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Introduction to Geriatric Medicine - Coggle Diagram
Introduction to Geriatric Medicine
1. Historical Background & Context
In the past, older adults were treated identically to the general population.
Treating them the same neglects critical elements of their health and well-being.
Longevity results in a broader, overlapping spectrum of health and life problems.
Disease symptoms tend to show up in more varied and subtle ways in older adults.
Care requires a multidisciplinary approach focusing on biological, psychological, and social interactions.
2. Definition & Core Aims
Specialty focused on physical, mental, functional, and social conditions of older patients.
Encompasses five care settings: acute, chronic, rehabilitative, preventive, and end-of-life.
Aim 1: Maintenance of health in old age by continuing social engagement and avoiding disease.
Aim 2: Early detection and appropriate treatment of disease.
Aim 3: Maintenance of maximum functional independence.
Aim 4: Sympathetic care and support during terminal illness.
3. Scope of Geriatric Practice
Requires diagnostic reasoning and the ability to confidently manage clinical uncertainty.
Must manage the challenges of frailty, complex co-morbidities, and slower responses to treatment.
Core values rely heavily on patient-centered approaches, safety, and interdisciplinary teamwork.
Hospital-based roles: Specialists working closely with other medical departments.
Community-based roles: Specialists working closely with primary care and local community services.
4. Special Features of Geriatric Illness
Key Philosophy: Age and disease are not synonymous.
Misconception: Believing disability is unavoidable delays therapy and prolongs illness.
Communication barriers: Dementia or stroke can cause aphasia or dysarthria, blocking speech.
Common illnesses frequently present with atypical (unusual) symptomatology.
Altered pain perception: Feeling pain is significantly different compared to younger adults.
Hidden infections: Fever is often minimal and elevated white blood cell counts (leukocytosis) can be entirely absent
5.
The Four Cardinal Presenting Symptoms
Mental Confusion: Acute illnesses trigger low blood oxygen (anoxaemia) or toxins (toxemia), overwhelming limited brain reserve.
Incontinence: Systemic or local pathologies disrupt the brain's cerebral control over urination.
Instability: Postural instability and falling caused by aging in the C.N.S., muscles, and joints, plus chronic joint/foot disorders.
Immobility: A primary cardinal sign that indicates a severe breakdown in general functional health.
6. Classification of Geriatric Diseases
Acute brain failure: Underlying age changes compounded by acute pathologies that impair blood or oxygen supply to the brain.
Acute anoxic brain failure triggers: Bronchopneumonia, congestive cardiac failure, acute bronchitis, or heart attacks.
Acute infection triggers: Pyelitis, pneumonia, and influenza.
Metabolic toxemia triggers: Liver failure, uremia, and high blood sugar (hyperglycemia).
Exogenous triggers: Acute medication poisoning.
Clinical Warning: Acute confusion can mask traditional emergency signs, completely hiding the pain of a heart attack or appendicitis.
Chronic illness triggers: Prolonged lifespan increases risk for long-term disabilities like COPD, Parkinsonism, and osteoarthrosis.
7. Pharmacology & Pharmacokinetics (ADME)
Pharmacokinetics: How the body absorbs, distributes, metabolizes, and eliminates a drug.
Absorption: Medication absorption from the intestinal tract is physically reduced.
Distribution: Total body water decreases (causing dangerous spikes in water-soluble drug concentrations).
Retention: Body fat proportion increases, causing lipid-soluble (fat-soluble) agents to remain trapped in the body for longer periods.
Metabolism: Hepatic (liver) metabolic breakdown capacity is decreased.
Elimination: Excretion of drugs through the renal (kidney) system is significantly reduced and affected.
Pharmacodynamics: The direct interaction between a drug and its specific body receptors.
General Rule: Aging changes how drugs are handled, making drug reactions much greater and more severe than in the young.