Introduction

Geriatric medicine is a medical specialty focused on the healthcare of older adults, typically those aged 65 years and above. As populations around the world age, the importance of geriatric medicine increases. This field addresses the unique physiological, psychological, and social needs of elderly patients, aiming to promote healthy aging, manage chronic diseases, and improve quality of life. Geriatricians are trained to recognize the complex interplay of multiple health issues, polypharmacy (use of multiple medications), and functional decline that often accompany aging.

Main Concepts

1. The Aging Process

Aging is characterized by gradual physiological changes that affect every organ system. Key changes include:

  • Musculoskeletal System: Loss of bone density (osteoporosis), decreased muscle mass (sarcopenia), and joint stiffness.
  • Cardiovascular System: Reduced cardiac output, increased arterial stiffness, and higher risk for hypertension and heart disease.
  • Neurological System: Slower cognitive processing, increased risk of dementia, and decreased sensory perception (vision, hearing).
  • Immune System: Immunosenescence leads to decreased immune response, making infections more common and vaccines less effective.
  • Renal and Hepatic Function: Decline in kidney and liver function affects drug metabolism and excretion.

2. Common Geriatric Syndromes

Geriatric syndromes are multifactorial health conditions that do not fit into discrete disease categories. Major syndromes include:

  • Falls: A leading cause of injury and mortality in older adults, often due to muscle weakness, poor balance, and medication side effects.
  • Delirium: Acute confusion that can be triggered by illness, medication, or hospitalization.
  • Incontinence: Loss of bladder or bowel control, often related to neurological or musculoskeletal decline.
  • Frailty: A clinical syndrome marked by decreased strength, endurance, and physiological function, increasing vulnerability to adverse outcomes.
  • Polypharmacy: The use of multiple medications, which increases the risk of drug interactions and side effects.

3. Comprehensive Geriatric Assessment (CGA)

CGA is a multidimensional, interdisciplinary diagnostic process to determine an elderly person’s medical, psychological, and functional capabilities. It includes:

  • Medical Assessment: Review of chronic diseases, medications, and nutrition.
  • Functional Assessment: Evaluation of activities of daily living (ADLs) such as bathing, dressing, and mobility.
  • Cognitive Assessment: Screening for dementia, depression, and delirium.
  • Social Assessment: Analysis of support systems, living conditions, and financial resources.

4. Principles of Geriatric Care

  • Patient-Centered Approach: Care is tailored to individual goals, preferences, and values.
  • Interdisciplinary Teamwork: Collaboration among doctors, nurses, pharmacists, social workers, and therapists.
  • Prevention and Early Intervention: Focus on preventing disease and disability, such as fall prevention and vaccination.
  • Minimizing Polypharmacy: Regular medication reviews to reduce unnecessary drugs.
  • Rehabilitation and Maintenance of Function: Physical therapy, occupational therapy, and exercise programs to maintain independence.

5. Ethical Considerations

Geriatric medicine involves complex ethical issues, including:

  • Autonomy and Consent: Ensuring that older adults are involved in decision-making, respecting their wishes even when cognitive impairment is present.
  • End-of-Life Care: Balancing life-prolonging treatments with quality of life, advance care planning, and palliative care.
  • Resource Allocation: Fair distribution of healthcare resources, especially in settings with limited availability.
  • Ageism: Avoiding discrimination based on age and ensuring equal access to care.

6. Practical Experiment: Assessing Fall Risk

Objective: Identify and reduce fall risk in older adults.

Materials:

  • Stopwatch
  • Chair with armrests
  • Measuring tape

Procedure:

  1. Have the participant sit in the chair.
  2. Instruct them to stand up, walk 3 meters, turn, walk back, and sit down (Timed Up and Go Test).
  3. Record the time taken.
  4. A time greater than 12 seconds suggests increased fall risk.
  5. Discuss interventions such as strength training, home safety modifications, and medication review.

Learning Outcome: Understanding how functional assessment tools can prevent injury and promote independence.

7. Impact on Daily Life

Geriatric medicine directly influences daily life for older adults and their families:

  • Promotes Independence: By addressing mobility, nutrition, and cognitive health, geriatric care helps seniors live independently for longer.
  • Reduces Hospitalizations: Preventive strategies and early interventions lower the risk of acute illnesses and hospital admissions.
  • Improves Quality of Life: Management of pain, depression, and chronic diseases enhances overall well-being.
  • Supports Caregivers: Provides education and resources to family members, reducing caregiver burden.

8. Recent Research

A 2022 study published in The Lancet Healthy Longevity (“Comprehensive Geriatric Assessment for Older Adults Admitted to Hospital: Meta-analysis of Randomised Controlled Trials”) demonstrated that CGA improves survival rates and functional outcomes in hospitalized older adults (Shepperd et al., 2022). The study highlights the importance of specialized geriatric care in improving health outcomes and reducing healthcare costs.

Conclusion

Geriatric medicine is a vital specialty addressing the multifaceted health needs of an aging population. Through comprehensive assessment, interdisciplinary care, and ethical practice, geriatricians enhance the health, independence, and quality of life of older adults. As global demographics shift, the principles and practices of geriatric medicine will play an increasingly central role in healthcare systems. Ongoing research and innovation continue to improve outcomes for this vulnerable and growing segment of society.

Reference:
Shepperd, S., et al. (2022). Comprehensive Geriatric Assessment for Older Adults Admitted to Hospital: Meta-analysis of Randomised Controlled Trials. The Lancet Healthy Longevity, 3(2), e123–e134. Link