Approach To Elderly Patient

Family physicians are responsible for caring increasing number of elderly patients.Older patients have co morbidities, functional, psychological and social problems that need to be considered by the the family physician.

Goals of Geriatric Assessment

1. Focus on preventive medicine rather than acute medicine.
2. Focus on improving or maintaining functional ability and not necessarily on a “cure.”
3. Provide a long-term solution for “difficult to manage” patients with multiple physicians, recurrent emergency department visits, and hospital admissions with poor follow-up.
4. Aid in the diagnosis of health-related problems.
5. Develop plans for treatment and follow-up care.
6. Establish plans for coordination of care.
7. Determine the need and site of long-term care as appropriate.
8. Determine optimal use of health care resources.
9. Prevent readmission into the hospital.

The geriatric assessment can be divided into four categories: medical, functional, psychological, and social.

Medical Assessment The medical assessment includes a review of the patient’s medical record, medication history (past and present), and a nutritional evaluation. On average, elderly patients have four to six diagnosable disorders, which may require the use of several medications. One disorder can affect another, and in turn a collective deterioration of both can lead to overall poor outcomes.

During the medical assessment, the review of systems should be completed with special emphasis on sensory impairment, dentition, mood, memory, urinary symptoms, falls, nutrition, and pain.

Depression In Elderly

Depression in elderly is very common but that does not mean that it is normal. It affects about 6 million Americans who are above the age of 65 years. Older patients are more at risk of suffering from depression due to a number of factors like retirement, isolation, death of loved ones and medical problems.

Depression- Definition: Anyone can feel sad or down but when these feelings of sadness are persistent causing trouble in daily routine activities then it becomes a disease. Depression is defined as a medical illness in which there is persistent feeling of sadness, often associated with discouragement and lack of self worth.

Clinical Features:Identifying an elderly suffering from depression is necessary as it is frequently confused with the symptoms of other medical conditions the patient is already having and with the affect of multiple treatments the patient is receiving. It is important to remember that depression is a disease that affects both the body and the mind. The main signs and symptoms are as follows:

• Sadness
• Fatigue
• Lost of interest in hobbies and things that used to give pleasure in the past
• Decreased appetite
• Sleep disturbances ( both either difficulty sleeping or excessive sleep )
• Weight loss
• Subtle signs of distress like irritable, agitated or difficulty sitting still.
• Inability to concentrate.
• Generalized body aches, headaches, digestive disturbance
• Thoughts of suicide or a suicidal attempt.

Depression In elderly Is Different from Depression In Younger Patients:

• Depression affects older people differently than in younger patients. Depression in the elderly often increases the risk of cardiac disease by two fold and thus increases the risk of death.

Managing Diabetes In The Elderly Patients

As the medical care is advancing and the life expectancy is increasing there are now more people who are now elderly and are patients of type 2 diabetes mellitus. Although the pharmacological treatment options are almost the same for the older patients as those in the younger adults but the elderly need some specific care and management if they have diabetes. Also it is important to take note of the fact that diabetes is not the only disease that may be affecting the patient because elderly people above the age of 70 have more than one chronic diseases that are present at the same time.

The overall goal of management of diabetes in the elderly patients includes maintaining optimal glycemic control as well as managing the associated risk factors due to advanced age.

1 Educating about the disease: Studies have shown that patients who know their diseases well are able to manage it more properly than those who are not educated about the disease. This is especially very important in case of diabetes. Elderly patients may not be able to remember properly about their drugs and doses or may forget about the nutritional care. It is important to educate them as well as their primary care givers.

2. Preventing and Recognizing Hypoglycemia: The risk of hypoglycemia is much more in the older adults and the symptoms may be missed or confused and so the hypoglycemic episodes are not properly reported in the elderly patients. Even a mild hypoglycemia that caused dizziness may lead do major problems like a fall and resulting fracture that is very difficult to heal due to the age factor. Thus it is important to take care and prevent hypoglycemia to occur at the first place.

3. Care for Proper Nutrition: Senior patients with diabetes should always be helped by a proper dietitian for the nutrition care. They should be advised to take protein rich food as protein slows sugar absorption.

4. Choosing the Medications: It is important to consider different factors like weight, mobility,