Common Medical Problems in Geriatrics PDF

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.