GERIATRIC

COUNSELLING
Introduction

 Old age, also called senescence , in

human beings, the final stage of the normal
life span.
 Old age is frequently defined as 60 or 65
years of age or older.
 Old age has a dual definition. It is the last
stage in the life processes of an individual
 It is an age group or generation comprising
a segment of the oldest members of a
population
 The social aspects of old age are
influenced by the relationship of the
physiological effects of aging and the
collective experiences and shared values
of that generation to the particular
organization of the society in which it
exists.
 There is no universally accepted age that
is considered old among or within
societies.
 Often discrepancies exist as to what age
a society may consider old.
 In most contemporary countries, 60 or
65 is the age of eligibility for retirement
and old-age social programs, although
many countries and societies regard old
age as occurring anywhere from the
mid-40s to the 70s.
Characteristics of Old Age

 The distinguishing marks associated

with old age comprise both physical and
psychological characteristics.
 The marks of old age are so unlike the
marks of middle age that it has been
suggested that, as an individual
transitions into old age, he/she might
well be thought of as different persons.
 These marks do not occur at the same
chronological age for everyone.
 They, also, occur at different rates and
order for different people.
 Because each person is unique, marks
of old age vary between people, even
those of the same chronological age.
Physical marks of old age

 Bone and joint: Old bones are marked

by “thinning and shrinkage.”
 This results in a loss of height (about
two inches by age 80), a stooping
posture in many people, and a greater
susceptibility to bone and joint diseases
such as osteoarthritis and osteoporosis.
 Chronic diseases: Most older persons
have at least one chronic condition and
many have multiple conditions.
 The most frequently occurring conditions
among older persons were uncontrolled
hypertension, arthritis and heart
disease.
 Dental problems. Less saliva and less
ability for oral hygiene in old age
increases the chance of
tooth decay and infection.
 Digestive system. About 40% of the
time, old age is marked by digestive
disorders such as difficulty in swallowing,
inability to eat enough and to absorb
nutrition, constipation, and bleeding.[
 Eyesight. Diminished eyesight makes it
more difficult to read in low lighting and
in smaller print.
 Speed with which an individual reads
and the ability to locate objects may also
be impaired.
 Falls. Old age spells risk for injury from
falls that might not cause injury to a
younger person.
 Falls are the leading cause of injury and
death for old people.
 Hair usually becomes thinner and
grayer.
 Hearing. By age 75 and older, 48% of
men and 37% of women encounter
impairments in hearing. Of the millions
people over age 50 with a hearing
impairment, only one in seven uses a
hearing aid.
 Hearts are less efficient in old age with
a resulting loss of stamina.
 Immune function. Less efficient immune
function (Immunosenescence) is a mark
of old age.
 Lungs expand less well; thus, they
provide less oxygen.
 Pain afflicts old people at least 25% of the
time, increasing with age up to 80% for
those in nursing homes.
 Most pains are rheumatological or
malignant.
 Sexual activity decreases significantly with age,
especially after age 60, for both women and
men.
 Sexual drive in both men and women
decreases as they age.
 Skin loses elasticity, becomes drier, and more
lined and wrinkled.
 Sleep trouble holds a chronic prevalence of
about 50% in old age and results in daytime
sleepiness.
 By age 65, deep sleep goes down to about 5%.
 Taste buds diminish so that by age 80
taste buds are down to 50% of normal. Food
becomes less appealing and nutrition can
suffer.
 Urinary incontinence is often found in old
age.
 Voice. In old age, vocal chords weaken and
vibrate more slowly. This results in a
weakened, breathy voice that is sometimes
called an “old person’s voice.”

Psychological marks of old age
 Adaptable describes most people in
their old age, inspite the stressfulness of
old age, they are described as
“agreeable” and “accepting.”
 However, old age dependence induces
feelings of incompetence and
worthlessness in a minority.
 Caution marks old age. This antipathy
toward “risk-taking” stems from the fact that
old people have less to gain and more to
loose by taking risks than younger people.
 Depressed mood. Old age is a risk factor
for depression caused by prejudice (i.e.,
“deprejudice”). When people are prejudiced
against the elderly and then become old
themselves, their anti-elderly prejudice
turns inward, causing depression.
 “People with more negative age stereotypes
will likely have higher rates of depression as
they get older.” Old age depression results
in the over-65 population having the highest
suicide rate.
 Fear of crime in old age, sometimes weighs
more heavily than concerns about finances or
health and restricts what they do. The fear
persists in spite of the fact that old people are
victims of crime less often than younger
people.
 Mental disorders afflict about 15% of
people aged 60+ according to estimates
by the World Health Organization.
 Another survey taken in 15 countries
reported that mental disorders of adults
interfered with their daily activities more
than physical problems.
 Reduced mental and cognitive ability
afflicts old age.
 Memory loss is common in old age due
to the decrease in speed of information
being encoded, stored, and retrieved. It
takes more time to learn new information.
Dementia is a general term for memory
loss and other intellectual abilities serious
enough to interfere with daily life.
 Its prevalence increases in old age from
about 10% at age 65 to about 50% over
age 85. Alzheimer's disease accounts
for 50 to 80 percent of dementia cases.
Demented behavior can include
wandering, physical aggression, verbal
outbursts, depression, and psychosis.
 Set in one’s ways describes a mind set
of old age, i.e., “preference for the
routine.”
Age Related Physical
Hazards
 People over the age of 60 years can
experience a range of health problems
including:
 Reduced muscle mass, strength and
physical endurance
 Reduced coordination and balance
 Reduced joint flexibility and mobility
 Reduced cardiovascular and respiratory
function
 Reduced bone strength
 Increased body fat levels
 Increased blood pressure
 Increased susceptibility to mood
disorders, such as anxiety and
depression
 Increased risk of various diseases
including cardiovascular disease and
stroke.
Problems of Old Age

 Bereavement
 Bereavement refers to the period of
mourning and grief following the death
of a beloved person or animal.
 Mourning is the word that is used to
describe the public rituals or symbols of
bereavement, such as holding funeral
services, wearing black clothing, closing
a place of business temporarily, or
 lowering a flag to half mast.
 Grief refers to one's personal experience
of loss; it includes physical symptoms as
well as emotional and spiritual reactions
to the loss.
 While public expressions of mourning
are usually time-limited, grief is a
process that takes most people several
months or years to work through.
Causes and symptoms

 Causes
 The immediate cause of bereavement is
usually the death of a loved friend or relative.
 There are a number of situations, however,
which can affect or prolong the grief process:
 The relationship with the dead person was a
source of pain rather than love and support.
Examples would include an abusive parent
or spouse.
 The person died in military service or in
a natural, transportation, or workplace
disaster.
 The person was murdered.
 The person is missing and presumed
dead but their death has not been
verified.
 The person committed suicide..
 The relationship with the dead person
cannot be openly acknowledged. This
situation often leads to what is called
disenfranchised grief..
 The loved one was an animal rather
than a human being.
 Symptoms
 Bereavement typically affects a person's
physical well-being as well as emotions.
 Common symptoms of grief include
changes in appetite and weight, fatigue,
insomnia and other sleep disturbances,
loss of interest in sex, low energy levels,
nausea and vomiting, chest or throat
pain, and headache.
 People who have lost a loved one in
traumatic circumstances may have such
symptoms of
post-traumatic stress disorder as an
exaggerated startle response, visual or
auditory hallucinations, or high levels of
muscular tension.
 Counselors have identified four stages or
phases in uncomplicated bereavement:
 Shock, disbelief, feelings of numbness.
This initial phase lasts about two weeks,
during which the bereaved person finally
accepts the reality of the loved one's
death.
 Suffering the pain of grief. This phase
typically lasts for several months. Some
people undergo a mild temporary
depression about six months after the
loved one's death.
 Adjusting to life without the loved one. In
this phase of bereavement, survivors
may find themselves taking on the loved
one's roles and responsibilities as well as
redefining their own identities.
 Moving forward with life, forming new
relation-ships, and having positive
expectations of the future. Most people
reach this stage within one to two years
after the loved one's death.
 As people get older, bereavements
occur more frequently. Older people
commonly endure loss of a husband,
wife or partner, other relatives, friends,
former colleagues and associates.
 Widowhood is usual and because
women generally live longer there are
more widowed women than men.
 Loss through bereavement is a major
stress on older people, and along with
other losses experienced in old age, can
reduce people’s ability to cope and be
independent.
 How does bereavement affect older
people?
 Older people’s responses vary greatly and
coping with loss is not necessarily a by-
product of being older. Other losses in an
older person’s life will affect how they
grieve the loss of someone close:
 existing health conditions
 communication and cognitive difficulties
 reduced social support
 changed living arrangements i.e. moving
to sheltered housing
 financial difficulties.
 reciprocal support of and for family and
friends
 better health for longer
 financial stability
 ability to work or contribute to society in
a range of ways.
 Loss of Independence in Old Age
 Loss of independence occurs as people
age, as they suffer physical, social or
emotional setbacks which prevent them
from functioning independently.
 The key to this loss of independence is
how easy people find to accept help
 Physical and Mental Losses
 These can include:
 Forgetting appointments and day-to-day
tasks
 Having difficulty climbing stairs or
getting in and out of the bath
 No longer able to walk long distances
 Vision problems
 Less control over emotions
 Less physical energy
 Less flexibility
 Hearing problems
 Less ability to move easily
 Memory problems
 Lower levels of stamina
 Social Loss
 Going out to eat
 Playing sport
 Going to parties
 Visiting places
 Emotional Loss
 Loss of independence can create
tremendous frustration, feelings of
uselessness, and sadness, due to a
sense of loss of control in one’s life.
 Typical reactions to loss of
independence
 Reactions are often complicated. These can
include:
 • Fear Some people become frightened by
their new vulnerability, wondering how they
will manage on their own.
 Overwhelmed, they begin to expect close
friends and family to be always available for
them and become overly dependent
 • Anger. Others feel angry that they can
no longer manage on their own and may
take their anger out on their loved ones
 • Guilt. Others feel guilty and refuse
help from family and friends, because
they think they will be a burden
 • Confusion. It is not uncommon for
people to feel confused about needing
help and long for “what was”
 How can you help the elderly to cope
with their loss of independence?
 Be patient with them.
 It takes time for them to acknowledge their
losses and to understand how these are
affecting their life now
 Help them understand that losing
independence is a common experience as
people age, and not a sign of personal
failure
 Help them to recognize their feelings and
that it’s OK to feel sad and frustrated at
times without putting themselves down
for not being able to do what they used to
do
 Try to get them to listen to your
suggestions about how to make things
easier. This is not always easy to do, but
there are many ways to keep your elderly
relative engaged and interested
 Try to help them to maintain
relationships with loving and caring
friends and family
 Work out what help they need and try to
encourage them to accept it
 Seek help from your GP if you are
worried either with your parent or alone
Health Problems in Old Age

 From mild aches and pains to the most

devastating illnesses, seniors face it all. The
common health issues/loss in the old age
are:

Alzheimer's disease is the most common

form of dementia, affecting over 5 million
people. There are other types of dementias,
memory loss and impaired cognitive function
that impact seniors.
 Parkinson's Disease
Parkinson's disease is a chronic,
neurological disorder that affects nerve cells
in the part of the brain that controls muscle
movement.
Incontinence
Incontinence, or loss of bladder control, can
happen for a number of reasons. Whether
it's temporary or chronic, it's unpleasant. It
also can lead to emotional distress.
 Cancer
Cancer is a group of more than 100 diseases in
which abnormal cells grow out of control, thereby
invading other parts of the body. There were more
than 1.5 million new cases of cancer reported
every year.
Heart Disease
Heart disease—whether it's a heart attack, stroke,
cardiac arrest, high blood pressure, peripheral
artery disease, or another cardiovascular condition
—is the number one killer.
 Arthritis
Arthritis is a painful condition that can strike
the spine, neck, back, shoulder, hands and
wrists, hip, knee, ankle, and feet. It can be
immobilizing, and it comes in many forms.
Vision
Macular degeneration, cataracts, glaucoma,
presbyopia, and retinal disorders are just
some eye diseases that can reduce a senior's
ability to see well.
 Diabetes
Having high blood glucose levels is the hallmark
of diabetes, a group of diseases that affects the
body's ability to produce or use insulin correctly.
Sleep Disorders
Sleep disorders—whether insomnia, sleep
apnea, or movement disorders—all can rob
elderly parents of needed sleep.
 Disruption in sleep patterns can lead to more
problems than just making the elderly feel more
fatigued.
 Depression
Depression is a serious medical illness. It’s more
than just feeling "down in the dumps" or "blue"
for a few days. It can be mild or so major that it's
disabling and it can also be hard to recognize.
Hearing Loss
About one third of Indians between the ages of
65 and 74 have hearing problems. That statistic
increases with age. Yet only one in five people
who could benefit from a hearing aid actually
wears one.
 Osteoporosis
Osteoporosis is a condition that causes
bones to break more easily and take longer
to heal. As a result, even minor falls can land
seniors in the hospital.
Lung Disease
Lung diseases can diminish a senior's ability
to breathe well. While many types of lung
problems can be treated or prevented, they
can be serious, with major complications.
 Loss of Mobility
 Mobility is essential for getting through
the day, whether you need to walk across
a room to the bathroom or kitchen, get out
of bed or a chair, or walk through a
grocery store.
 Loss of mobility, which is common among
older adults, has profound social,
psychological, and physical
consequences.
 “If you’re unable to get out then you
can’t go shopping, you can’t go out with
your friends to eat dinner or go to the
movies, and you become dependent on
other people to get you places. So you
become a recluse, you stay home, you
get depressed. With immobilization
comes incontinence, because you can’t
get to the bathroom, you can develop
urinary infections, skin infections.
 The common factors that lead to loss of
mobility are older age, low physical activity,
obesity, impaired strength and balance, and
chronic diseases such as diabetes and
arthritis. Less common red flags included
symptoms of depression, problems with
memory or thinking skills, being female, a
recent hospitalization, drinking alcohol or
smoking, and having feelings of
helplessness. Individuals with one or more of
these factors are at risk for immobility.
 Anxiety in the Elderly
 It was previously thought that as a person
ages, the level of anxiety and the increase in
anxiety disorders in the elderly decreased.
According to the Anxiety Disorders
Association of America, however, that
“anxiety is as common in the old as in the
young, although how and when it appears is
distinctly different in older adults.”
 While worry is a normal reaction to
certain situations, chronic or excessive
worry is not. Although there are several
different types of anxiety, all with specific
symptoms, there are also a few common
characteristics of anxiety disorders:
 • Constant, exaggerated or excessive
worry.
• Physical symptoms such as rapid heart
rate, sweating, dizziness, headache,
stomachache, tense muscles, or trembling
• Feeling on edge, restless, being startled
easily or irritability
• Trouble sleeping
• Avoidance of situations that may cause
anxiety
 Recent research indicates that one in every
five elderly persons suffer from anxiety severe
enough to warrant treatment. There are a
number of reasons this may be true:

Physical illness – As people age, medical

problems increase. The stress associated with
physical illness or chronic medical conditions
can increase anxiety.
 Psychological and Emotional Issues – The
elderly are less likely to discuss psychiatric or
emotional problems, leading these to go
untreated and increase anxiety. Depression, a
concern for many elderly people, is often
accompanied by anxiety.

Increase in the Use of Prescription Medication –

Certain medications can increase or cause
symptoms of anxiety or can mimic symptoms of
anxiety.
 Lifestyle Changes – As people age, there
are many changes in lifestyle they must
deal with, including loss of independence,
loss of friends and loved ones, and loss
of going to work each day. All of these are
major changes in lifestyle and each one
is enough to cause anxiety, however, as
people age, they often must deal with
many major changes in lifestyle within a
short period of time.
 Specific Symptoms of Anxiety in the Elderly

• Avoiding situations or social events that once

were considered to be enjoyable.

• Excessive or chronic worrying without reason or

worrying more that the situation calls for.

• Insomnia, trouble sleeping or sleeping more than

normal (can be a sign of depression – depression
and anxiety are common co-existing conditions)
 • Symptoms such as shortness of breath, trembling, or
irregular heartbeat. (These symptoms can also be a sign
of physical illness as well, the physician should check for
the presence of physical illness before making a
diagnosis of anxiety).

• Depression symptoms such as loss of interest in

activities, increased sadness or withdrawal from family
and friends. Depression and anxiety are common co-
existing conditions and if depression has been
diagnosed, the physician may want to discuss the
possibility of anxiety as well.
 Treatment for Anxiety

The treatment of anxiety in the elderly is

the same as treatment for those
younger. Antianxiety medications are
the most common medication treatment
used to treat anxiety in the elderly.
 Cognitive behavioral therapy has also
been shown to help and can include
relaxation training and exposure therapy.
 This type of treatment has been shown to
be effective in treating many forms of
anxiety and frequently takes several
months of therapy before improvements
are seen.
Depression in Old Age

 Depression in the elderly is common.

 Late-life depression affects many older
adults.
 But very few receive treatment. The likely
reason is that the elderly often display
symptoms of depression differently.
 Depression in the elderly is also frequently
confused with the effects of multiple
illnesses and the medicines used to treat
them.
 Depression impacts older people
differently than younger people.
 In the elderly, depression often occurs
with other medical illnesses and
disabilities and lasts longer.
 Depression in the elderly often
increases their risk of cardiac diseases.
 Depression doubles an elderly person's
risk of cardiac diseases and increases
their risk of death from illness.
 At the same time, depression reduces
an elderly person's ability to rehabilitate
 Studies of nursing home patients with physical
illnesses have shown that the presence of
depression substantially increases the likelihood
of death from those illnesses.
 Depression also has been associated with
increased risk of death following a heart attack.
 For that reason, making sure that an elderly
person you are concerned about is evaluated
and treated is important, even if the depression
is mild.
 Depression also increases the risk of
suicide, especially elderly men.
 In addition, advancing age is often
accompanied by loss of social support
systems due to the death of a spouse or
siblings, retirement, or relocation of
residence.
 Because of changes in an elderly
person's circumstances and the fact that
elderly people are expected to slow
down, doctors and family may miss the
signs of depression.
 As a result, effective treatment often
gets delayed, forcing many elderly
people unnecessarily struggle with
depression.
 Risk Factors for Depression In the
Elderly
 Factors that increase the risk of
depression in the elderly include:
 Being single, unmarried, divorced, or
widowed
 Lack of a supportive social network
 Stressful life events
 Physical conditions like stroke,
hypertension, diabetes, cancer, dementia,
and chronic pain further increase the risk
of depression.
 Additionally, the following risk factors for
depression are often seen in the elderly:
 Certain medicines or combination of
medicines
 Damage to body image (from amputation,
cancer surgery, or heart attack)
 Family history of major depressive
disorder
 Fear of death
 Living alone, social isolation
 Other illnesses
 Past suicide attempt(s)
 Presence of chronic or severe pain
 Previous history of depression
 Recent loss of a loved one
 Substance abuse
 Signs and symptoms of depression
 Different people have different
symptoms. Some symptoms of
depression include:
 Feeling sad or "empty"
 Feeling hopeless, irritable, anxious, or
guilty
 Loss of interest in favorite activities
 Feeling very tired
 Not being able to concentrate or remember
details
 Not being able to sleep, or sleeping too
much
 Overeating, or not wanting to eat at all
 Thoughts of suicide, suicide attempts
 Aches or pains, headaches, cramps, or
digestive problems.
 Treatment: Pharmacotherapy, ECT and
psychotherapy
Dementia in Old Age

 Key facts
 Dementia is a syndrome – usually of a
chronic or progressive nature – in which
there is deterioration in cognitive function
(i.e. the ability to process thought) beyond
what might be expected from normal ageing.
 It affects memory, thinking, orientation,
comprehension, calculation, learning
capacity, language, and judgement.
Consciousness is not affected.
 The impairment in cognitive function is
commonly accompanied, and
occasionally preceded, by deterioration
in emotional control, social behaviour, or
motivation.
 Dementia is caused by a variety of
diseases and injuries that primarily or
secondarily affect the brain, such as
Alzheimer's disease or stroke.
 Signs and symptoms
 Dementia affects each person in a
different way, depending upon the
impact of the disease and the person’s
personality before becoming ill.
 The signs and symptoms linked to
dementia can be understood in three
stages.
 Early stage: the early stage of dementia
is often overlooked, because the onset
is gradual.
 Common symptoms include:
 forgetfulness
 losing track of the time
 becoming lost in familiar places.
 Middle stage: as dementia progresses to the
middle stage, the signs and symptoms become
clearer and more restricting. These include:
 becoming forgetful of recent events and
people's names
 becoming lost at home
 having increasing difficulty with communication
 needing help with personal care
 experiencing behaviour changes, including
wandering and repeated questioning.
 Late stage: the late stage of dementia is one of
near total dependence and inactivity. Memory
disturbances are serious and the physical signs
and symptoms become more obvious.
Symptoms include:
 becoming unaware of the time and place
 having difficulty recognizing relatives and friends
 having an increasing need for assisted self-care
 having difficulty walking
 experiencing behaviour changes that may
escalate and include aggression.
 Treatment and care
 There is no treatment currently available to
cure dementia or to alter its progressive
course. Numerous new treatments are
being investigated in various stages of
clinical trials.
 Much can be, however, offered to support
and improve the lives of people with
dementia and their caregivers and families.
The principal goals for dementia care are:
 early diagnosis
 optimizing physical health, cognition,
activity and well-being
 identifying and treating accompanying
physical illness
 detecting and treating behavioural and
psychological symptoms
 providing information and long-term
support to caregivers.
Loneliness in Old Age

 Loneliness is defined as “an unwelcome

feeling of loss of companionship, or feeling
that one is alone and not liking it” As this
definition makes clear, the experience of
loneliness is subjective: circumstances that
cause loneliness for one person may be
experienced as welcome solitude by another.
 Nonetheless, loneliness in later life affects
about 10 per cent of older adults, and is
closely related to depression and an ensuing
risk of suicide.
 Loneliness increases gradually with age,
is more common in women and is highly
correlated with physical health, although
causality is not clear.
 Other risk factors include low economic
status and a lack of security and social
networks.
 The absence of supportive friendships
appears to be a major determining factor for
loneliness.
 Further, widowed men and women report
higher levels of loneliness and depression
than their married counterparts.
 However, in older adults who are married vs.
those who are single, and among those who
have children vs. those who are childless,
perceptions of well-being are reported as
similar.
 Reducing loneliness may be addressed
by improving older people’s functional
status and socialization, although it is
thought that research into coping
strategies used by older people who do
not experience loneliness may offer
further insight into other solutions.
Empty Nest Syndrome

 Empty nest syndrome is a feeling of grief

and loneliness parents especially old
age people may feel when their children
leave home such as to live on their own
or to attend a college or university, or
employment purpose.
 It is not a clinical condition. Since a
young adult moving out from his or her
parents' house is generally a normal and
healthy event,
 the symptoms of empty nest syndrome
often go unrecognized.
 This can result in depression and a loss
of purpose for parents, since the
departure of their children from "the nest
" leads to adjustments in parents' lives.
Empty nest syndrome is especially
common in older adults.
Palliative Care
 Definitions: The World Health
Organization’s (WHO) definition is an
approach that improves the quality of life of
patients and their families facing the
problem associated with life-threatening
illness, through the prevention and relief of
suffering by means of early identification
and impeccable assessment and treatment
of pain and other physical, psychosocial
and spiritual problems (WHO, 2005).
 Geriatric palliative care: the approach
to care for the chronically ill and frail
elderly. The focus is on quality of life,
support for functional independence,
and centrality of the patient's values and
experiences in determining the goals of
medical care (Morrison & Meier, 2003).
 Geriatric palliative care is integrative
using interdisciplinary delivery of care.
The goal to relieve pain and suffering
and improve quality of life for elderly
patients and their families. The core
principles are comprehensive
patient/family unit centered that enhance
functional independence and quality of
life transitioning between levels of care .
 Symptom management: recognition and
treatment of physical and nonphysical
symptoms to prevent suffering and
improve quality of life
 Goal of Palliative Care
The goal of palliative care is "to prevent
and relieve suffering and to support the
best possible quality of life for patients
and their families regardless of the stage
of disease".
 Markers for Initiation of Palliative
Care in Geriatrics
Core End-stage Indicators indicating
terminal phase of chronic illness are
physical decline, weight loss, multiple
comorbidities, and a serum albumin of
<2.5 g/dL. Dependence on assistance
with most activities of daily living and a
Performance score of less than 50%.
 Non-Disease Specific Indicators
 Frailty – extreme vulnerability to morbidity
and mortality due to progressive decline in
function and physiological reserve.
Frequent falls, disability, susceptibility to
acute illness and reduced ability to recover
are examples of frailty.
 Functional dependence – dependence on
others to perform activities of daily life.
 Cognitive impairment – changes in
memory, attention, thinking, language,
praxis, and executive function.
 Family support needs – emotional
support, information and educational
support unique to each patient/family
and/or caregivers.
 Disease Specific Markers
 Dementia
 Stroke
 Stroke
 Cancer
 Recurrent infections
 Degenerative joint disease causing
functional impairment and chronic pain
 Needs of the Geriatric Palliative Care
Patient
 Continuity and coordination of care that
responds to episodic and long-term chronic
illnesses and transitioning between levels of
care
 Management of multiple chronic illnesses
 Assistance in navigating a complex medical
system
 Maintaining functional independence
 Decision making regarding care and
treatment decisions
 Pain and symptom control
 Determining risk versus benefit of
treatment
 Home support for family caregivers
 Community resource information and
access assistance
 #####