 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
Here you will find answers to frequently asked questions. If you cannot find your question please email us at SaranMedicalCenter@att.net and we will answer your questions as soon as possible.
Questions: (click on each question to see the anwer)
What are the other roles of Geriatric medicine?
What are the goals in geriatric medicine?
What are the Unique Features of Geriatric Patients?
What is Comprehensive geriatric assessment?
What are Situations in which assessment may be required?
Who is in danger of getting dementia?
What are the causes of dementia?
What are the relative causes of dementia ?
What is the clinical course of Alzheimer disease?
What are the criteria for diagnosing Alzheimer disease?
What are neurobehavioral feature of Alzheimer disease?
What does Executive dysfunction mean?
What is typical language disturbance of AD?
What are the strategies in management of Dementia?
What are the pharmacologic agents that are effective in Dementia?
What are the nonpharmacologic techniques that are effective?
What are the caregiver issues?
How can we help the caregiver?
Answers:
Geriatric medicine has been defined as a branch of medicine that concerns itself with the aging process; the prevention, diagnosis, and treatment of health care problems in the aged; and the social and economic conditions that affect the health care of the elderly. Arbitrarily, the aged or elderly population is defined as persons aged 65 or older.
Geriatricians (physicians who specialize in the care of elderly patients) are typically physicians who are certified in internal or family medicine and who have completed fellowship training in geriatrics and passed the certificate of added qualifications examination offered by the American Board of Internal Medicine or the American Board of Family Practice.
What are the other roles of Geriatric medicine?
The other major goal of geriatric medicine is to educate students and physicians about the principles of geriatric medicine and through research to discover new knowledge about aging and the diseases that disable elderly patients. As a result, geriatricians have achieved high visibility in medical schools and academic medical centers.
What are the goals in geriatric medicine?
- Care versus cure
- Improvement in or maintenance of function and quality of life
- Prevention
- Comfort for the terminally ill
These goals occur in the context of a high prevalence of chronic illness in geriatric patients and focus on detecting and managing disease rather than on curing disease. Also paramount in geriatric practice is an emphasis on the measurement and promotion of function. For decades, medical practice has emphasized the diagnosis of illness and associated therapy. This approach remains essential to geriatric practice but must be complemented by an assessment of the impact of illness on the patient's life.
What are the Unique Features of Geriatric Patients?
- Multiplicity and complexity of disease
- Chronicity of illness
- Greater severity of acute illnesses and slower recovery
- Functional impairments limiting the ability to live independently
- Fragility of response to illness, intervention, and stress whether physical, emotional, or socioeconomic
- Unstable economic and social supports
- Limitation in reversibility of impairments makes cure less likely and maintenance of rehabilitation the main treatment focus
What are some key issues in geriatrics merit special attention that may not arise in caring for other groups of adult patients?
- Cognitive impairment
- Dental status
- Falls
- Foot disorders
- Gait abnormalities or use of adaptive equipment
- Hearing loss
- Incontinence (fecal and urinary)
- Nutrition or feeding impairment
- Osteoporosis
- Pressure ulcers
- Psychiatric illness (depression, paranoia, anxiety, grief)
- Sexual history
- Sleep disorders
- Vision loss
What is Comprehensive geriatric assessment?
Comprehensive geriatric assessment has been well defined as a “multidimensional—usually interdisciplinary—diagnostic process designed to quantify an elderly individual's medical, psychosocial, and functional capabilities and problems with the intention of arriving at a comprehensive plan for therapy and long-term follow-up.”
This approach to decision making and developing plans for the care of older patients with complex problems at critical points in their lives has developed from the experience and observations of clinicians involved in the care of older persons over the last three quarters of the century.
This comprehensive approach to patient evaluation has been examined and refined in a number of studies in both inpatient and outpatient settings and adapted for use in many countries throughout the world.
What are Situations in which assessment may be required?
Assessment of frail elderly people may be needed for a variety of purposes: (1) screening for early detection of potential disabilities, (2) case finding to offer relevant care to those who need it, (3) comprehensive diagnostic work-up as part of developing a plan of therapy, (4) monitoring progress, (5) determining the level or setting of long-term care required, and (6) determining the appropriateness of the use of long-term care services and facilities.
The most important use of comprehensive assessment as part of the diagnostic work-up of a frail elderly person is to evaluate a patient whose physical, mental, or social condition is changing, most likely in the direction of an increased need for long-term care services.
Dementia is a syndrome of acquired persistent dysfunction in several domains of intellectual ability, including memory, language, visuospatial ability, praxis, gnosis, executive functioning, and calculation. Disturbances of mood and alterations in demeanor often accompany the intellectual deterioration. Dementia results from a wide variety of conditions, including degenerative, vascular, neoplastic, demyelinating, infectious, inflammatory, toxic, metabolic, and psychiatric disorders.
The onset of dementia may be abrupt (trauma or stroke) but is more often gradual. Although most dementing illnesses are progressive, in some cases the course of dementia may be modified by appropriate therapeutic interventions. Despite accurate identification of the cause of the dementia and provision of symptomatic treatment, affected patients typically suffer marked and progressive impairment in occupational and social functioning. The economic, social, and psychological cost of dementing illnesses on patients and their families is staggering.
Who is in danger of getting dementia?
Dementia is a growing public health concern across the world. Although exact figures vary, there is a consensus that the incidence and prevalence of dementia increase with advancing age. In many studies, it has been reported that dementia affects almost 5% of the population over the age of 65 years. Dementia most frequently occurs in the fastest growing segment of the population, those over age 75. Studies have suggested that 3% of the population between the ages of 65 and 74 may have Alzheimer's disease (AD), the most common cause of dementia. This number increases to almost 19% of those aged 75 to 84 years and, among persons aged 85 years and older, may approach 50%.It has been estimated that approximately 4.5 million Americans suffer from the disorder.
What are the causes of dementia?
- Degenerative disorders
- Cortical
- Alzheimer's disease
- Frontotemporal dementia, Pick's disease
- Subcortical
- Parkinson's disease
- Progressive supranuclear palsy
- Corticobasal ganglionic degeneration
- Huntington's disease
- Idiopathic basal ganglia calcification
- Multisystem atrophy
- Thalamic dementia
- Dementia with Lewy bodies
- Vascular dementias
- Multiple large vessel occlusions
- Lacunar state (multiple subcortical infarctions)
- Binswanger's disease (hemispheric white matter ischemia)
- Mixed cortical and subcortical infarctions
- Metabolic disorders
- Cardiopulmonary failure
- Hepatic encephalopathy
- Uremic encephalopathy
- Anemia and hematologic conditions
- Endocrine disturbances
- Vitamin deficiency states
- Porphyria
- Toxic conditions
- Medication toxicity
- Alcoholic dementia
- Polysubstance abuse
- Heavy-metal intoxication
- Myelin disorders
- Normal-pressure hydrocephalus
- Neoplastic and paraneoplastic dementias
- Traumatic dementias
- Infection-related dementias
- Inflammatory disorders
- Psychiatric disorders
What are the relative causes of dementia?
Alzheimer's disease was found in 50%, cerebrovascular disease in 17%, and mixed AD and cerebrovascular disease in 25%. Together, neuropathologic changes consistent with AD and cerebrovascular disease were found in more than 90% of all patients with dementia.
In many studies it is suggested that a host of disease states can cause or contribute to the development of dementia. In some of these disorders, timely identification and subsequent treatment may alter the course of intellectual decline
It was found that medical comorbidity was more serious in dementia patients than in nondemented controls. Importantly, the seriousness of medical comorbidity in the demented patients was significantly associated with worse daily functioning and cognition.
Alzheimer's disease is the most common cause of dementia in the elderly. The onset of the disease is insidious, generally occurring after the age of 55 years and increasing in incidence with advancing age. The average risk of developing AD is approximately 5% at age 65, and subsequently increasing twofold every 5 years.
What is the clinical course of Alzheimer disease?
The clinical course is marked by a gradual deterioration of intellectual function, a decline in the ability to accomplish routine activities of daily living, and enduring changes in personality and behavior.
What are the criteria for diagnosing Alzheimer disease?
These criteria require that the patient be between the ages of 40 and 90 years at the time of disease onset, demonstrate progressive loss of memory, and have impairment of at least one additional neuropsychological function. These required deficits must be documented by a standardized mental status examination and neuropsychological assessment. Finally, no additional systemic or brain disorder may be present that could be the cause of the dementia.
What are neurobehavioral feature of Alzheimer disease?
The neurobehavioral features of classic dementia of the Alzheimer type include memory impairment, executive dysfunction, disturbances in language (aphasia), visuospatial deficits, and impaired ability in calculation and abstraction. Disturbances of other cortical functions such as agnosia (impaired recognition) and apraxia (inability to carry out a motor task in the absence of sensory loss, hemiparesis, or difficulty in comprehension) may be observed. The memory impairment characteristic of AD includes deficits in new learning and an inability to recall previously learned material accurately. Patients are noted to be markedly forgetful and repetitive; there is a tendency to misplace items.
What does Executive dysfunction mean?
Executive dysfunction is marked by difficulties in organization, planning, and strategizing.
What is typical language disturbance of AD?
It is best characterized as a transcortical sensory aphasia—there is a fluent verbal output accompanied by anomia, impaired auditory comprehension, preserved repetition, and aphasic writing.
Although patients may be able to read aloud, their comprehension for written material is impaired. To the casual listener, affected patients have difficulty finding words and may inappropriately substitute related words or improper phonemes when conversing. The patient's verbal discourse is vague to the listener and lacks clear direction of purpose (circumlocution).
As a consequence of impaired auditory comprehension, the patient is often noted to be uncharacteristically passive and remote.
What are the strategies in management of Dementia?
The neuropsychological deficits, neuropsychiatric symptoms, and medical illnesses that afflict demented patients pose significant clinical challenges for physicians and caregivers. Effective treatment and management involve pharmacologic and nonpharmacologic interventions.
What are the pharmacologic agents that are effective in Dementia?
At present, no single pharmacologic agent has shown clear efficacy in reversing or halting the intellectual deterioration accompanying the two most common dementia syndromes, AD and vascular dementia.
Numerous short- and long-term placebo-controlled trials of medications conducted worldwide have demonstrated their modest efficacy in improving cognition, behavior, and function in patients with mild to moderate dementia severity. There is also evidence that functional decline and admission to nursing homes might be delayed in some patients.
What are the nonpharmacologic techniques that are effective?
Several nonpharmacologic techniques can aid caregivers and physicians in helping the demented patient to remain as functional as possible throughout the course of the illness. These include the following:
1) Maintaining eye contact and speaking to the patient in a simple, distinct, and calm manner;
2) Asking only one question at a time, and allowing ample time for a response;
3) Establishing a regular, structured daily routine while encouraging the patient's active participation;
4) Calmly reorienting the patient when necessary;
5) Breaking down all tasks into several simple steps; and
6) Setting realistic expectations for what the patient can and cannot do.
What are the caregiver issues?
Ongoing surveillance and treatment of caregiver stress and depression are of paramount importance for the successful management of the demented patient. Identification and participation of other potential caregivers should be encouraged. When feasible, primary caregivers should be encouraged to attend caregiver support groups while lessening their own burden of responsibility through the use of additional assistance such as daycare, respite, or home health aides.
How can we help the caregiver?
Early in the course of the dementia, referrals should be made for financial and legal counseling. Additionally, caregivers should be educated about the signs and symptoms of potentially complicating medical problems, such as urinary tract infection and incontinence. Simple strategies, such as beginning a regular toileting schedule, using adult diapers, and monitoring fluid intake, can aid in the successful management of urinary incontinence. Over time, information should also be gathered about the family's attitudes toward nursing home admission, and appropriate advice about this issue should be given as needed.
For more information please refer to: Duthie: Practice of Geriatrics, 4th -ed. Copyright © 2007 Saunders, An Imprint of Elsevier
