Common Medical Problems in Geriatrics PDF
Document Details
South Valley University
Dr. Mohamed tag eldeen
Tags
Summary
This presentation discusses common medical problems in geriatrics. It covers topics such as frailty, falls, osteoporosis, delirium, urinary incontinence, and liver cirrhosis. The presentation also outlines assessment parameters, causes, and interventions for these conditions.
Full Transcript
Common Medical Problems in Geriatrics By Dr. Mohamed tag eldeen Lecturer of internal medicine South Valley University Introduction Ageing can be defined as a progressive accumulation of random defects through life result in functional impairment...
Common Medical Problems in Geriatrics By Dr. Mohamed tag eldeen Lecturer of internal medicine South Valley University Introduction Ageing can be defined as a progressive accumulation of random defects through life result in functional impairment of tissues and organs. Geriatric medicine is concerned particularly with frail older people with markedly reduced physiological capacity. Geriatrics frequently have multiple comorbidities, and acute illness that mostly present in non- specific ways, such as confusion, falls, or loss of mobility. These patients are prone to adverse drug reactions, partly because of polypharmacy and partly because of age-related changes in responses to drugs and their elimination. Frailty vs Disability Frailty means the loss of ability to withstand minor stresses because the reserves in function of several organ systems are severely reduced. So; even a trivial event may result in organ failure and death. Disability means established loss of function, as in fracture or stroke. So; frailty can be defined as vulnerability to disability. Assessment of Frailty Frailty can be assessed using the following parameters: 1. Cardiorespiratory Function 2. Cognitive Function 3. Integrative CNS Function (Gait and Balance) 4. Nutritional Status 5. Musculoskeletal function Common Medical Problems Falls Falls is one of the common health problem in geriatrics specially in frail individuals. It is one of the atypical presentations of acute illness like stroke or myocardial infarction Osteoporosis risk factors should also be sought and DEXA (dual energy X-ray absorptiometry) bone density scanning considered in all older patients who have recurrent falls. Main causes Muscle weakness History of falls Gait or balance abnormality Use of a walking aid Visual impairment Arthritis Depression Cognitive impairment Age over 80 years Psychotropic medication Interventions to prevent falls Individualised or group exercise training Rationalisation of medication, especially psychotropic drugs Correction of visual impairment, particularly cataract extraction Home environmental hazard assessment and safety education Treatment of cardiovascular disorders, including carotid sinus syndrome and postural hypotension Postural Hypotension Major cause of repeated falls, can be treated by: Correction of dehydration Head-up tilt of the bed Support stockings NSAIDs Fludrocortisone Midodrine Osteoporosis If osteoporosis is diagnosed, it should be treated using: Calcium Vitamin D Bisphosphonates. Delirium Delirium is acute loss of consciousness associated with cognition changes. Predisposing factors are: Dementia Admission with infection or dehydration Surgery Alcohol misuse Severe physical illness Frailty Visual impairment Polypharmacy Renal impairment Main Causes of Delirium Urin Incontinence One of the distressing problems in old age May be predisposed by Diuretic therapy Hyperglycemia Hypercalcaemia Delirium Uterine prolapse in females Sever constipation Can be minimized by Stop or modify diuretic dose Pelvic floor training Control of diabetes Avoid alcohol intake Minimize coffee, tea and cola Treatment of the contributing factor Catheterization Urology Consultation Liver Cirrhosis Definition Cirrhosis is the end point of any chronic liver disease. In Egypt , the most important causes of cirrhosis are : - Chronic hepatitis C - Chronic hepatitis B - Cardiac cirrhosis. - NAFLD/NASH - Alcohol. It leads to liver cell failure and liver cancer. Liver transplantation is the curative treatment. History of Liver Disease HCV and/ or HBV, or its TTT Presenting Problems of liver diseases Hepatotoxic agents, intake or exposure Special habits like Smoking & Alcoholism Recent Surgery even minor procedures like tattooing Comorbidities like Diabetes, Heart Failure, Renal Failure, and Haemolytic Anaemia Family history of liver diseases Bilharziasis or Anti- Bilharzial TTT (Injections). Presenting Problems Bleeding tendency Haematemesis , Melena Rectal Bleeding Jaundice Abdominal Swelling, and/or Abdominal Pain Abnormal Behavior, Disturbed Sleep rhythm, Disturbed Conscious level. Sexual Dysfunction Lower Limb Swelling Fatigue and General illness Accidentally Discovered EXAMINATIONS Complications of Liver Cirrhosis Oesophageal Varices Ascities Splenomegaly Hepatic Encephalopathy Liver Cancer Important Notes Musculoskeletal and rhumatological symptoms are common in patient with liver diseases as an extrahepatic manifestations. Patient with liver disease has a progressive decrease of muscle mass and bone density. Well balanced diet plays a crucial role in the care of such patient. Many drugs, supplements and herbals have a hepatotoxic potential that sometimes results in fatal outcome.