Geriatric Health Problems

1. Geriatric Health Problems Jameel Adnan, MD. Community & Primary Health CareKAAU-RABEG BRANCH

2. Patient • A 70-year-old woman; was referred to a dietitian for dietary counseling regarding an involuntary weight loss of approximately 1o kgs. Her presenting problem was weakness and decreased appetite. She has COPD. She had MI 5 years ago. Her hypothyroidism in her thirties was controlled by daily medication. She is a widowed and lives alone. She quitted smoking 10 years ago.

3. DD • Protein-calorie malnutrition • Depression • Dyspepsia • COPD • Atherosclerotic CVD • Hypertension with CHF • Hypothyroidism

4. Risk Factors • Inadequate or inappropriate food intake • Depression • Isolation • Oral health problems

5. Risk Factors (cont.) • Acute or poorly controlled chronic illness • Dependence or disability • Multiple medication intake

6. Arthritis Hypertension Impaired Hearing CVD Cataracts Sinusitis Orthopedic Impaired Vision Diabetes Geriatric Health Problems • Chronic illness is common

7. Demographic Imperative • Persons >65 = Fasting growing age group • By 2030, geriatric patients will comprise 10-22% of population and may account for up to 70% of ambulance transports

8. Effects of Aging

9. General Changes • Total body water decreases • 61% at 25 • <53% at 70 • Total body fat decreases • Subcutaneous fat deposits decrease

10. General Changes (cont.) • Generalized body tissue fibrosis • Progressive loss of homeostatic systems ability to adjust

11. Communication Problems • Diminished • Sight • Hearing • Mental faculties • Depression • Poor cooperation/limited mobility

12. Polypharmacy • Up to 30% of geriatric hospitalizations are drug induced

13. Specific Changes • Height • Weight • Skin • Musculoskeletal • Respiratory System • Cardiovascular System • Renal System • Nervous System

14. Cardiovascular System • Speed, force of myocardial contraction decreases • Cardiac conducting system deteriorates • Resistance to peripheral blood flow rises, elevating systolic blood pressure • Blood vessels lose ability to constrict, dilate efficiently

15. Respiratory System • Respiratory muscles lose strength; rib cage calcifies, becomes more rigid • Respiratory capacity decreases • Gas exchange across alveolar membrane slows • Cough, gag reflexes diminish increasing risk of aspiration, lower airway infection

16. Musculoskeletal System • Osteoporosis develops, especially in females • Spinal disks narrow, resulting in kyphosis • Joints lose flexibility, become more susceptible to repetitive stress injury • Skeletal muscle mass decreases

17. Nervous System • Brain weight of decreases 6 to 7% • Brain size decreases • Cerebral blood flow declines 15 to 20% • Nerve conduction slows up to 15%

18. Gastrointestinal System • Senses of taste, smell decline • Gums, teeth deteriorate • Saliva flow decreases • Cardiac sphincter loses tone, esophageal reflux becomes more common • Peristalsis slows • Absorption from GI tract slows

19. Renal System • Renal blood flow decreases 50% • Functioning nephrons decrease 30 to 40%

20. Integumentary System • Dermis thins by 20% • Sweat glands decrease; sweating decreases

21. Geriatric Assessment

22. Factors Complicating Assessment • Variability • Older people differ from one another more than younger people do • Physiological age is more important than chronological age

23. Factors Complicating Assessment • Response to illness • Seek help for only small part of symptoms • Perceive symptoms as “just getting old” • Delay seeking treatment • Trivialize chief complaints

24. Factors Complicating Assessment • Presence of multiple pathologies • 85% have one chronic disease; 30% have three or more • One system’s acute illness stresses other’s reserve capacity • One disease’s symptoms may mask another’s • One disease’s treatment may mask another’s symptoms

25. Factors Complicating Assessment • Altered presentations • Diminished, absent pain • Depressed temperature regulation • Depressed thirst mechanisms • Confusion, restlessness, hallucinations • Generalized deterioration • Vague, poorly-defined complaints

26. Factors Complicating Assessment The Organs of the Aged Do Not Cry!

27. Factors Complicating Assessment • Communication problems • Diminished sight • Diminished hearing • Diminished mental faculties • Depression • Poor cooperation, limited mobility

28. Factors Complicating Assessment • Polypharmacy • Too many drugs! • up to 30% of geriatric hospitalizations drug induced

29. THANK YOU Do NOT assume confused or disoriented patient is “just senile!”