"Old age is not a disease". Besides the diseases that affect older people, various other issues influence the downfall of the health of the old people and here comes the relevance of geriatric medicine. It differs from Internal Medicine in the focus of the treatment. As people age, they become more heterogeneous, meaning that they become more and more different, sometimes strikingly so, with respect to their health and medical needs. Different organs age at different rates in the same person. Some 70 year old's walk without support, some cannot. A husband may be actively walking but suffer from memory loss, whereas the wife may be wheelchair bound, but have a clear mind.
As we grow older, our bodies are increasingly more susceptible to any stress or, such as an infection, trauma, and the effects of medications. For example, let's consider the effects of an annoying case of the common cold. A younger person may feel run down and achy, have little appetite, and sleep poorly. Most over-the-counter cold remedies can help him. The same viral illness and these same effects can cause far more havoc in an older person. A 75-year-old may present with c/o of not taking food, increased tiredness which may be easily mistaken for age related problems. A poor appetite can result in significant dehydration and cause dizziness or even a fall, especially if the person is taking medications for high blood pressure. Just a day or two lying in bed and not walking much will make an older person noticeably weaker, again increasing the risk of falls. Many over-the-counter cold medications can cause confusion in addition to constipation in them.
Older patients often have multiple illnesses and would be consulting multiple specialists. The treatment for one problem might even make another condition worse since elderly patients are more prone to suffer from adverse effects of drugs. This is an excellent example of how the expertise of a geriatrician can help prevent drug related interactions that at times may be deleterious.
Diseases may show up in older adults in very unusual ways. The crushing chest pain and feeling of impending doom so commonly thought of as the symptoms of a heart attack are rarely present in an older patient. Instead, an older person may have a stomach ache and feel nauseous or simply feel extremely tired. Therefore, the medical history of older patients may not be completely reliable and often a corroborative history from other members need to be considered.
Older patients often visit their physician for a worsening of a chronic condition. This is, at times quite a challenge as these patients are already on various medication regimens for multiple illnesses.
So how do geriatricians do it? Instead of treating each of the many medical conditions separately in older patients, a geriatrician focuses specifically on those conditions that affect a patient’s functional abilities. Trained to treat medically complicated elderly patients, they use a global approach that encompasses aggressive disease prevention and address the social aspects of illness.
The role of the geriatrician, therefore, is to coordinate and guide a team of professionals not only for the clinical management of acute and chronic disease, but also to optimize and maintain functional status, in a concerted effort to keep the patient out of the hospital and living independently and safely at home for as long as possible.
