‫بسم اهلل الرمحن الرحيم‬

Geriatric health
By
Dr. Ahmad Al-Hazmi
“Family medicine consultant”
(MBBS(KSU),PHCD(KSU),ABFM,SBFM,JBFM- & e-learning diploma from
south Korea).
• Background 2
 Introduction :
α Comprehensive evaluation of an older individual's health status is one of the
most challenging aspects of clinical geriatrics.
α It requires sensitivity to the concerns of people, awareness of the many unique
aspects of their medical problems, ability to interact effectively with a variety of
health professionals, and often a great deal of patience.
α Most importantly, it requires a perspective different from that used in the
evaluation of younger individuals.
α The term “geriatric assessment” has given way to the concept of geriatric
evaluation and management.
 Epidemiology & statistics:
The global population aged 65 years and older is more than 500 million people,
about 7 % of the world’s population.

By 2040, the world is projected to have 1.3 billion older people, accounting for
14% of the total population. In 2040, 28% of the population in western Europe will
be 65 years and older, including about 9.3% older than 80 years.

Japan is currently the oldest country in the world, with 22% of the population aged
65 years and older, compared with 18% in western Europe and 21% in North
America.
More than 40 million adults older than 65 years are now living in the United
States, and they account for 13 % of the total population. Even more notably, 5.5
million people (1.8% of the population) are older than 85 years, and more than
50,000 people (0.02% of the population) are older than 100 years.

Although only 13 % of the U.S. population is older than 65 years, they account for
36 % of all medical expenditures.

In 2008, the population aged 65 years and older was already 166 million in China
and India.
Geriatric assessment has been tested in a variety of forms:

Components of
assessment of older
patients
 Sir William Osler's aphorism, “Listen to the patient,

he'll give you the diagnosis,” is as true in older

patients as it is in younger patients.

 In the geriatric population, however, several factors

make taking histories more challenging, difficult, and

time consuming.
Several essential aspects of evaluating older patients are common to all purposes and
settings. Several comments on addressing them are in order:

1) Physical, psychological, and socioeconomic factors interact in complex

ways to influence the health and functional status of the geriatric
population.

2) Comprehensive evaluation of an older individual's health status requires

an assessment of each of these domains. The coordinated efforts of
several different health-care professionals functioning as an
interdisciplinary team are needed.
3) Functional abilities should be a central focus of the comprehensive
evaluation of geriatric patients. Other more traditional measures of
health status (such as diagnoses and physical and laboratory
findings) are useful in dealing with underlying etiologies and
detecting treatable conditions, but in the geriatric population,
measures of function are often essential in determining overall
health, well-being, and the need for health and social services.
Geriatric syndrome

α Group of common heath problems among elderly.

α Usually multifactorial.
α Do not fit in single-organ categories.
α For example:
» Cognitive impairment.
» Weakness/ fatigue.
» Fall.
A. Functional status.
B. Risks of fall .
C. Cognition.
D. Mood.
E. Polypharmacy.
F. Social support.
G. Financial concerns.
H. Goals of care.
I. Advanced care preferences.
A. Basis activities of the daily living ( daily practices); basic self care tasks (
walking-bathing-dressing-feeding); if the elder appears not apple to do
these activities he needs assistant ( skill nursery facilities and assistants or
with other people known nursing home).

B. Instrumental activities of the daily living ( tasks are required to remain

independent); like ( cooking by him self, shopping). However, patient that
could not do some of these can live independently but need some help.

C. Advanced activities of daily living→ ( participation in family, social, or

work related roles). Elderly who is able to do these tasks in the society he
is functioning not like the elderly.
 Basic activities of the daily living.

A. Feeding.
B. Bathing.
C. Dressing.
D. Toileting.
E. Transferring ( getting up of the chair or the bed)
F. Walking.
*Patients who appear not able to achieve these (A through F) they need a
very high level of care and help.
 Instrumental activities of the daily living.
A. Shopping for groceries.
B. Driving or using public transportation.
C. Using telephone.
D. Doing a housework.
E. Preparing food.
F. Taking their medications.
G. Managing finances
*Elderly who appears able to achieve these (A through G) can live by him-
self and may need some assistant from family or other assistant people to
see him frquently (he can live with him-self in the apartment).
 Falls
 Very common in the elderly.
 50 % of the elderly above 80 years fall
each year.
 Many risk factors:
– Prior falls.
– Weakness.
– Balance problems.  Best prevention: exercise:
– Arthritis. – Strength training.
 Very high-yield certain drugs-CNS – Gait and balance training.
drugs ( medications that effect  Avoid certain medication.
CNS)e.g. benzodiazepines
(alprazolam, clonazepam); hypnotics
(zaleplon, zolpidem).
 Home safety evaluation
 This Usually achieved by
visiting home-nurse for
preventing falls
– Stair hand rails.
 Best prevention: exercise:
– Rails in bath rooms.
– Strength training.
– Improved lighting. – Gait and balance training.

– Nonslip bath mats.  Avoid certain medication.

 Walkers/ Canes
– May help mobility.
– Little evidence of fall
prevention.
 Cognition and mood
Elderly patients need to be screened for
Mood
Cognition and mood.
 Depression is very common in the
Cognition
elderly.
 Incidence of dementia ↑ with age.
 Often goes un-diagnosed.
 Cognition problems are often under
 Leads to impaired function,
diagnosed.
hospitalization.
 Polypharmacy
 Elderly patients are often in multiple medications .
 often have multiple providers for those medications ( PC-physicians, specialist) .
 Reviewing these medications is of valid important to prevent medical error and
interactions.

 Removing unnecessary drugs.

α
α

α
α

α
α
α
α
 Because of the multidimensional nature of geriatric patients' problems and
the frequent presence of multiple interacting medical conditions,
comprehensive evaluation of the geriatric patient can be time consuming
and thus costly.

 Unlike younger patients, older patients often have had multiple prior
illnesses.
Potential Difficulties in Taking Geriatric Histories
General symptoms can be especially difficult to interpret.
 Fatigue can result from a number of common conditions such as depression, congestive
heart failure, anemia, and hypothyroidism.

 Anorexia and weight loss can be symptoms of an underlying malignancy, depression, or

poorly fitting dentures and diminished taste sensation.

 Age-related changes in sleep patterns, anxiety, gastroesophageal reflux, congestive heart

failure with orthopnea, or nocturia can underlie complaints of insomnia.
 Evaluating the Geriatric Patient

Aging changes do not occur in these parameters; abnormal values should prompt further
evaluation.
Comprehensive Geriatric Consultation