Geriatrics

Geriatrics

Overview

A geriatrician is trained to give importance to the special problems of the older person. Often, common diseases produce unusual symptoms which are difficult to interpret by those unfamiliar with older persons. For example, pneumonia may not cause fever and cough, instead the person has leakage of urine; or, urinary infection causes the person to become restless, or drowsy and behave abnormally. Some diseases occur frequently in the elderly, such as falls, osteoporosis, Parkinsons' disease, urine incontinence, strokes, heart disease, and hypertension. Often several diseases occur together causing many medicines to be prescribed, and this leads to side effects. Additionally some medicines cannot be tolerated in the elderly, and a geriatrician's advice is useful.

Dr.Alka Ganesh

MD
Chairperson General Medicine & Section Head Geriatric Services

Treatment & Procedures

How can a geriatrician give better medical care?

Even though respective specialists can offer excellent treatment for each organ which is causing ill health, a geriatrician is needed to decide what modifications are needed for the particular individual. For example, a coronary bypass graft may be indicated theoretically in an older person with a heart attack, but if the patient has frailty, advanced dementia and is bedridden, such a procedure may in fact be inappropriate.

Diet has to be carefully watched because older persons need vitamins, protein, and calcium in greater amounts, and salt sugar and fats in smaller amounts.

A geriatrician is aware of the many preventive treatments required for future well being. Falls can cause great disability. The risk for a fall must be found out before a patient falls, and corrective action should be taken early. Similarly, failing vision if detected early can alert the doctor to detect glaucoma, or macular degeneration which is common in the elderly. Other important preventive treatments include vaccinations for lung infections, detection and treatment of thin bones (osteoporosis), B12 deficiency, and malignancies.

Comprehensive geriatric assessment

The geriatrician’s clinical assessment is to arrive at a comprehensive evaluation based on the patient's various illnesses.

This includes:

History: complete list of all co-morbidities, incontinence, falls, activities of daily living, screening for depression.

Examination: Memory assessment, musculoskeletal assessment, vision and hearing.

Scope of management

Management of delirium, dementia, depression, urinary incontinence, assessment and prevention of falls, rehabilitation and palliation of bed-bound patients.