Array ( [0] => {{short description|Specialty that focuses on health care of elderly people}} [1] => {{Use dmy dates|date=June 2020}} [2] => {{other uses}} [3] => {{Infobox medical specialty [4] => | title = Geriatrics [5] => | subdivisions = [6] => | image = [[File:Nurse in geriatry.jpg|300px]] [7] => | caption = An elderly woman in a residential care home receiving a birthday cake [8] => | diseases = [[Dementia]], [[arthritis]], [[osteoporosis]], [[osteoarthritis]], [[rheumatoid arthritis]], [[Parkinson's disease]], [[atherosclerosis]], [[heart disease]], [[high blood pressure]] [9] => | tests [10] => [11] => | specialist = Geriatrician [12] => }} [13] => {{Infobox Occupation [14] => | name= Geriatrician [15] => | image= [16] => | caption= [17] => | official_names= [18] => * Physician [19] => | type= [[Specialty (medicine)|Specialty]] [20] => | activity_sector= [[Medicine]] [21] => | competencies= [22] => | formation= [23] => * [[Doctor of Medicine]] (M.D.) [24] => * [[Doctor of Osteopathic medicine]] (D.O.) [25] => * [[Bachelor of Medicine, Bachelor of Surgery]] (M.B.B.S.) [26] => * [[Bachelor of Medicine, Bachelor of Surgery]] (MBChB) [27] => | employment_field= [[Hospital]]s, [[Clinic]]s [28] => | related_occupation= [29] => }} [30] => '''Geriatrics''', or '''geriatric medicine''',{{cite web | vauthors = Marks JW | date = 3 June 2021 |url=https://www.medicinenet.com/script/main/art.asp?articlekey=18390|title=Medical Definition of Geriatric medicine|website=MedicineNet}} is a medical specialty focused on providing care for the unique health needs of the [[old age|elderly]].{{cite web | url = http://www.med.umn.edu/agingcf/continuity.html | title = Geriatrics separation from internal medicine | archive-url = https://web.archive.org/web/20090114131504/http://www.med.umn.edu/agingcf/continuity.html | archive-date=14 January 2009 | work = University of Minnesota }} The term ''geriatrics'' originates from the [[Greek language|Greek]] γέρων ''geron'' meaning "old man", and ιατρός ''iatros'' meaning "healer". It aims to promote [[health]] by [[prevention (medical)|preventing]], diagnosing and treating [[disease]] in [[older adults]].{{cite web | title = Geriatric Medicine Specialty Description | publisher = American Medical Association | url = https://www.ama-assn.org/specialty/geriatric-medicine-specialty-description | access-date = 5 September 2020}} There is no defined [[Ageing|age]] at which [[patient]]s may be under the care of a '''geriatrician''', or '''geriatric physician''', a physician who specializes in the care of older people. Rather, this decision is guided by individual patient need and the caregiving structures available to them. This care may benefit those who are managing multiple chronic conditions or experiencing significant age-related complications that threaten quality of daily life. Geriatric care may be indicated if caregiving responsibilities become increasingly stressful or medically complex for family and caregivers to manage independently.{{Cite web |title=About Geriatrics {{!}} American Geriatrics Society |url=https://www.americangeriatrics.org/geriatrics-profession/about-geriatrics |access-date=2022-08-29 |website=www.americangeriatrics.org}} [31] => [32] => There is a distinction between geriatrics and [[gerontology]]. Gerontology is the multidisciplinary study of the [[aging]] process, defined as the decline in organ function over time in the absence of injury, illness, environmental risks or behavioral risk factors.{{Cite web |title=What is Gerontology? |url=https://www.geron.org/about-us/our-vision-mission-and-values/what-is-gerontology |access-date=2022-09-12 |website=www.geron.org}} However, geriatrics is sometimes called '''medical gerontology'''. [33] => [34] => == Scope == [35] => [[File:Nursing home.JPG|thumb|300px|Elderly man at a [[nursing home]] in [[Norway]]]] [36] => [37] => === Differences between adult and geriatric medicine === [38] => Geriatric providers receive specialized training in caring for elderly patients and promoting healthy aging. The care provided is one largely based on shared-decision making and is driven by patient goals and preferences, which can vary from preserving function, improving quality of life, or prolonging years of life. A guiding [[mnemonic]] commonly used by geriatricians in the United States and Canada is the 5 M's of Geriatrics which describes mind, mobility, multicomplexity, [[medication]]s and matters most to elicit patient values.{{Cite journal |last1=Molnar |first1=Frank |last2=Frank |first2=Christopher C. |date=January 2019 |title=Optimizing geriatric care with the GERIATRIC 5Ms |journal=Canadian Family Physician |volume=65 |issue=1 |pages=39 |issn=0008-350X |pmc=6347324 |pmid=30674512}} [39] => [40] => It is common for [[Old age|elderly]] adults to be managing multiple medical conditions, or, multi-morbidity. Age-associated changes in physiology drive a compounded increase in susceptibility to illness, disease-associated morbidity, and death. Furthermore, common diseases may present atypically in elderly patients, adding further [[Diagnosis|diagnostic]] and therapeutical complexity in patient care. [41] => [42] => Geriatrics is highly interdisciplinary consisting of specialty providers from the fields of medicine, nursing, pharmacy, social work, physical and occupational therapy. Elderly patients can receive care related to medication management, pain management, psychiatric and memory care, rehabilitation, long-term nursing care, nutrition and different forms of therapy including physical, occupational and speech. Non-medical considerations include social services, transitional care, advanced directives, power of attorney and other legal considerations. [43] => [44] => ===Increased complexity=== [45] => The decline in physiological reserve in organs makes the elderly develop some kinds of diseases and have more complications from mild problems (such as [[dehydration]] from a mild [[gastroenteritis]]). Multiple problems may compound: A mild [[fever]] in elderly persons may cause confusion, which may lead to a fall and to a fracture of the [[Femur neck|neck of the femur]] ("broken hip"). [46] => [47] => 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 low-grade [[fever]] and confusion, rather than the high fever and cough seen in younger people.) Some elderly people may find it hard to describe their [[symptoms]] in words, especially if the disease is 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 [[myocardial infarction|heart attack]]. Many of these problems are treatable, if the root cause can be discovered. [48] => [49] => === Geriatric pharmacology === [50] => Elderly people require specific attention to [[medications]]. Elderly people particularly are subjected to [[polypharmacy]] (taking multiple medications) given their accumulation of multiple chronic diseases. Many of these individuals have also self-prescribed many [[herbal medication]]s and [[over-the-counter drug]]s. This polypharmacy, in combination with geriatric status, may increase the risk of [[drug interaction]]s or [[adverse drug reaction]]s.{{Cite journal |last1=Dagli |first1=Rushabh J |last2=Sharma |first2=Akanksha |date=2014 |title=Polypharmacy: A Global Risk Factor for Elderly People |journal=Journal of International Oral Health|volume=6 |issue=6 |pages=i–ii |issn=0976-7428 |pmc=4295469 |pmid=25628499}} [[Pharmacokinetics|Pharmacokinetic]] and [[Pharmacodynamics|pharmacodynamic]] changes arise with older age, impairing their ability to metabolize and respond to drugs. Each of the four pharmacokinetic mechanisms (absorption, distribution, metabolism, excretion) are disrupted by age-related physiologic changes. For example, overall decreased hepatic function can interfere with clearance or metabolism of drugs and reductions in kidney function can affect renal elimination.{{Cite web |title=Pharmacokinetics in Older Adults - Geriatrics |url=https://www.merckmanuals.com/professional/geriatrics/drug-therapy-in-older-adults/pharmacokinetics-in-older-adults |access-date=2022-09-12 |website=Merck Manuals Professional Edition |language=en-US}} Pharmacodynamic changes lead altered sensitivity to drugs in geriatric patients, such as increased pain relief with [[morphine]] use.{{Cite journal |last1=Mangoni |first1=A A |last2=Jackson |first2=S H D |date=January 2004 |title=Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications |journal=British Journal of Clinical Pharmacology |volume=57 |issue=1 |pages=6–14 |doi=10.1046/j.1365-2125.2003.02007.x |issn=0306-5251 |pmc=1884408 |pmid=14678335}} Therefore, geriatric individuals require specialized pharmacological care that is informed by these age-related changes. [51] => [52] => === Geriatric syndromes === [53] => Geriatric syndromes{{Cite web |title=Geriatric Syndrome - an overview {{!}} ScienceDirect Topics |url=https://www.sciencedirect.com/topics/medicine-and-dentistry/geriatric-syndrome |access-date=2023-03-01 |website=www.sciencedirect.com}} is a term used to describe a group of clinical conditions that are highly prevalent in elderly people. These syndromes are not caused by specific pathology or disease, rather, are a manifestation of multifactorial conditions affecting several organ systems. Common conditions include frailty, functional decline, falls, loss in continence and malnutrition, amongst others.{{Cite journal |last1=Mallappallil |first1=Mary |last2=Friedman |first2=Eli A |last3=Delano |first3=Barbara G |last4=McFarlane |first4=Samy I |last5=Salifu |first5=Moro O |date=2014 |title=Chronic kidney disease in the elderly: evaluation and management |journal=Clinical Practice (London, England) |volume=11 |issue=5 |pages=525–535 |doi=10.2217/cpr.14.46 |issn=2044-9038 |pmc=4291282 |pmid=25589951}} [54] => [55] => ==== Frailty ==== [56] => Frailty is marked by a decline in physiological reserve, increased vulnerability to physiological and emotional stressors, and loss of function. This may present as progressive and unintentional weight loss, fatigue, muscular weakness and decreased mobility.{{Cite journal |last1=Pal |first1=Laura M |last2=Manning |first2=Lisa |date=June 2014 |title=Palliative care for frail older people |journal=Clinical Medicine |volume=14 |issue=3 |pages=292–295 |doi=10.7861/clinmedicine.14-3-292 |issn=1470-2118 |pmc=4952544 |pmid=24889576}} It is associated with increased injuries, hospitalization and adverse clinical outcomes. [57] => [58] => ==== Functional decline ==== [59] => Functional disability can arise from a decline in physical function and/or cognitive function. It is associated with an acquired difficulty in performing basic everyday tasks resulting in an increased dependence of other individuals and/or medical devices.{{Citation |last1=Edemekong |first1=Peter F. |title=Activities of Daily Living |date=2022 |url=http://www.ncbi.nlm.nih.gov/books/NBK470404/ |work=StatPearls |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=29261878 |access-date=2022-09-12 |last2=Bomgaars |first2=Deb L. |last3=Sukumaran |first3=Sukesh |last4=Schoo |first4=Caroline}}{{Cite journal |last1=Aliberti |first1=Marlon J. R. |last2=Covinsky |first2=Kenneth E. |date=2019-02-01 |title=Home Modifications to Reduce Disability in Older Adults With Functional Disability |url=https://doi.org/10.1001/jamainternmed.2018.6414 |journal=JAMA Internal Medicine |volume=179 |issue=2 |pages=211–212 |doi=10.1001/jamainternmed.2018.6414 |pmid=30615064 |s2cid=58561131 |issn=2168-6106}} These tasks are sub-divided into basic activities of daily living (ADL) and instrumental activities of daily living (IADL) and are commonly used as an indicator of a person's functional status. [60] => [61] => [[Activities of daily living|Activities of daily living (ADL)]] are fundamental skills needed to care for oneself, including feeding, personal hygiene, toileting, transferring and ambulating. Instrumental activities of daily living (IADL) describe more complex skills needed to allow oneself to live independently in a community, including cooking, housekeeping, managing one's finances and medications. Routine monitoring of ADL and IADL is an important functional assessment used by clinicians to determine the extent of support and care to provide to elderly adults and their caregivers. It serves as a qualitative measurement of function over time and predicts the need for alternative living arrangements or models of care, including senior housing apartments, skilled nursing facilities, palliative, hospice or home-based care. [62] => [63] => ==== Falls ==== [64] => Falls are the leading cause of emergency department admissions and hospitalizations in adults age 65 and older, many of which result in significant injury and permanent disability.{{Cite web |last=CDC |date=2020-12-16 |title=Keep on Your Feet |url=https://www.cdc.gov/injury/features/older-adult-falls/index.html |access-date=2022-09-12 |website=Centers for Disease Control and Prevention |language=en-us}} As certain risk factors can be modifiable for the purpose of reducing falls, this highlights an opportunity for intervention and risk reduction. Modifiable factors include: [65] => [66] => * Improving balance and muscle strength. [67] => * Removing environmental hazards. [68] => * Encouraging use of assistive devices. [69] => * Treating chronic conditions. [70] => * Adjusting medication. [71] => [72] => ==== Urinary incontinence ==== [73] => Urinary incontinence or overactive bladder symptoms is defined as unintentionally urinating oneself. These symptoms can be caused by medications that increase urine output and frequency (e.g. anti-hypertensives and diuretics), urinary tract infections, pelvic organ prolapse, pelvic floor dysfunction, and diseases that damage the nerves that regulate [[Urinary bladder|bladder]] emptying.{{Cite web |title=Urinary Incontinence in Older Adults |url=https://www.nia.nih.gov/health/urinary-incontinence-older-adults |access-date=2022-09-12 |website=National Institute on Aging |language=en}} Other [[Human musculoskeletal system|musculoskeletal]] conditions affecting mobility should be considered, as these can make accessing bathrooms difficult. [74] => [75] => ==== Malnutrition ==== [76] => [[Malnutrition]] and poor nutritional status is an area of concern, affecting 12% to 50% of hospitalized elderly patients and 23% to 50% of institutionalized elderly patients living in long-term care facilities such as assisted living communities and skilled nursing facilities.{{Cite journal |last=Evans |first=Carol |date=2005 |title=Malnutrition in the Elderly: A Multifactorial Failure to Thrive |journal=The Permanente Journal |volume=9 |issue=3 |pages=38–41 |doi=10.7812/TPP/05-056 |issn=1552-5767 |pmc=3396084 |pmid=22811627}} As malnutrition can occur due to a combination of physiologic, pathologic, psychologic and socioeconomic factors, it can be difficult to identify effective interventions.{{Cite journal |last=Evans |first=Carol |date=Summer 2005 |title=Malnutrition in the Elderly: A Multifactorial Failure to Thrive |journal=The Permanente Journal |language=en |volume=9 |issue=3 |pages=38–41 |doi=10.7812/tpp/05-056 |pmid=22811627|pmc=3396084 }} Physiologic factors include reduced smell and taste, and a decreased metabolic rate affecting nutritional food intake. Unintentional weight loss can result from pathologic factors, including a wide range of chronic diseases that affect cognitive function, directly impact digestion (e.g. poor dentition, [[gastrointestinal cancer]]s, [[Gastroesophageal reflux disease|gastroesophageal]] reflux disease) or may be managed with dietary restrictions (e.g. congestive heart failure, diabetes mellitus, [[hypertension]]). Psychologic factors include conditions including depression, anorexia, and grief. [77] => [78] => === Practical concerns === [79] => Functional abilities, independence and [[quality of life]] issues are of great concern to geriatricians and their patients. Elderly people generally want to live independently as long as possible, which requires them to be able to engage in [[self-care]] and other [[activities of daily living]]. A geriatrician may be able to provide information about [[elder care]] options, and refers people to [[home care]] services, [[skilled nursing facilities]], [[assisted living facilities]], and [[hospice]] as appropriate. [80] => [81] => [[Frailty syndrome|Frail elderly]] people may choose to decline some kinds of medical care, because the risk-benefit ratio is different. For example, frail elderly women routinely stop [[screening mammogram]]s, because [[breast cancer]] is typically a slowly growing disease that would cause them no pain, impairment, or loss of life before they would die of other causes. Frail people are also at significant risk of post-surgical complications and the need for extended care, and an accurate prediction—based on validated measures, rather than how old the patient's face looks—can help older patients make fully informed choices about their options. Assessment of older patients before elective surgeries can accurately predict the patients' recovery trajectories.{{cite journal | vauthors = Makary MA, Segev DL, Pronovost PJ, Syin D, Bandeen-Roche K, Patel P, Takenaga R, Devgan L, Holzmueller CG, Tian J, Fried LP | display-authors = 6 | title = Frailty as a predictor of surgical outcomes in older patients | journal = Journal of the American College of Surgeons | volume = 210 | issue = 6 | pages = 901–908 | date = June 2010 | pmid = 20510798 | doi = 10.1016/j.jamcollsurg.2010.01.028 | name-list-style = vanc }} One frailty scale uses five items: unintentional weight loss, [[muscle weakness]], exhaustion, low physical activity, and slowed walking speed. A healthy person scores 0; a very frail person scores 5. Compared to non-frail elderly people, people with intermediate frailty scores (2 or 3) are twice as likely to have post-surgical complications, spend 50% more time in the hospital, and are three times as likely to be discharged to a skilled nursing facility instead of to their own homes. Frail elderly patients (score of 4 or 5) who were living at home before the surgery have even worse outcomes, with the risk of being discharged to a nursing home rising to twenty times the rate for non-frail elderly people. [82] => [83] => == Subspecialties and related services == [84] => [85] => 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{{Cite web | vauthors = Burton JR | date = 2008 |url=http://www.americangeriatrics.org/specialists/geri_for_spec_update_fall_08.pdf |title=Geriatrics-for-Specialists Initiative (GSI) | quote = Increasing Geriatrics Expertise in Surgical and Related Medical Specialties | work = The American Geriatrics Society (AGS) |access-date=9 February 2016 |archive-url=https://web.archive.org/web/20090325055546/http://www.americangeriatrics.org/specialists/geri_for_spec_update_fall_08.pdf |archive-date=25 March 2009 |url-status=dead}}{{cite journal | vauthors = Solomon DH, Burton JR, Lundebjerg NE, Eisner J | title = The new frontier: increasing geriatrics expertise in surgical and medical specialties | journal = Journal of the American Geriatrics Society | volume = 48 | issue = 6 | pages = 702–4 | date = June 2000 | pmid = 10855612 | doi = 10.1111/j.1532-5415.2000.tb04734.x | s2cid = 19434523 | url = http://www.americangeriatrics.org/specialists/new_frontier.pdf |archive-url=https://web.archive.org/web/20090325055544/http://www.americangeriatrics.org/specialists/new_frontier.pdf |archive-date=25 March 2009 |url-status=dead }} including: [86] => [87] => === Medical === [88] => * [[Geriatric cardiology]] or [[cardiogeriatrics]]. [89] => * [[Geriatric dentistry]]. [90] => * [[Geriatric dermatology]]. [91] => * Geriatric diagnostic imaging. [92] => * Geriatric emergency medicine. [93] => * [[Geriatric nephrology]]. [94] => * [[Geriatric neurology]]. [95] => * [[Geriatric oncology]]. [96] => * Geriatric physical examination of interest especially to physicians & physician assistants. [97] => * [[Geriatric psychiatry]] or [[geriatric psychiatry|psychogeriatrics]] (focus on [[dementia]], [[delirium]], [[clinical depression|depression]] and other psychiatric disorders). [98] => * Geriatric public health or preventive geriatrics [99] => * [[Geriatric rehabilitation]]. [100] => * [[Geriatric rheumatology]] (focus on joints and soft tissue disorders in elderly). [101] => * [[Geriatric sexology]] (focus on sexuality in aged people). [102] => * Geriatric subspeciality medical clinics (such as geriatric anticoagulation clinic, geriatric assessment clinic, falls and balance clinic, continence clinic, palliative care clinic, elderly pain clinic, cognition and memory disorders clinic). [103] => [104] => === Surgical === [105] => * Geriatric orthopaedics or orthogeriatrics (close cooperation with [[orthopedic surgery]] and a focus on [[osteoporosis]] and rehabilitation). [106] => * Geriatric cardiothoracic surgery. [107] => * Geriatric urology. [108] => * Geriatric otolaryngology. [109] => * Geriatric general surgery. [110] => * [[Geriatric trauma]]. [111] => * Geriatric gynecology. [112] => * Geriatric ophthalmology. [113] => * Perioperative medicine for Older People having Surgery (POPS) [114] => [115] => === Other geriatrics subspecialties === [116] => * [[Geriatric anesthesia]] (focuses on [[anesthesia]] & perioperative care of elderly). [117] => * [[Geriatric intensive-care unit]]: (a special type of [[intensive care unit]] dedicated to critically ill elderly). [118] => * [[Geriatric nursing]] (focuses on nursing of elderly patients and the aged). [119] => * Geriatric nutrition. [120] => * Geriatric occupational therapy. [121] => * Geriatric pain management. [122] => * Geriatric pharmacy. [123] => * Geriatric [[optometry]]. [124] => * Geriatric physical therapy. [125] => * Geriatric [[podiatry]]. [126] => * [[Geriatric psychology]]. [127] => * Geriatric speech-language [[pathology]] (focuses on neurological disorders such as dysphagia, stroke, aphasia, and traumatic brain injury). [128] => * Geriatric mental health counselor/specialist (focuses on treatment more so than assessment). [129] => * Geriatric audiology. [130] => [131] => ==History== [132] => {{Cite check|section|date=September 2010}} [133] => [134] => A number of physicians in the [[Byzantine Empire]] studied geriatrics, with doctors like [[Aëtius of Amida]] evidently specializing in the field. [[Alexander of Tralles]] viewed the process of aging as a natural and inevitable form of [[marasmus]], caused by the loss of moisture in body tissue.{{citation needed|date=August 2022}}{{Cite journal |last=Schäfer |first=Daniel |date=2002 |title='That Senescence Itself is an Illness': A Transitional Medical Concept of Age and Ageing in the Eighteenth Century |journal=Medical History |volume=46 |issue=4 |pages=525–548 |doi=10.1017/S0025727300069726 |pmid=12408094 |pmc=1044563 }} The works of Aëtius describe the mental and physical symptoms of aging. [[Theophilus Protospatharius]] and [[Joannes Actuarius]] also discussed the topic in their medical works. Byzantine physicians typically drew on the works of [[Oribasius]] and recommended that elderly patients consume a diet rich in foods that provide "heat and moisture". They also recommended frequent bathing, massaging, rest, and low-intensity exercise regimens.{{cite journal | vauthors = Lascaratos J, Poulacou-Rebelacou E | title = The roots of geriatric medicine: care of the aged in Byzantine times (324-1453 AD) | journal = Gerontology | volume = 46 | issue = 1 | pages = 2–6 | year = 2000 | pmid = 11111221 | doi = 10.1159/000022125 | s2cid = 29651187 }} [135] => [136] => In ''[[The Canon of Medicine]]'', written by [[Avicenna]] in 1025, the author was concerned with how "old folk need plenty of sleep" and how their bodies should be [[Anointing|anointed]] with [[oil]], and recommended [[exercise]]s such as [[walking]] or [[Equestrianism|horse-riding]]. Thesis III of the ''Canon'' discussed the [[diet (nutrition)|diet]] suitable for [[Old age|old people]], and dedicated several sections to elderly patients who become [[Constipation|constipated]].{{cite journal | vauthors = Howell TH | title = Avicenna and his regimen of old age | journal = Age and Ageing | volume = 16 | issue = 1 | pages = 58–59 | date = January 1987 | pmid = 3551552 | doi = 10.1093/ageing/16.1.58 }}{{cite journal | vauthors = Howell TH | title = Avicenna and the care of the aged | journal = The Gerontologist | volume = 12 | issue = 4 | pages = 424–426 | date = 1972 | pmid = 4569393 | doi = 10.1093/geront/12.4.424 }}{{cite journal | vauthors = Pitskhelauri GZ, Dzhorbenadze DA | title = [Gerontology and geriatrics in the works of Abu Ali Ibn Sina (Avicenna) (on the 950th anniversary of the manuscript, Canon of Medical Science)] | language = ru | journal = Sovetskoe Zdravookhranenie | volume = 29 | issue = 10 | pages = 68–71 | date = 1970 | pmid = 4931547 }} [137] => [138] => The [[Islamic medicine|Arab]] physician [[Ibn Al-Jazzar|Algizar]] ({{circa|898}}–980) wrote a book on the medicine and health of the elderly.{{cite web | url = http://www.islam.org.br/al_jazzar.htm | title = Al Jazzar | archive-url = https://web.archive.org/web/20080706155736/http://www.islam.org.br/al_jazzar.htm | archive-date=6 July 2008 | work = www.islam.org }}{{cite journal | vauthors = Ammar S | title = Ibn Al Jazzar and the Kairouan medical school of the tenth century AD | journal = Vesalius: Acta Internationales Historiae Medicinae | volume = 4 | issue = 1 | pages = 3–4 | date = June 1998 | pmid = 11620335 | doi = | url = http://www.bium.univ-paris5.fr/ishm/vesalius/VESx1998x04x01.pdf }} He also wrote a book on [[sleep disorder]]s and another one on [[Forgetting|forgetfulness]] and how to strengthen [[memory]],{{cite web | url = http://www.medarus.org/Medecins/MedecinsTextes/al_jazzar.htm | title = Algizar | language = French | archive-url = https://web.archive.org/web/20160407202425/http://medarus.org/Medecins/MedecinsTextes/al_jazzar.htm | archive-date=7 April 2016 | work = medarus.org }}{{Cite web|url=https://www.nlm.nih.gov/hmd/arabic/bioI.html#jazzar|title=Islamic Medical Manuscripts: Bio-Bibliographies - I|website=www.nlm.nih.gov}}{{cite book | vauthors = Bos G |title=Ibn al-Jazzār on forgetfulness and its treatment: critical edition of the Arabic text and the Hebrew translations with commentary and translation into English |date=1995 |publisher=Royal Asiatic Society of Great Britain and Ireland |location=London |isbn=978-0-947593-12-4}} and a treatise on causes of [[Death|mortality]].{{dead link|date=June 2012}} Another Arab physician in the 9th century, [[Ishaq ibn Hunayn]] (died 910), the son of Nestorian Christian scholar [[Hunayn Ibn Ishaq]], wrote a ''Treatise on Drugs for Forgetfulness''.{{cite web|url=https://www.nlm.nih.gov/exhibition/islamic_medical/islamic_08.html|title=Islamic Culture and the Medical Arts: Specialized Literature|website=www.nlm.nih.gov}} [139] => [140] => George Day published the ''Diseases of Advanced Life'' in 1849, one of the first publications on the subject of geriatric medicine.{{cite journal | vauthors = Barton A, Mulley G | title = History of the development of geriatric medicine in the UK | journal = Postgraduate Medical Journal | volume = 79 | issue = 930 | pages = 229–234 | date = April 2003 | pmid = 12743345 | pmc = 1742667 | doi = 10.1136/pmj.79.930.229 | doi-access = free }} The first modern geriatric hospital was founded in Belgrade, Serbia, in 1881 by doctor [[Laza Lazarević]].{{cite journal | vauthors = Kanjuh V, Pavlović B | title = New bibliography of scientific papers by Dr. Laza K. Lazarević. | journal = Glas SANU–Medicinske Nauke | date = 2002 | volume = 46 | pages = 37–51 | url = http://scindeks.nb.rs/article.aspx?artid=0371-40390246037K&lang=en | archive-url= https://web.archive.org/web/20120325142042/http://scindeks.nb.rs/article.aspx?artid=0371-40390246037K&lang=en | archive-date=25 March 2012 }} [141] => [142] => The term ''geriatrics'' was proposed in [[Élie Metchnikoff|1908 by Ilya Ilyich Mechnikov]], Laurate of the Nobel Prize for Medicine and later by 1909 by [[Ignatz Leo Nascher]],{{cite web|url= http://www.americangeriatrics.org/about_us/ags_awards/naschermanning_award/|title= Nascher/Manning Award|access-date= 1 November 2012|archive-url= https://web.archive.org/web/20121020095954/http://americangeriatrics.org/about_us/ags_awards/naschermanning_award/|archive-date= 20 October 2012|url-status= dead}} former Chief of Clinic in the [[Mount Sinai Hospital, New York|Mount Sinai Hospital]] Outpatient Department (New York City) and a "father" of geriatrics in the United States.{{cite book |title=Profiles in Gerontology: A Biographical Dictionary |page=256 |chapter=Ignatz Leo Nascher| vauthors = Achenbaum WA, Albert DM |year=1995 |publisher=Greenwood |isbn=9780313292743 }} [143] => [144] => Modern geriatrics in the United Kingdom began with the "mother"{{cite journal | vauthors = Denham MJ | title = Dr Marjory Warren CBE MRCS LRCP (1897-1960): the mother of British geriatric medicine | journal = Journal of Medical Biography | volume = 19 | issue = 3 | pages = 105–110 | date = August 2011 | pmid = 21810847 | doi = 10.1258/jmb.2010.010030 | s2cid = 6847487 }} of geriatrics, [[Marjory Warren]]. Warren emphasized that rehabilitation was essential to the care of older people. Using her experiences as a physician in a London Workhouse infirmary, she believed that merely keeping older people fed until they died was not enough; they needed diagnosis, treatment, care, and support. She found that patients, some of whom had previously been bedridden, were able to gain some degree of independence with the correct assessment and treatment.{{Cite web |title=Vignette: Marjory Warren (1897-1960) |url=https://www.mddus.com/resources/publications-library/insight/q3-2019/vignette-marjory-warren |access-date=2022-08-16 |website=MDDUS |language=en}} [145] => [146] => The practice of geriatrics in the UK is also one with a rich multidisciplinary history. It values all the professions, not just medicine, for their contributions in optimizing the well-being and independence of older people. [147] => [148] => Another innovator of British geriatrics is Bernard Isaacs, who described the "giants" of geriatrics mentioned above: immobility and instability, [[Urinary incontinence|incontinence]], and [[dementia|impaired intellect]].{{cite web|url=https://www.bgs.org.uk/a-giant-of-geriatric-medicine-professor-bernard-isaacs-1924-1995-post-1|title=A giant of geriatric medicine - Professor Bernard Isaacs (1924-1995)|publisher=British Geriatrics Society|access-date=23 October 2018}}{{cite book |title=An introduction to geriatrics | vauthors = Isaacs B |date=1965 |publisher=Balliere, Tindall and Cassell |location=London }} Isaacs asserted that, if examined closely enough, all common problems with older people relate to one or more of these giants. [149] => [150] => The care of older people in the UK has been advanced by the implementation of the National Service Frameworks for Older People, which outlines key areas for attention.{{cite web |url= http://www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/OlderPeoplesServices/fs/en | archive-url = https://web.archive.org/web/20070103221354/http://www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/OlderPeoplesServices/fs/en | archive-date = 3 January 2007 | work = Department of Health | title = Older People's information}} [151] => [152] => == Geriatrician training == [153] => [154] => ===United States=== [155] => In the [[United States]], geriatricians are [[primary-care physician]]s ([[Doctor of Osteopathic Medicine|D.O]]. or [[Doctor of Medicine|M.D.]]) who are board-certified in either [[family medicine]] or [[internal medicine]] and who have also acquired the additional training necessary to obtain the Certificate of Added Qualifications (CAQ) in geriatric medicine. Geriatricians have developed an expanded expertise in the aging process, the impact of aging on illness patterns, drug therapy in seniors, health maintenance, and [[Rehabilitation (penology)|rehabilitation]]. They serve in a variety of roles including hospital care, long-term care, home care, and terminal care. They are frequently involved in ethics consultations to represent the unique health and diseases patterns seen in seniors. The model of care practiced by geriatricians is heavily focused on working closely with other disciplines such as nurses, [[clinical pharmacy|pharmacists]], therapists, and social workers. [156] => [157] => ===United Kingdom=== [158] => In the United Kingdom, most geriatricians are hospital physicians, whereas others focus on community geriatrics in particular. Although originally a distinct clinical specialty, it has been integrated as a specialization of general medicine since the late 1970s.{{cite journal | vauthors = Barton A, Mulley G | title = History of the development of geriatric medicine in the UK | journal = Postgraduate Medical Journal | volume = 79 | issue = 930 | pages = 229–34; quiz 233–4 | date = April 2003 | pmid = 12743345 | pmc = 1742667 | doi = 10.1136/pmj.79.930.229 }} Most geriatricians are, therefore, accredited for both. Unlike in the United States, geriatric medicine is a major specialty in the United Kingdom and are the single most numerous internal medicine specialists. [159] => [160] => ===Canada=== [161] => In [[Canada]], there are two pathways that can be followed in order to work as a physician in a geriatric setting. [162] => #Doctors of Medicine (M.D.) can complete a three-year core internal medicine residency program, followed by two years of specialized geriatrics residency training. This pathway leads to certification, and possibly fellowship after several years of supplementary academic training, by the [[Royal College of Physicians and Surgeons of Canada]]. [163] => # Doctors of Medicine (M.D.) can opt for a two-year residency program in family medicine and complete a one-year enhanced skills program in [[care of the elderly]]. This post-doctoral pathway is accredited by the [[College of Family Physicians of Canada]]. [164] => Many universities across Canada also offer gerontology training programs for the general public, such that [[nurses]] and other health care professionals can pursue further education in the discipline in order to better understand the process of aging and their role in the presence of older patients and residents. [165] => [166] => ===India=== [167] => In India, Geriatrics is a relatively new speciality offering. A three-year post graduate residency (M.D) training can be joined for after completing the 5.5-year undergraduate training of [[MBBS]] (Bachelor of Medicine and Bachelor of Surgery). Unfortunately, only eight major institutes provide M.D in Geriatric Medicine and subsequent training. Training in some institutes are exclusive in the Department of Geriatric Medicine, with rotations in Internal medicine, medical subspecialties etc. but in certain institutions, are limited to 2-year training in Internal medicine and subspecialities followed by one year of exclusive training in Geriatric Medicine. [168] => [169] => ==Minimum geriatric competencies== [170] => In July 2007, the [[Association of American Medical Colleges]] (AAMC) and the [[John A. Hartford Foundation]]{{cite web|url=http://www.jhartfound.org/|title=The John A. Hartford Foundation|website=www.jhartfound.org}} hosted a National Consensus Conference on Competencies in Geriatric Education where a consensus was reached on minimum competencies (learning outcomes) that graduating medical students needed to assure competent care by new interns to older patients. Twenty-six (26) Minimum Geriatric Competencies in eight content domains were endorsed by the [[American Geriatrics Society]] (AGS), the [[American Medical Association]] (AMA), and the Association of Directors of Geriatric Academic Programs (ADGAP). The domains are: cognitive and behavioral disorders; medication management; self-care capacity; falls, balance, gait disorders; atypical presentation of disease; palliative care; hospital care for elders, and health care planning and promotion. Each content domain specifies three or more observable, measurable competencies. [171] => [172] => == Research == [173] => [174] => Changes in physiology with aging may alter the absorption, the effectiveness and the side effect profile of many drugs. These changes may occur in oral protective reflexes (dryness of the mouth caused by diminished salivary glands), in the gastrointestinal system (such as with delayed emptying of solids and liquids possibly restricting speed of absorption), and in the distribution of drugs with changes in [[body fat]] and muscle and drug elimination.{{Cite journal |last=D'Souza |first=A L |date=2007-01-01 |title=Ageing and the gut |journal=Postgraduate Medical Journal |language=en |volume=83 |issue=975 |pages=44–53 |doi=10.1136/pgmj.2006.049361 |issn=0032-5473 |pmc=2599964 |pmid=17267678}} [175] => [176] => Psychological considerations include the fact that elderly persons (in particular, those experiencing substantial memory loss or other types of cognitive impairment) are unlikely to be able to adequately monitor and adhere to their own scheduled [[pharmacological]] administration. One study (Hutchinson et al., 2006) found that 25% of participants studied admitted to skipping doses or cutting them in half. Self-reported noncompliance with adherence to a medication schedule was reported by a striking one-third of the participants. Further development of methods that might possibly help monitor and regulate dosage administration and scheduling is an area that deserves attention.{{citation needed|date=October 2022}} [177] => [178] => Another important area is the potential for improper administration and use of potentially inappropriate medications, and the possibility of errors that could result in dangerous drug interactions. Polypharmacy is often a predictive factor (Cannon et al., 2006). Research done on home/community health care found that "nearly 1 of 3 medical regimens contain a potential medication error" (Choi et al., 2006). [179] => [180] => == Ethical and medico-legal issues == [181] => Elderly persons sometimes cannot make decisions for themselves. They may have previously prepared a [[power of attorney]] and [[advance directives]] to provide guidance if they are unable to understand what is happening to them, whether this is due to long-term dementia or to a short-term, correctable problem, such as [[delirium]] from a fever. [182] => [183] => [[Geriatricians]] must respect the patients' privacy while seeing that they receive appropriate and necessary services. More than most specialties, they must consider whether the patient has the legal [[Moral responsibility|responsibility]] and [[Competence (law)|competence]] to understand the facts and make decisions. They must support [[informed consent]] and resist the temptation to manipulate the patient by withholding information, such as the dismal [[prognosis]] for a condition or the likelihood of recovering from surgery at home. [184] => [185] => [[Elder abuse]] is the physical, financial, emotional, sexual, or other type of abuse of an older dependent. Adequate training, services, and support can reduce the likelihood of elder abuse, and proper attention can often identify it. For elderly people who are unable to care for themselves, geriatricians may recommend [[legal guardianship]] or [[conservatorship]] to care for the person or the estate. [186] => [187] => Elder abuse occurs increasingly when caregivers of elderly relatives have a mental illness. These instances of abuse can be prevented by engaging these individuals with mental illness in mental health treatment. Additionally, interventions aimed at decreasing elder reliance on relatives may help decrease conflict and abuse. Family education and support programs conducted by mental health professionals may also be beneficial for elderly patients to learn how to set limits with relatives with psychiatric disorders without causing conflict that leads to abuse.{{cite journal | vauthors = Labrum T | title = Factors related to abuse of older persons by relatives with psychiatric disorders | journal = Archives of Gerontology and Geriatrics | volume = 68 | pages = 126–134 | year = 2017 | pmid = 27810660 | doi = 10.1016/j.archger.2016.09.007 }} [188] => [189] => == See also == [190] => {{col div|colwidth=20em}} [191] => * [[Aging in Place]] [192] => * [[Aging-associated diseases]] [193] => * [[Alliance for Aging Research]] [194] => * [[Commission for Certification in Geriatric Pharmacy]] [195] => * [[Elderly care]] [196] => * [[Gero-Informatics]] [197] => * [[GERRI]] [198] => * [[Nosokinetics]] [199] => * [[Life extension]] [200] => * [[Geriatric medicine in Egypt]] [201] => * [[Transgenerational design]] [202] => * ''[[Physical & Occupational Therapy in Geriatrics]]'' (journal) [203] => * [[Gerontological nursing]] [204] => {{colend}} [205] => [206] => == References == [207] => {{reflist|30em}} [208] => [209] => == Further reading == [210] => {{refbegin}} [211] => * {{cite book | vauthors = Atchley RC, Baxter SL, Blanchard J, Brady K, Comfort WE, Egbert AB | title = Working with seniors: Health, financial and social issues. | location = Denver, CO | publisher = Society of Certified Senior Advisors | date = 2009 }} [212] => * {{cite journal | vauthors = Cannon KT, Choi MM, Zuniga MA | title = Potentially inappropriate medication use in elderly patients receiving home health care: a retrospective data analysis | journal = The American Journal of Geriatric Pharmacotherapy | volume = 4 | issue = 2 | pages = 134–143 | date = June 2006 | pmid = 16860260 | doi = 10.1016/j.amjopharm.2006.06.010 }} [213] => * {{cite journal | vauthors = Gidal BE | title = Drug absorption in the elderly: biopharmaceutical considerations for the antiepileptic drugs | journal = Epilepsy Research | volume = 68 | issue = Suppl 1 | pages = S65–S69 | date = January 2006 | pmid = 16413756 | doi = 10.1016/j.eplepsyres.2005.07.018 | s2cid = 39671722 }} [214] => * {{cite journal | vauthors = Hutchison LC, Jones SK, West DS, Wei JY | title = Assessment of medication management by community-living elderly persons with two standardized assessment tools: a cross-sectional study | journal = The American Journal of Geriatric Pharmacotherapy | volume = 4 | issue = 2 | pages = 144–153 | date = June 2006 | pmid = 16860261 | doi = 10.1016/j.amjopharm.2006.06.009 }} [215] => {{refend}} [216] => [217] => == External links == [218] => * [http://www.merck.com/mrkshared/mm_geriatrics/home.jsp Merck Manual of Geriatrics] [219] => * [http://ec.europa.eu/health-eu/my_health/elderly/index_en.htm Health-EU Portal] – Care for the elderly in the EU [220] => * [http://www.americangeriatrics.org American Geriatrics Society] [221] => [222] => {{Medicine}} [223] => [224] => {{Authority control}} [225] => [226] => [[Category:Geriatrics| ]] [227] => [[Category:Ageing]] [] => )
good wiki

Geriatrics

Geriatrics is a medical specialty that focuses on the healthcare needs of elderly individuals. It involves the prevention, diagnosis, and treatment of diseases and disorders that commonly affect older adults.

More about us

About

It involves the prevention, diagnosis, and treatment of diseases and disorders that commonly affect older adults. The field of geriatrics encompasses a broad range of disciplines, including internal medicine, gerontology, psychiatry, and rehabilitation medicine. The Wikipedia page on geriatrics provides an overview of this field, highlighting its significance in addressing the unique healthcare challenges faced by older adults. It explains how geriatrics differs from general adult medicine due to the distinctive physiological and psychological changes that occur with aging. The page also delves into the various medical conditions commonly associated with aging, such as dementia, osteoporosis, and cardiovascular disease. The page emphasizes the comprehensive approach taken by geriatricians, who not only focus on treating specific diseases but also on managing the overall well-being of their older patients. This interdisciplinary approach often involves coordinating care with other healthcare professionals, including nurses, social workers, and physical therapists. Furthermore, the Wikipedia page explores the concept of frailty and the importance of assessing an individual's functional abilities. It highlights the role of preventive care, as well as the ethical considerations involved in medical decision-making for older adults. The page also discusses the challenges faced by geriatric medicine, such as the shortage of geriatricians and the need for more research in the field. Overall, the Wikipedia page on geriatrics provides a comprehensive overview of this medical specialty, showcasing the importance of specialized care for the elderly population. It serves as a valuable resource for individuals seeking information on geriatrics and its role in improving the health outcomes of older adults.

Expert Team

Vivamus eget neque lacus. Pellentesque egauris ex.

Award winning agency

Lorem ipsum, dolor sit amet consectetur elitorceat .

10 Year Exp.

Pellen tesque eget, mauris lorem iupsum neque lacus.

You might be interested in

Anesthesia

Anesthesia, also known as anaesthesia, is a medical procedure that aims to render a patient unconscious, insensible to pain, and immobile during surgical or medical procedures.

Avicenna

Avicenna, also known as Ibn Sina, was a renowned Persian physician, philosopher, and scientist who lived during the Islamic Golden Age.

Disease

A disease, in the context of health, is a condition that impairs the normal functioning of the body or mind.

Exercise

The Wikipedia page on exercise provides an overview of the concept, benefits, and different types of exercise.

Health

Health is a state of physical, mental, and social well-being in which an individual is able to function optimally and cope with daily stressors.

Hospice

Hospice is a specialized form of healthcare that focuses on providing holistic and compassionate care for individuals who have a terminal illness or are facing the end of their lives.

Hospital

A hospital is a healthcare institution that provides medical and surgical treatment to patients.

Medication

Medication is a term used to describe any substance administered to a person or animal for the purpose of treating, curing, or preventing a medical condition.

Medicine

The Wikipedia page on medicine provides an overview of the field of medicine, covering various aspects such as its history, branches, education, research, practice, and ethics.

Pathology

Pathology is a branch of medical science that involves the study of disease processes, their causes, and their effects on body structures and functions.

Pharmacokinetics

Pharmacokinetics is a branch of pharmacology that focuses on the study of how drugs are absorbed, distributed, metabolized, and eliminated by the body.