"Health in the elderly is measured in terms of function" (WHO). The concept of health in the elderly is not always linked to the absence of disease. Should include both physical and mental disorders as personal and socioeconomic circumstances.
The physiological aging will you meet accepted biological parameters for different ages and keep the ability to relate to the social environment. And be pathological when alter disease incidence and biological parameters such difficult social relations.
A direct consequence of the above would be the concept of atypical presentation of disease. This is many times a diagnostic challenge (eg., Pneumonia can manifest manifest with delirium without fever or cough or chest pain).
Often the elderly manifest nonspecific symptoms, not necessarily the typical picture of the particular disease. Diseases present with different signs and symptoms as they do young people (eg., Parkinson manifested by falls and not tremor). These differences in disease presentation regarding the younger population will be more pronounced the older the patient. This influence also other reasons, such as the frequent coexistence of multiple conditions or comorbidities, polypharmacy and more fragile, which mask individual frames.
For good health care to elderly patients it is necessary knowledge of:
- The heterogeneity of the population over 65 years old healthy, sick elderly, frail elderly and geriatric patient.
- The peculiarities of disease in them: atypical presentations of disease.
- The fragility as a marker of vulnerability in older people.
- Comorbidity and polypharmacy: Several diseases can affect different organs or systems related to each other or not. They are favored by many factors.
- The tendency to chronicity and frequent failure: high prevalence of chronic and degenerative diseases, which cause overload dependence of caregivers and high percentage of institutionalization.
- Less favorable forecast of disease: they settle in an organism with decreased functional reserve and responsiveness to external stressors.
Although this should not justify delaying treatment.
- Diagnostic and therapeutic difficulties: both diagnostic and therapeutic attitudes in geriatrics should be guided by the risk / benefit always looking for the latter. It will take into account the views of the elderly and again following a comprehensive geriatric correct assessment.
- Increased use of health resources: the elderly are major consumers of health care resources.
- The hospital demand is characterized by:
• hospitalization rate twice that of the general population, being 3 times more freccuent on the larger group of 80.
• Large hospital stay linked in many cases to increased dependency and iatrogenesis.
• Large number of readmissions.
- Increased need for rehabilitation: the causes of functional impairment in an elderly include: multiple and disabling.
- One of the objectives of geriatrics will be the maintenance of autonomy and function through the use of early rehabilitation.
- Frequent need to use social resources: in the elderly often the onset of disease causes or exacerbates social and family problems appear.
- Frequent ethical problems: in decision-making: in the final stages of life, longer life artificially in the absence of a living will of the individual, legal incapacities people with dementia ...
Problems that may occur:
- Incomplete medical diagnosis.
- Overprescribing drug.
- Under-utilization of rehabilitation.
- Poor coordination between services that prevent continuity of care.
- Institutionalization inadequate.
Importance of:
- Comprehensive geriatric assessment
- Comprehensive treatment (medical, functional, psychological and social
- Coordination through levels of care to ensure continuity of care,
- Institutionalized elderly supervision
GERIATRIC SYNDROMES
Geriatric syndromes are usually caused by a combination of diseases with high prevalence in the elderly. They are often the source of social functional disability or the elderly.
Are expressed in disease situations a set of symptoms, but also the beginning of many other problems that need to be taken into account from detection to establish a good prevention.
These syndromes can lead to increased morbidity and sometimes more serious consequences than the disease that occurs (eg., Immobility syndrome generated a CVA [stroke], without good prevention of pressure ulcers can occur and generate these more problems).
Your screening as "complaints" or "problems" to be included in the history of the elderly person history.
They are rarely addressed in clinical pathology books or in epidemiological studies because its manifestation is not in common diseases. They are a common form of presentation of illness in the elderly. They require a careful assessment of its meaning
and causes. Do not fall into the "ageism" to interpret the pathological situation of the elderly but it is important to interpret and meet geriatric syndromes.
• Immobility.
• Instability: (falls).
• Incontinence (urinary and fecal).
• Intellectual impairment: dementia and acute confusional state.
• Infection
• inanition: malnutrition
• Impairment of vision and hearing: changes in vision and hearing.
• Irritable colon: constipation, fecal impaction.
• Isolation (depression) / insomnia: depression / insomnia.
• iatrogenesis: iatrogenic.
• Immune deficiency.
• Impotence: Impotence or sexual dysfunction.
Geriatric syndromes care:
- Multiple studies indicate that use primary care service 3 times more than the average population.
- Consumption of 1.5-2 times more drugs.
- Hospital admissions in those over 65 years is twice that in the general population, tripling the rate in over 80 years.
- His stays are longer.
- Summarized 2000 data that 49% of hospital stays up to age 65 years.
REFERENCES:
- Treaty of geriatrics for residents. Spanish Society of Geriatrics and Gerontology. [Home Site] [accessed May 18, 2013] Available at: http://www.segg.es/tratadogeriatria/main.html
- Nobili A,
Garattini S, Mannucci PM. Multiple diseases and polypharmacy in the elderly:
challenges for the internist of the third millennium. Journal of Comorbidity
2011; 1:28–44
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