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By J. Manuel Cordova, M. D.
Edited by Maria Montenegro
Geriatrics is the branch of medicine that focuses on health care of the elderly. It aims to promote health and to prevent and treat diseases and disabilities in older adults. Geriatrics was separated from Internal Medicine Specialty as a distinct entity in the same way that pediatrics is separated from adult medicine.
There is no set age at which patients may be under the care of a geriatrician. A person in his 40s or 50s may have special health care needs based on environmental exposures, nutrition, genetics, smoking, previous illnesses, etc.
Geriatrics differs from adult medicine in many respects. The body of an elderly person is substantially different physiologically from a younger adult. Old age is the decline of the various organ systems in the body. The organ reserves vary from person to person. Smokers, for example, consume their respiratory system reserve earlier in life than a non-smoker. The decline of organ reserves makes the geriatric patient more susceptible to disease than a younger adult.
Many people cannot differentiate between disease and aging effects. For example, renal impairment may be a part of aging but renal failure is not. Also urinary incontinence is not part of normal aging, but is a disease that may occur at any age and is frequently treatable.
Geriatricians aim to treat the disease and to decrease the effects of aging on the body. Years of training and experience, above and beyond basic medical training, go into recognizing the difference between what is normal aging and what is, in fact, pathological. Functional ability, independence and quality of life issues are also of greater concern to geriatricians than to adult physicians.
Treating an elderly person is not like treating a younger adult. Elderly persons sometimes are unable to make decisions concerning themselves. Geriatricians often have to ‘treat’ the caregivers and sometimes, the family, rather than just the elder.
Elderly people have specific issues regarding medications. Some elderly people have multiple medical disorders. Some use many herbs and OTCs (over the counter). Some adult physicians may prescribe medications without reviewing other medications used by the elder patient. This ‘polypharmacy’ may result in drug interactions and cause serious adverse reactions.
Drugs are excreted mostly by the kidneys or the liver, either of which may be impaired in the elderly. As a result, the medication might need adjustment, either renal (kidneys) or hepatic (liver). This is an extremely important part of the Geriatric Physician´s role in treating the patient.
The so-called ‘Geriatric giants’ are immobility, instability, incontinence and impaired intellect/memory. Health issues in older adults may also include delirium, impaired vision and hearing.
Some diseases commonly seen in elderly are rare in younger adults, such as dementia, delirium, falls, etc. This is one reason that non-geriatric specialists may not readily detect certain underlying conditions in the geriatric patient.
Care of the aged is very different than younger adult care. The amount of sleep, diet and exercise is extremely important for the aged person and is different for a younger adult. Family members and other care givers sometimes find it hard to understand why the treatment plan is different for the aged patient than for a younger adult.
In order to be a Geriatrics Specialist, you must first be trained and licensed as an Internal Medicine Specialist. At least two additional years of education and training in an accredited medical university is required to qualify as a Geriatric Specialist. To get the most out of your ´Golden Years´ be proactive with prevention and wellness.