Approach to a Geriatric patient
Dr. Maria Varghese, Welcare Hospital, Cochin
The elderly population needs a different approach compared to regular patients because of their heterogenecity, and atypical presentations. Increasing age brings disability and frailty. The focus in geriatric care is on function rather than on the problem alone, on care rather than cure and on the maintenance of independent living. It is also important to prevent iatrogenesis. It is important to recognize the geriatric giants viz. immobility, confusion, falls, incontinence, dizziness, imbalance, pressure, sores, and fatigue. A geriatric functional assessment includes a) Cognitive function by MMSE b) Activities of daily living like feeding, transfer, bathing, stair climbing, bowel & bladder incontinence etc. c) Instrumental activities of daily living including meal preparation, housework, laundry, shopping, managing finances, using telephone. d) Ability to ambulate by the get up and go test and e) geriatric depression scale. Only one third of functional decline is due to actual aging, one third is attributable to disease, and remaining is due to disuse. The elderly have a limited ability to bounce back from physiological insults. This is a concept known as Homeostenosis. While working with older patients, one should be patient, optimize communication, make the patient feel safe and comfortable and also get a full medication list. The basic benefits of geriatric assessment include increased diagnostic accuracy, improved functional status, improved survival, decreased hospital use and costs and decreased medication use.