Differences between adult and geriatric medicine
Geriatrics differs from adult medicine in many respects. The body of an elderly person is substantially different physiologically from that of an adult. Old age is the period of manifestation of decline of the various organ systems in the body. This varies according to various reserves in the organs, as smokers, for example, consume their respiratory system reserve early and rapidly.Many people cannot differentiate between Disease and Ageing effects; e.g., renal impairment may be a part of ageing but renal failure is not. Also urinary incontinence is not part of normal ageing, but it 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.
The decline in physiological reserve in organs makes the elderly develop diseases (such as dehydration from a mild gastroenteritis) and be liable to complications from mild problems. Fever in elderly persons may cause confusion leading to a fall and to a fracture of the neck of the femur ("breaking her/his hip").
Functional ability, independence and quality of life issues are of greater concern to geriatricians, perhaps, than to adult physicians.
Treating an elderly person is not like treating an adult. A major difference between geriatrics and adult medicine is that elderly persons sometimes cannot make decisions for themselves. The issues of power of attorney, privacy, legal responsibility, advance directives and informed consent must always be considered in geriatric procedure. Elder abuse is also a major concern in this age group. In a sense, geriatricians often have to "treat" the caregivers and sometimes, the family, rather than just the elder.
Elderly people have specific issues as regard medications. Elderly people particularly are subjected to polypharmacy due to many causes. Some elderly people have multiple medical disorders; some use many herbs & OTCs; some adult physicians just prescribe medications to their specialty without reviewing other medications used by the elder patient. This polypharmacy may result in many drug interactions and may cause some drug adverse reactions. Drugs are excreted mostly by the kidneys or the liver, either of which may be impaired in the elderly, and as a result the medication might need adjustment, either renal (kidneys) or hepatic (liver).
The presentation of disease in elderly persons may be vague and non-specific, or it may include delirium or falls. (Pneumonia, for example, may present with fever, low-grade fever, dehydration, confusion or falls.) Some elderly people may find it hard to describe their symptoms in words, especially if the disease is active and causing confusion, or if they have cognitive impairment. Delirium in the elderly may be caused by a minor problem such as constipation or by something as serious and life-threatening as a heart attack (myocardial infarction).
All of the baby boomers will be 65 years and older by 2030. At the same time, there is a deficiency of geriatric-trained physicians, nurses, and other health professionals. This will create a challenge for the health-care workforce. It will be necessary to have models of care that meet the needs of the aging population. Geriatricians will need to have training in public health and to lead programs as they may not be able to physically consult on all the vulnerable frail elderly.
Geriatrics giants and elderly diseases
The so-called 'Geriatric giants' are immobility, instability, incontinence and impaired intellect/memory. Health issues in older adults may also include elderly care, delirium, use of multiple medications, impaired vision, and hearing.
Geriatrics subspecialties and related specialties
Some diseases commonly seen in elderly are rare in adults, e.g., dementia, delirium, falls. As societies aged, many specialized geriatric- and geriatrics-related services emerged including:Medical
* Geriatric psychiatry or psychogeriatrics (focus on dementia, delirium, depression and other psychiatric disorders).* Cardiogeriatrics (focus on cardiac diseases of elderly)
* Geriatric nephrology (focus on kidney diseases of elderly)
* Geriatric dentistry (focus on dental disorders of elderly)
* Geriatric Rehabilitation (focus on physical therapy in elderly)
* Geriatric oncology (focus on tumors in elderly)
* Geriatric rheumatology (focus on joints and soft tissue disorders in elderly)
* Geriatric neurology (focus on neurologic disorders in elderly)
* Geriatric diagnostic imaging
* Geriatrics dermatology (focus on skin disorders in elderly)
* Geriatric subspeciality medical clinics (As Geriatric Anticoagulation Clinic Geriatric Assessment Clinic, Falls and Balance Clinic, Continence Clinic, Palliative Care Clinic, Elderly Pain Clinic, Cognition and Memory Disorders Clinic
* Geriatric emergency medicine
* Geriatric Physical Examination of interest especially to Physicians & Physician Assistants.
* Geriatric public health or Preventive Geriatrics (focuses on geriatrics public health issues including disease prevention and health promotion in elderly)
* Geriatric pharmacotherapy
Surgical
* Orthogeriatrics (close cooperation with orthopedic surgery and a focus on osteoporosis and rehabilitation).* Geriatric Cardiothoracic Surgery
* Geriatric urology
* Geriatric otolaryngology
* Geriatric General Surgery
* Geriatrics trauma
* Geriatric gynecology
* Geriatric ophthalmology
Other geriatrics subspecialties
* Geriatric anesthesia (focuses on anesthesia & perioperative care of elderly)* Geriatric intensive-care unit: (a special type of intensive care unit dedicated to critically-ill elderly)
* Geriatric nursing (focuses on nursing of elderly patients and the aged).
* Geriatric nutrition
* Geriatric Occupational Therapy (part of Geriatric Rehabilitation)
* Geriatric Pain Management
* Geriatric Physical Therapy
* Geriatric podiatry
* Geriatric psychology
Adapted from the Wikipedia article Geriatrics, under the G. N. U. Free Documentation License. Please also see http://en.wikipedia.org/wiki
