Special Features of Geriatric Medicine
The word “Geriatrics” was derived from the greek word “Gerios” meaning old age and “iatros” meaning medicine and was coined by an American, Doctor Nascher in 1914. The British Geriatric Society has defined Geriatrics as “The branch of general medicine concerned with the clinical, preventive, medical and social aspects of illness in the elderly”. It was Dr.Nascher who was instrumental in the establishment of the field of geriatrics in 1914 and today this field is well established in all developed countries.
Who belongs to the geriatric group?
Strictly speaking, old age is not entirely a matter of years. Some people continue to remain young even in their seventies while others seem old in their fifties or even earlier. Hence it is difficult to specify an age limit beyond which a patient can be called as belonging to the geriatric group. For practical purposes howev er, old age can be best defined as the age of retirement, for it is at that time that the combined effects of ageing, social changes and diseases are likely to cause a breakdown in health. In our country since the age of retirement generally varies from 58 to 60, the geriatric age group is fixed as 60 years and above
How geriatrics differs from the other specialities?
Elderly patients differ in many ways from the young; indeed such distinctions underlie the separate existence of geriatrics as a medical speciality. They differ mainly because of diagnostic, therapeutic and social problems.
Attitude of elders
The improper psychological attitude of elders is an important cause which leads to diagnostic error on the part of the doctor. This is an important factor which hinders the early detection and treatment of diseases which at later stages may become incurable.
To cite an example, elders regard lack of appetite and loss of weight as inevitable effects of the ageing process. So when these symptoms occur, they generally tend to ignore them. What they don’t realize is that these symptoms may also be preliminary indications of tuberculosis or diabetes. Elders seem to have an inherent aversion to consult a doctor or to seek medical treatment. This factor may be responsible for delay in diagnosis by the doctor.
Attitude of relatives
Another problem related to diagnosis of disorders in the elderly is the wroing attitude of other members in the family. when elders complain of any physical discomfort, it is not taken seriously by the other members in the family. They tend to ignore such discomfort as an inevitable part of ageing and hence ignore these symptoms. When a child has a minor problem, it is immediately taken to the doctor for treatment, whereas when an elder suffers from the same problem, he is just given a tablet and left to himself without any further action being taken.
Such an attitude hinders the early and correct diagnosis of disease by the doctor.
Unique characteristics of diseases in the elderly
Atypical presentation of illness in the elderly is very common. Accordingly they may be obscured or misleading or less florid and dramatic. This makes accurate and early diagnosis and treatment difficult. For example if one suffers from chest infection, one normally exhibits such symptoms like fever, cough and phlegm. But these symptoms may not be exhibited by elders and may present as only acute confusional state.
Similarly elders may suffer from heart attacks without pain in the chest; they may have stomach ulcer, gall bladder complaints or appendicitis without any abdominal discomfort or pain. Hence a geriatricican specializing in treatment of diseases in the elder can make an accurate diagnosis.
It is often said that an elderly person is a grazing ground for diseases. Sometimes he may not even be aware of the presence of a disease. When dealing with younger patients, it is customary to try to explain every symptom, sign and abnormal laboratory finding in terms of a single pathological disorder. This approach is completely inappropriate while treating the elderly. Once people are in their 60s and 70s, they commonly show evidence of several pathological processes, some active and others inactive but yet contributing to the total disability of the elderly patient.
Problems with investigations
A problem which commonly arises in investigating the diseases in the elderly is to decide what is normal and what is abnormal. This is because there is increasing evidence to show that standards set for the younger patients cannot always be used for the elderly. For example, if the laboratory investigations reveal slightly higher sugar levels in the blood of an elderly person, it may not mean that he is a diabetic patient. Similarly, slightly higher level of urea may not mean that the kidneys are in bad shape. The results of investigations should be systematically analysed before arriving at a conclusion on the nature of the illness.
Treatment of diseases in the elderly is as complicated as the diagnosis. The side-effects of drugs increase both with age and the number of drugs prescribed. This may be due to routine prescription of the adult dose to the elderly, and leads to poor excretion and accumulation of drugs with unwanted side-effects. Multiple diseases mean multiple prescriptions. This leads to more drug-related side-effects, interactions and omissions. Sometimes side-effects of drugs may be more than its beneficial effects. It is not necessary to have a “pill for every ill”. Many diseases in old age can be managed by non-drug regiments like diet, exercise, physical therapy and counselling.
In addition, elders suffer from socio-economical problems like isolation, dependency, poverty, and so on. These problems will only precipitate or aggravate the already existing medical conditions. Only a geriatrician can completely assess this and advise appropriate management to improve the quality of life of the elders.