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20-September-2008 09:29:10 - Geriatrics Geriatrics is the branch of internal medicine that focuses on health care of the elderly. It aims to promote health and to prevent and treat diseases and disabilities in older adults. Elderly female in residential care home Elderly female in residential care home There is no set age at which patients may be under the care of a geriatrician. Rather, this is determined by a profile of the typical problems that geriatrics focuses on. This includes the so-called 'geriatric giants' of immobility, instability, incontinence and impaired intellect/memory. Health issues in older adults may also include elderly care, delirium, use of multiple medications, impaired vision and hearing. The term geriatrics differs from gerontology. This is the study of the aging process itself. The term comes from the Greek geron meaning old man and iatros meaning healer. Contents 1 Scope 2 History 3 Current trends 4 Pharmacology 5 See also 6 Notes 7 References 8 External links Scope In the United States, geriatricians are primary care physicians who are board-certified in either family practice or internal medicine and have also acquired the additional training necessary to obtain the Certificate of Added Qualifications CAQ in geriatric medicine. In the United Kingdom, most geriatricians are hospital physicians, while some focus on community geriatrics. While originally a distinct clinical speciality, it has been integrated as a specialism of general medicine since the late 1970s.1 Most geriatricians are therefore accred for both. Specialized geriatrics services include orthogeriatrics close cooperation with orthopaedic surgery and a focus on osteoporosis and rehabilitation, psychogeriatrics focus on dementia, delirium, depression and other conditions common in the elderly, Cardiogeriatrics focus on cardiac diseases of elderly and rehabilitation of elderly. Rehabilitation may also take in intermediate care, where patients are referred by a hospital or family doctor, when there is a requirement to provide hospital based short term intensive physical therapy aimed at the recovery of musculoskeletal function, particularly recovery from joint, tendon, or ligament repair and, or, physical medicine and rehabilitation care when elderly patients get out of synch with their medication resulting in a deterioration of their personal health which reduces their ability to live independently. History The Canon of Medicine,2 written by Abu Ali Ibn Sina Avicenna in 1025, was the first book to offer instruction for the care of the aged, foreshadowing modern gerontology and geriatrics. In a chapter entitled Regimen of Old Age, Avicenna was concerned with how old folk need plenty of sleep, how their bodies should be anointed with oil, and recommended exercises such as walking or horse-riding. Thesis III of the Canon discussed the diet suitable for old people, and dedicated several sections to elderly patients who become constipated.345 The famous Arabic physician, Ibn Al-Jazzar Al-Qayrawani Algizar, circa 898-980, also wrote a special book on the medicine and health of the elderly, entitled Kitab Tibb al-Machayikh6 or Teb al-Mashaikh wa hefz sehatahom.7 He also wrote a book on sleep disorders and another one on forgetfulness and how to strengthen memory, entitled Kitab al-Nissian wa Toroq Taqwiati Adhakira,8910 and a treatise on causes of mortality entitled Rissala Fi Asbab al-Wafah.11 Another Arabic physician in the 9th century, Ishaq ibn Hunayn died 910, the son of Hunayn Ibn Ishaq, wrote a Treatise on Drugs for Forgetfulness Risalah al-Shafiyah fi adwiyat al-nisyan.12 The term geriatrics was proposed in 1909 by Dr. Ignatz Leo Nascher, 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 really began with the Mother of Geriatrics, Dr. Marjorie Warren. Warren emphasised that rehabilitation was essential to the care of older people. She took her experiences as a physician in a London Workhouse infirmary and developed the concept 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 history of multidisciplinary working, valuing all the professions, not just medicine, for their contributions in optimising the well-being and independence of older people. Another hero of British Geriatrics is Bernard Isaacs, who described the giants of geriatrics: immobility and instability, incontinence and impaired intellect.13 Isaacs asserted that if you look closely enough, all common problems with older people relate back to one of these giants. The care of older people in the UK has been forwarded by the implementation of the National Service Frameworks for Older People, which outlines key areas for attention.14 Current trends Perhaps the most pressing issue facing geriatrics is the treatment and prevention of delirium. This is a condition in which hospitalized elderly patients become confused and disoriented when confronted with the uncertainty and confusion of a hospital stay. The health of the patient will decline as a result of delirium and can increase the length of hospitalization and lead to other health complications. The treatment of delirium involves keeping the patient mentally stimulated and oriented to reality, as well as providing specialized care in order to ensure that their needs are being met. The Hospital Elder Life Program, HELP, is a system that was created at Yale New Haven Hospital and has been introduced to several hospitals. The goal of the program is to prevent delirium and thus improve the quality of care provided to the elderly. Yale New Haven Hospital has since developed HELP into the more comprehensive Elder Horizons Program, whose goals in addition to preventing delirium include maintenance of mobility and of functional and cognitive states. In July 2007 the American Association of Medical Colleges AAMC and the Hartford Foundation hosted a National Consensus Conference on Competencies in Geriatric Education where a consensus was reached on minimum competencies learning outcomes that graduating medical student needed to assure competent care to older patients by new interns. There are 26 competencies in eight content domains. 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. The entire list is available on the Portal of Geriatric Online Education www.pogoe.org. Pharmacology Pharmacological constitution and regimen for older people is an important topic, one which is related to changing and differing physiology and psychology. 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 and muscle and drug elimination. Psychological consideration is that of elderly persons particularly those experiencing substantial problems of memory loss or other types of cognitive impairment being able to adequately monitor and adhere to their own scheduled pharmacological 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 medication schedule was reported by a striking one-third of the participants. Further development of methods which might possibly help monitor and regulate dosage administration and scheduling is an area that deserves further attention. Another area of importance is the potential for improper administration and usage of potentially inappropriate medications, and possibility of errors which 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. See also Aging in Place Aging-associated diseases Commission for Certification in Geriatric Pharmacy Elderly care Gero-Informatics Life extension Geriatric medicine in Egypt Notes ^ Barton Mulley 2003 ^ Al-Canon scanned photos ^ Howell, Trevor H. 1987, Avicenna and His Regimen of Old Age, Age and Ageing 16: 58-59 ^ Avicenna and the care of the aged by TH Howell Gerontologist 1972 12: 424-426. ^ Gerontology and geriatrics in the works of Abu Ali Ibn Sina in Sovetskoe zdravookhranenie ^ Al Jazzar ^ Vesalius Official journal of the International Society for the History of Medicine ^ Algizar a web page in french ^ Ibn Jazzar ^ Geritt Bos, Ibn al-Jazzar, Risala fi l-isyan Treatise on forgetfulness, London, 1995 ^ Al Jazzar ^ Islamic culture and medical arts ^ Isaacs 1965 ^ Department of Health Older People's information References Barton A, Mulley G. History of the development of geriatric medicine in the UK. Postgrad Med J 2003;79:229-34. Fulltext. PMID 12743345. Cannon, K.T., Choi, M.M., Zuniga, M.M. 2006. Potentially inappropriate medication use in elderly patients receiving home health care: a retrospective data analysis. The American Journal of Geriatric Pharmacotherapy, 4, 134-143. Gidal, B.E. 2006. Drug Absorption in the Elderly: Biopharmaceutical Considerations for the Antiepileptic Drugs. Epilepsy Research, 68S, S65-S69. Hutchison, L.C., Jones, S.K., West, D.S., Wei, J.Y. 2006. Assessment of Medication Management by Community-Living Elderly Persons with Two Standardized Assessment Tools: A Cross-Sectional Study. The American Journal of Geriatric Pharmacotherapy, 4, 144-153. Isaacs B. An introduction to geriatrics. London: Balliere, Tindall and Cassell, 1965. External links British Geriatrics Society American Geriatrics Society Irish Gerontological Society American Board Family Medicine CAQ Geriatric Medicine Merck Manual of Geriatrics Geriatric Nursing v d e Health science Medicine Specialties and subspecialties Surgery Anesthesiology · Cardiac surgery · Cardiothoracic surgery · General surgery · Neurosurgery · Oral and maxillofacial surgery · Orthopedic surgery Hand surgery · Otolaryngology ENT · Pediatric surgery · Plastic surgery · Surgical oncology · Thoracic surgery · Transplant surgery · Trauma surgery · Urology · Vascular surgery Internal medicine Cardiology · Endocrinology · Gastroenterology · Hematology · Hepatology · Infectious diseases · Intensive care medicine · Nephrology · Oncology · Proctology · Pulmonology · Rheumatology Diagnostic Clinical laboratory sciences Cellular pathology, Clinical chemistry, Hematology, Clinical microbiology, Clinical immunology, Transfusion medicine · Radiology Interventional radiology, Nuclear Medicine · Pathology Anatomical, Clinical · Clinical neurophysiology Other specialties Allergy and immunology · Dermatology · Disaster medicine · Emergency medicine · General practice · Geriatrics · Neurology · Obstetrics and gynaecology Fertility medicine, Reproductive medicine · Occupational medicine · Ophthalmology · Palliative care · Pediatrics · Physical medicine and rehabilitation Physiatry · Preventive medicine · Psychiatry · Sleep medicine · Other Epidemiology · History of medicine · Hospital medicine · Medical education · Medical genetics · Medical school · Osteopathic medicine · Pharmacy · Physician MD and DO · Physician Assistant · Public health · Sports medicine · Medical fiction Retrieved from http://en..org/wiki/Geriatrics Categories: Aging | Anti-aging | Geriatrics Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages БългарÑ?ки Català Česky Deutsch Eesti Español Français Italiano עברית Nederlands 日本語 Polski Português РуÑ?Ñ?кий СрпÑ?ки / Srpski Suomi Türkçe This page was last modified on 13 August 2008, at 2
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