go Test patient is observed and timed as he or she
rises from a chair, walks 3 m, turns around, and returns to sit down in the chair
healthy older adult should be able to complete the test in <10 s
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Approach to the Geriatric Patient MMSE Confusion Assessment Method (CAM) Visual acuity
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Geriatric Syndromes a symptom presentation that is common in
older adults most are multifactorial in origin DELIRIUM and DEMENTIA FALLS URINARY INCONTINENCE PRESSURE ULCERS
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Dimensia and Delirium Dementia is a syndrome of progressive
decline in which multiple intellectual abilities deteriorate, causing both cognitive and functional impairment
dementia is a state of chronic confusion, delirium is an acute state of confusion
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Dimentia and Delirium Both are characterized by disorientation,
memory impairment, paranoia, hallucinations, emotional lability, and sleep-wake cycle reversal
features of delirium are acute onset, impaired attention, and an altered level of consciousness
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Dimentia Most Common Causes of Dementia Alzheimer's disease Vascular dementia Multi-infarct Diffuse white matter disease
(Binswanger's) Alcoholisma Parkinson's disease Drug/medication intoxicationa
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Alzheimer’s Disease most often presents with subtle onset of
memory loss followed by a slowly progressive dementia that has a course of several years
diffuse atrophy of the cerebral cortex with secondary enlargement of the ventricular system
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Alzheimer’s Disease Tend to follow a characteristic pattern beginning with memory impairment and
spreading to language and visuospatial deficits 20% of AD patients present with nonmemory
complaints cognitive problems begin to interfere with daily
activities the patient is unable to work, easily lost some persons remain ambulatory but wander
aimlessly in severe stages
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Epidemiology most important risk factors for AD are
old age and a positive family history Female gender past history of head trauma with
concussion frequency of AD increases with each
decade of adult life
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Treatment of AD primary focus is on long-term
amelioration of associated behavioral and neurologic problems
No cure Memory aids, pleasant home, safe living
space, stop driving, communication, repeated calm reassurance
Meds: Donepezil, rivastigmine, galantamine, memantine