1. Geriatric Health Problems Jameel Adnan, MD. Community & Primary Health Care KAAU-RABEG BRANCH

2. Patient A 70-year-old woman; was referred to a dietitian for dietary counseling regarding an involuntary weight loss of approximately 1o kgs. Her presenting problem was weakness and decreased appetite. She has COPD. She had MI 5 years ago. Her hypothyroidism in her thirties was controlled by daily medication. She is a widowed and lives alone. She quitted smoking 10 years ago.

3. DD Protein-calorie malnutrition Depression Dyspepsia COPD Atherosclerotic CVD Hypertension with CHF Hypothyroidism

4. Risk Factors Inadequate or inappropriate food intake Depression Isolation Oral health problems

5. Risk Factors (cont.) Acute or poorly controlled chronic illness Dependence or disability Multiple medication intake

6. Geriatric Health Problems Arthritis Hypertension Impaired Hearing CVD Cataracts Sinusitis Orthopedic Impaired Vision Diabetes n Chronic illness is common

7. Demographic Imperative Persons >65 = Fasting growing age group By 2030, geriatric patients will c omprise 10-22% of population and may account for up to 70% of ambulance transports

8. Effects of Aging

9. General Changes Total body water decreases 61% at 25 <53% at 70 Total body fat decreases Subcutaneous fat deposits decrease

10. General Changes (cont.) Generalized body tissue fibrosis Progressive loss of homeostatic systems ability to adjust

11. Communication Problems Diminished Sight Hearing Mental faculties Depression Poor cooperation/limited mobility

12. Polypharmacy Up to 30% of geriatric hospitalizations are drug induced

13. Specific Changes Height Weight Skin Musculoskeletal Respiratory System Cardiovascular System Renal System Nervous System

14. Cardiovascular System Speed, force of myocardial contraction decreases Cardiac conducting system deteriorates Resistance to peripheral blood flow rises, elevating systolic blood pressure Blood vessels lose ability to constrict, dilate efficiently

15. Respiratory System Respiratory muscles lose strength; rib cage calcifies, becomes more rigid Respiratory capacity decreases Gas exchange across alveolar membrane slows Cough, gag reflexes diminish increasing risk of aspiration, lower airway infection

16. Musculoskeletal System Osteoporosis develops, especially in females Spinal disks narrow, resulting in kyphosis Joints lose flexibility, become more susceptible to repetitive stress injury Skeletal muscle mass decreases

17. Nervous System Brain weight of decreases 6 to 7% Brain size decreases Cerebral blood flow declines 15 to 20% Nerve conduction slows up to 15%

18. Gastrointestinal System Senses of taste, smell decline Gums, teeth deteriorate Saliva flow decreases Cardiac sphincter loses tone, esophageal reflux becomes more common Peristalsis slows Absorption from GI tract slows

19. Renal System Renal blood flow decreases 50% Functioning nephrons decrease 30 to 40%

20. Integumentary System Dermis thins by 20% Sweat glands decrease; sweating decreases

21. Geriatric Assessment

22. Factors Complicating Assessment Variability Older people differ from one another more than younger people do Physiological age is more important than chronological age

23. Factors Complicating Assessment Response to illness Seek help for only small part of symptoms Perceive symptoms as “just getting old” Delay seeking treatment Trivialize chief complaints

24. Factors Complicating Assessment Presence of multiple pathologies 85% have one chronic disease; 30% have three or more One system’s acute illness stresses other’s reserve capacity One disease’s symptoms may mask another’s One disease’s treatment may mask another’s symptoms

25. Factors Complicating Assessment Altered presentations Diminished, absent pain Depressed temperature regulation Depressed thirst mechanisms Confusion, restlessness, hallucinations Generalized deterioration Vague, poorly-defined complaints

26. Factors Complicating Assessment The Organs of the Aged Do Not Cry!

27. Factors Complicating Assessment Communication problems Diminished sight Diminished hearing Diminished mental faculties Depression Poor cooperation, limited mobility

28. Factors Complicating Assessment Polypharmacy Too many drugs! up to 30% of geriatric hospitalizations drug induced

29. THANK YOU Do NOT assume confused or disoriented patient is “just senile!”