GERIATRICS

Dr. Meg-angela Christi Amores

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

Aging defined

is not a disease however, the risk of developing disease

is increased, often dramatically, as a function of age

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

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

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

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

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

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

Theories of agingHypothesis How it may work

Genetic 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

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

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

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

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

Approach to the Geriatric Patient MMSE Confusion Assessment Method (CAM) Visual acuity

Geriatric Syndromes

a symptom presentation that is common in older adults

most are multifactorial in origin DELIRIUM and DEMENTIA FALLS URINARY INCONTINENCE PRESSURE ULCERS

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

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

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

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

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

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

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