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Wikipedia

Geriatrics

April 12, 2023

Geriatrics, or geriatric medicine,[1] is a medical specialty focused on providing care for the unique health needs of older adults.[2] The term geriatrics originates from the Greek γέρων geron meaning "old man", and ιατρός iatros meaning "healer". It aims to promote health by preventing, diagnosing and treating disease in older adults.[3] There is no defined age at which patients may be under the care of a geriatrician, or geriatric physician, a physician who specializes in the care of elderly 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.[4]

Geriatrics
An elderly woman in a residential care home receiving a birthday cake
Significant diseasesDementia, arthritis, osteoporosis, osteoarthritis, rheumatoid arthritis, Parkinson's disease, atherosclerosis, heart disease, high blood pressure,
SpecialistGeriatrician
Geriatrician
Occupation
Names
  • Physician
Occupation type
Specialty
Activity sectors
Medicine
Description
Education required
Fields of
employment
Hospitals, Clinics

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.[5] However, geriatrics is sometimes called medical gerontology.

Scope

 
Elderly man at a nursing home in Norway

Differences between adult and geriatric medicine

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, mentation, medications and matters most to elicit patient values.[6]

It is common for 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 diagnostic and therapeutical complexity in patient care.

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.

Increased complexity

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 neck of the femur ("broken hip").

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 heart attack. Many of these problems are treatable, if the root cause can be discovered.

Geriatric Pharmacology

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 medications and over-the-counter drugs. This polypharmacy, in combination with geriatric status, may increase the risk of drug interactions or adverse drug reactions.[7] Pharmacokinetic and 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.[8] Pharmacodynamic changes lead altered sensitivity to drugs in geriatric patients, such as increased pain relief with morphine use.[9] Therefore, geriatric individuals require specialized pharmacological care that is informed by these age-related changes.

Geriatric syndromes

Geriatric syndromes[10] 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.[11]

Frailty

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.[12] It is associated with increased injuries, hospitalization and adverse clinical outcomes.

Functional decline

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.[13][14] 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.

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.[13]

Falls

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.[15] 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:

  • Improving balance and muscle strength.
  • Removing environmental hazards.
  • Encouraging use of assistive devices.
  • Treating chronic conditions.
  • Adjusting medication.

Urinary incontinence

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 bladder emptying.[16] Other musculoskeletal conditions affecting mobility should be considered, as these can make accessing bathrooms difficult.

Malnutrition

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.[17] As malnutrition can occur due to a combination of physiologic, pathologic, psychologic and socioeconomic factors, it can be difficult to identify effective interventions.[18] 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 cancers, 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.[17]

Practical concerns

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.

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 mammograms, 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.[19] 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.[19] 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.

Subspecialties and related services

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[20][21] including:

Medical

Surgical

  • Geriatric orthopaedics or orthogeriatrics (close cooperation with orthopedic surgery and a focus on osteoporosis and rehabilitation).
  • Geriatric cardiothoracic surgery.
  • Geriatric urology.
  • Geriatric otolaryngology.
  • Geriatric general surgery.
  • Geriatric trauma.
  • Geriatric gynecology.
  • Geriatric ophthalmology.

Other geriatrics subspecialties

History

One of the eight branches of the traditional Indian system of medicine, Ayurveda, is jara or rasayana, similar to geriatrics.[22] Charaka described the fatigue and physical exhaustion caused by premature aging as the result of a poor diet. The Charaka Samhita recommends that elderly patients avoid excessive physical or mental strain and consume a light but nutritious diet.[23]

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][24] 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.[25]

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 anointed with oil, and recommended exercises such as walking or horse-riding. Thesis III of the Canon discussed the diet suitable for old people, and dedicated several sections to elderly patients who become constipated.[26][27][28]

The Arab physician Algizar (c. 898–980) wrote a book on the medicine and health of the elderly.[29][30] He also wrote a book on sleep disorders and another one on forgetfulness and how to strengthen memory,[31][32][33] and a treatise on causes of mortality.[29][dead link] 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.[34]

George Day published the Diseases of Advanced Life in 1849, one of the first publications on the subject of geriatric medicine.[35] The first modern geriatric hospital was founded in Belgrade, Serbia, in 1881 by doctor Laza Lazarević.[36]

The term geriatrics was proposed in 1908 by Ilya Ilyich Mechnikov, Laurate of the Nobel Prize for Medicine and later by 1909 by Dr. Ignatz Leo Nascher,[37] former Chief of Clinic in the Mount Sinai Hospital Outpatient Department (New York City) and a "father" of geriatrics in the United States.[38]

Modern geriatrics in the United Kingdom began with the "mother"[39] of geriatrics, Dr. Marjory Warren.[35] 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.[40]

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.

Another innovator of British geriatrics is Bernard Isaacs, who described the "giants" of geriatrics mentioned above: immobility and instability, incontinence, and impaired intellect.[41][42] Isaacs asserted that, if examined closely enough, all common problems with older people relate to one or more of these giants.

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.[43]

Geriatrician training

United States

In the United States, geriatricians are primary-care physicians (D.O. or 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. 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, pharmacists, therapists, and social workers.

United Kingdom

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.[44] 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.

Canada

In Canada, there are two pathways that can be followed in order to work as a physician in a geriatric setting.

  1. 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.
  2. 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.

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.

India

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.

Minimum geriatric competencies

In July 2007, the Association of American Medical Colleges (AAMC) and the John A. Hartford Foundation[45] 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.

Research

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.[citation needed]

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]

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).

Ethical and medico-legal issues

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.

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 responsibility and 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.

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.

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.[46]

See also

References

  1. ^ Marks JW (3 June 2021). "Medical Definition of Geriatric medicine". MedicineNet.
  2. ^ . University of Minnesota. Archived from the original on 14 January 2009.
  3. ^ "Geriatric Medicine Specialty Description". American Medical Association. Retrieved 5 September 2020.
  4. ^ "About Geriatrics | American Geriatrics Society". www.americangeriatrics.org. Retrieved 29 August 2022.
  5. ^ "What is Gerontology?". www.geron.org. Retrieved 12 September 2022.
  6. ^ Molnar, Frank; Frank, Christopher C. (January 2019). "Optimizing geriatric care with the GERIATRIC 5Ms". Canadian Family Physician. 65 (1): 39. ISSN 0008-350X. PMC 6347324. PMID 30674512.
  7. ^ Dagli, Rushabh J; Sharma, Akanksha (2014). "Polypharmacy: A Global Risk Factor for Elderly People". Journal of International Oral Health. 6 (6): i–ii. ISSN 0976-7428. PMC 4295469. PMID 25628499.
  8. ^ "Pharmacokinetics in Older Adults - Geriatrics". Merck Manuals Professional Edition. Retrieved 12 September 2022.
  9. ^ Mangoni, A A; Jackson, S H D (January 2004). "Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications". British Journal of Clinical Pharmacology. 57 (1): 6–14. doi:10.1046/j.1365-2125.2003.02007.x. ISSN 0306-5251. PMC 1884408. PMID 14678335.
  10. ^ "Geriatric Syndrome - an overview | ScienceDirect Topics". www.sciencedirect.com. Retrieved 1 March 2023.
  11. ^ Mallappallil, Mary; Friedman, Eli A; Delano, Barbara G; McFarlane, Samy I; Salifu, Moro O (2014). "Chronic kidney disease in the elderly: evaluation and management". Clinical Practice (London, England). 11 (5): 525–535. doi:10.2217/cpr.14.46. ISSN 2044-9038. PMC 4291282. PMID 25589951.
  12. ^ Pal, Laura M; Manning, Lisa (June 2014). "Palliative care for frail older people". Clinical Medicine. 14 (3): 292–295. doi:10.7861/clinmedicine.14-3-292. ISSN 1470-2118. PMC 4952544. PMID 24889576.
  13. ^ a b Edemekong, Peter F.; Bomgaars, Deb L.; Sukumaran, Sukesh; Schoo, Caroline (2022), "Activities of Daily Living", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 29261878, retrieved 12 September 2022
  14. ^ Aliberti, Marlon J. R.; Covinsky, Kenneth E. (1 February 2019). "Home Modifications to Reduce Disability in Older Adults With Functional Disability". JAMA Internal Medicine. 179 (2): 211–212. doi:10.1001/jamainternmed.2018.6414. ISSN 2168-6106. PMID 30615064. S2CID 58561131.
  15. ^ CDC (16 December 2020). "Keep on Your Feet". Centers for Disease Control and Prevention. Retrieved 12 September 2022.
  16. ^ "Urinary Incontinence in Older Adults". National Institute on Aging. Retrieved 12 September 2022.
  17. ^ a b Evans, Carol (2005). "Malnutrition in the Elderly: A Multifactorial Failure to Thrive". The Permanente Journal. 9 (3): 38–41. doi:10.7812/TPP/05-056. ISSN 1552-5767. PMC 3396084. PMID 22811627.
  18. ^ Evans, Carol (Summer 2005). "Malnutrition in the Elderly: A Multifactorial Failure to Thrive". The Permanente Journal. 9 (3): 38–41. doi:10.7812/tpp/05-056. PMC 3396084. PMID 22811627.
  19. ^ a b Makary MA, Segev DL, Pronovost PJ, Syin D, Bandeen-Roche K, Patel P, et al. (June 2010). "Frailty as a predictor of surgical outcomes in older patients". Journal of the American College of Surgeons. 210 (6): 901–908. doi:10.1016/j.jamcollsurg.2010.01.028. PMID 20510798.
  20. ^ Burton JR (2008). (PDF). The American Geriatrics Society (AGS). Archived from the original (PDF) on 25 March 2009. Retrieved 9 February 2016. Increasing Geriatrics Expertise in Surgical and Related Medical Specialties
  21. ^ Solomon DH, Burton JR, Lundebjerg NE, Eisner J (June 2000). (PDF). Journal of the American Geriatrics Society. 48 (6): 702–4. doi:10.1111/j.1532-5415.2000.tb04734.x. PMID 10855612. S2CID 19434523. Archived from the original (PDF) on 25 March 2009.
  22. ^ Editorial Board & Review Team of Medindia. "The Eight Branches of Ayurveda". Medindia. Retrieved 16 August 2022.
  23. ^ Devi D, Srivastava R, Dwivedi BK (October 2010). "A critical review of concept of aging in Ayurveda". Ayu. 31 (4): 516–519. doi:10.4103/0974-8520.82030. PMC 3202253. PMID 22048551.
  24. ^ Schäfer, Daniel (2002). "'That Senescence Itself is an Illness': A Transitional Medical Concept of Age and Ageing in the Eighteenth Century". Medical History. 46 (4): 525–548. doi:10.1017/S0025727300069726. PMC 1044563. PMID 12408094.
  25. ^ Lascaratos J, Poulacou-Rebelacou E (2000). "The roots of geriatric medicine: care of the aged in Byzantine times (324-1453 AD)". Gerontology. 46 (1): 2–6. doi:10.1159/000022125. PMID 11111221. S2CID 29651187.
  26. ^ Howell TH (January 1987). "Avicenna and his regimen of old age". Age and Ageing. 16 (1): 58–59. doi:10.1093/ageing/16.1.58. PMID 3551552.
  27. ^ Howell TH (1972). "Avicenna and the care of the aged". The Gerontologist. 12 (4): 424–426. doi:10.1093/geront/12.4.424. PMID 4569393.
  28. ^ Pitskhelauri GZ, Dzhorbenadze DA (1970). "[Gerontology and geriatrics in the works of Abu Ali Ibn Sina (Avicenna) (on the 950th anniversary of the manuscript, Canon of Medical Science)]". Sovetskoe Zdravookhranenie (in Russian). 29 (10): 68–71. PMID 4931547.
  29. ^ a b . www.islam.org. Archived from the original on 6 July 2008.
  30. ^ Ammar S (June 1998). "Ibn Al Jazzar and the Kairouan medical school of the tenth century AD" (PDF). Vesalius: Acta Internationales Historiae Medicinae. 4 (1): 3–4. PMID 11620335.
  31. ^ . medarus.org (in French). Archived from the original on 7 April 2016.
  32. ^ "Islamic Medical Manuscripts: Bio-Bibliographies - I". www.nlm.nih.gov.
  33. ^ Bos G (1995). Ibn al-Jazzār on forgetfulness and its treatment: critical edition of the Arabic text and the Hebrew translations with commentary and translation into English. London: Royal Asiatic Society of Great Britain and Ireland. ISBN 978-0-947593-12-4.
  34. ^ "Islamic Culture and the Medical Arts: Specialized Literature". www.nlm.nih.gov.
  35. ^ a b Barton A, Mulley G (April 2003). "History of the development of geriatric medicine in the UK". Postgraduate Medical Journal. 79 (930): 229–234. doi:10.1136/pmj.79.930.229. PMC 1742667. PMID 12743345.
  36. ^ Kanjuh V, Pavlović B (2002). . Glas SANU–Medicinske Nauke. 46: 37–51. Archived from the original on 25 March 2012.
  37. ^ . Archived from the original on 20 October 2012. Retrieved 1 November 2012.
  38. ^ Achenbaum WA, Albert DM (1995). "Ignatz Leo Nascher". Profiles in Gerontology: A Biographical Dictionary. Greenwood. p. 256. ISBN 9780313292743.
  39. ^ Denham MJ (August 2011). "Dr Marjory Warren CBE MRCS LRCP (1897-1960): the mother of British geriatric medicine". Journal of Medical Biography. 19 (3): 105–110. doi:10.1258/jmb.2010.010030. PMID 21810847. S2CID 6847487.
  40. ^ "Vignette: Marjory Warren (1897-1960)". MDDUS. Retrieved 16 August 2022.
  41. ^ "A giant of geriatric medicine - Professor Bernard Isaacs (1924-1995)". British Geriatrics Society. Retrieved 23 October 2018.
  42. ^ Isaacs B (1965). An introduction to geriatrics. London: Balliere, Tindall and Cassell.
  43. ^ . Department of Health. Archived from the original on 3 January 2007.
  44. ^ Barton A, Mulley G (April 2003). "History of the development of geriatric medicine in the UK". Postgraduate Medical Journal. 79 (930): 229–34, quiz 233–4. doi:10.1136/pmj.79.930.229. PMC 1742667. PMID 12743345.
  45. ^ "The John A. Hartford Foundation". www.jhartfound.org.
  46. ^ Labrum T (2017). "Factors related to abuse of older persons by relatives with psychiatric disorders". Archives of Gerontology and Geriatrics. 68: 126–134. doi:10.1016/j.archger.2016.09.007. PMID 27810660.

Further reading

  • Atchley RC, Baxter SL, Blanchard J, Brady K, Comfort WE, Egbert AB (2009). Working with seniors: Health, financial and social issues. Denver, CO: Society of Certified Senior Advisors.
  • Cannon KT, Choi MM, Zuniga MA (June 2006). "Potentially inappropriate medication use in elderly patients receiving home health care: a retrospective data analysis". The American Journal of Geriatric Pharmacotherapy. 4 (2): 134–143. doi:10.1016/j.amjopharm.2006.06.010. PMID 16860260.
  • Gidal BE (January 2006). "Drug absorption in the elderly: biopharmaceutical considerations for the antiepileptic drugs". Epilepsy Research. 68 (Suppl 1): S65–S69. doi:10.1016/j.eplepsyres.2005.07.018. PMID 16413756. S2CID 39671722.
  • Hutchison LC, Jones SK, West DS, Wei JY (June 2006). "Assessment of medication management by community-living elderly persons with two standardized assessment tools: a cross-sectional study". The American Journal of Geriatric Pharmacotherapy. 4 (2): 144–153. doi:10.1016/j.amjopharm.2006.06.009. PMID 16860261.

External links

  • Merck Manual of Geriatrics
  • Minimum Geriatric Competencies – Portal of Geriatric Online Education
  • Health-EU Portal – Care for the elderly in the EU
  • American Geriatrics Society

April 12, 2023
geriatrics, geriatric, medicine, medical, specialty, focused, providing, care, unique, health, needs, older, adults, term, geriatrics, originates, from, greek, γέρων, geron, meaning, ιατρός, iatros, meaning, healer, aims, promote, health, preventing, diagnosin. Geriatrics or geriatric medicine 1 is a medical specialty focused on providing care for the unique health needs of older adults 2 The term geriatrics originates from the Greek gerwn geron meaning old man and iatros iatros meaning healer It aims to promote health by preventing diagnosing and treating disease in older adults 3 There is no defined age at which patients may be under the care of a geriatrician or geriatric physician a physician who specializes in the care of elderly 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 4 GeriatricsAn elderly woman in a residential care home receiving a birthday cakeSignificant diseasesDementia arthritis osteoporosis osteoarthritis rheumatoid arthritis Parkinson s disease atherosclerosis heart disease high blood pressure SpecialistGeriatricianGeriatricianOccupationNamesPhysicianOccupation typeSpecialtyActivity sectorsMedicineDescriptionEducation requiredDoctor of Medicine M D Doctor of Osteopathic medicine D O Bachelor of Medicine Bachelor of Surgery M B B S Bachelor of Medicine Bachelor of Surgery MBChB Fields ofemploymentHospitals ClinicsThere 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 5 However geriatrics is sometimes called medical gerontology Contents 1 Scope 1 1 Differences between adult and geriatric medicine 1 2 Increased complexity 1 3 Geriatric Pharmacology 1 4 Geriatric syndromes 1 4 1 Frailty 1 4 2 Functional decline 1 4 3 Falls 1 4 4 Urinary incontinence 1 4 5 Malnutrition 1 5 Practical concerns 2 Subspecialties and related services 2 1 Medical 2 2 Surgical 2 3 Other geriatrics subspecialties 3 History 4 Geriatrician training 4 1 United States 4 2 United Kingdom 4 3 Canada 4 4 India 5 Minimum geriatric competencies 6 Research 7 Ethical and medico legal issues 8 See also 9 References 10 Further reading 11 External linksScope Edit Elderly man at a nursing home in Norway Differences between adult and geriatric medicine Edit 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 mentation medications and matters most to elicit patient values 6 It is common for 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 diagnostic and therapeutical complexity in patient care 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 Increased complexity Edit 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 neck of the femur broken hip 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 heart attack Many of these problems are treatable if the root cause can be discovered Geriatric Pharmacology Edit 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 medications and over the counter drugs This polypharmacy in combination with geriatric status may increase the risk of drug interactions or adverse drug reactions 7 Pharmacokinetic and 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 8 Pharmacodynamic changes lead altered sensitivity to drugs in geriatric patients such as increased pain relief with morphine use 9 Therefore geriatric individuals require specialized pharmacological care that is informed by these age related changes Geriatric syndromes Edit Geriatric syndromes 10 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 11 Frailty Edit 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 12 It is associated with increased injuries hospitalization and adverse clinical outcomes Functional decline Edit 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 13 14 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 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 13 Falls Edit 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 15 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 Improving balance and muscle strength Removing environmental hazards Encouraging use of assistive devices Treating chronic conditions Adjusting medication Urinary incontinence Edit 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 bladder emptying 16 Other musculoskeletal conditions affecting mobility should be considered as these can make accessing bathrooms difficult Malnutrition Edit 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 17 As malnutrition can occur due to a combination of physiologic pathologic psychologic and socioeconomic factors it can be difficult to identify effective interventions 18 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 cancers 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 17 Practical concerns Edit 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 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 mammograms 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 19 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 19 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 Subspecialties and related services EditSome 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 20 21 including Medical Edit Geriatric cardiology or cardiogeriatrics Geriatric dentistry Geriatric dermatology Geriatric diagnostic imaging Geriatric emergency medicine Geriatric nephrology Geriatric neurology Geriatric oncology Geriatric physical examination of interest especially to physicians amp physician assistants Geriatric psychiatry or psychogeriatrics focus on dementia delirium depression and other psychiatric disorders Geriatric public health or preventive geriatrics Geriatric rehabilitation Geriatric rheumatology focus on joints and soft tissue disorders in elderly Geriatric sexology focus on sexuality in aged people 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 Surgical Edit Geriatric orthopaedics or orthogeriatrics close cooperation with orthopedic surgery and a focus on osteoporosis and rehabilitation Geriatric cardiothoracic surgery Geriatric urology Geriatric otolaryngology Geriatric general surgery Geriatric trauma Geriatric gynecology Geriatric ophthalmology Other geriatrics subspecialties Edit Geriatric anesthesia focuses on anesthesia amp 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 Geriatric pain management Geriatric pharmacy Geriatric optometry Geriatric physical therapy Geriatric podiatry Geriatric psychology Geriatric speech language pathology focuses on neurological disorders such as dysphagia stroke aphasia and traumatic brain injury Geriatric mental health counselor specialist focuses on treatment more so than assessment Geriatric audiology History EditThis section possibly contains inappropriate or misinterpreted citations that do not verify the text Please help improve this article by checking for citation inaccuracies September 2010 Learn how and when to remove this template message One of the eight branches of the traditional Indian system of medicine Ayurveda is jara or rasayana similar to geriatrics 22 Charaka described the fatigue and physical exhaustion caused by premature aging as the result of a poor diet The Charaka Samhita recommends that elderly patients avoid excessive physical or mental strain and consume a light but nutritious diet 23 A number of physicians in the Byzantine Empire studied geriatrics with doctors like Aetius 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 24 The works of Aetius 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 25 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 anointed with oil and recommended exercises such as walking or horse riding Thesis III of the Canon discussed the diet suitable for old people and dedicated several sections to elderly patients who become constipated 26 27 28 The Arab physician Algizar c 898 980 wrote a book on the medicine and health of the elderly 29 30 He also wrote a book on sleep disorders and another one on forgetfulness and how to strengthen memory 31 32 33 and a treatise on causes of mortality 29 dead link 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 34 George Day published the Diseases of Advanced Life in 1849 one of the first publications on the subject of geriatric medicine 35 The first modern geriatric hospital was founded in Belgrade Serbia in 1881 by doctor Laza Lazarevic 36 The term geriatrics was proposed in 1908 by Ilya Ilyich Mechnikov Laurate of the Nobel Prize for Medicine and later by 1909 by Dr Ignatz Leo Nascher 37 former Chief of Clinic in the Mount Sinai Hospital Outpatient Department New York City and a father of geriatrics in the United States 38 Modern geriatrics in the United Kingdom began with the mother 39 of geriatrics Dr Marjory Warren 35 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 40 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 Another innovator of British geriatrics is Bernard Isaacs who described the giants of geriatrics mentioned above immobility and instability incontinence and impaired intellect 41 42 Isaacs asserted that if examined closely enough all common problems with older people relate to one or more of these giants 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 43 Geriatrician training EditUnited States Edit In the United States geriatricians are primary care physicians D O or 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 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 pharmacists therapists and social workers United Kingdom Edit 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 44 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 Canada Edit In Canada there are two pathways that can be followed in order to work as a physician in a geriatric setting 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 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 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 India Edit 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 Minimum geriatric competencies EditIn July 2007 the Association of American Medical Colleges AAMC and the John A Hartford Foundation 45 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 Research EditChanges 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 citation needed 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 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 Ethical and medico legal issues EditElderly 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 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 responsibility and 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 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 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 46 See also EditAging in Place Aging associated diseases Alliance for Aging Research Commission for Certification in Geriatric Pharmacy Elderly care Gero Informatics GERRI Nosokinetics Life extension Geriatric medicine in Egypt Transgenerational design Physical amp Occupational Therapy in Geriatrics journal Gerontological nursingReferences Edit Marks JW 3 June 2021 Medical Definition of Geriatric medicine MedicineNet Geriatrics separation from internal medicine University of Minnesota Archived from the original on 14 January 2009 Geriatric Medicine Specialty Description American Medical Association Retrieved 5 September 2020 About Geriatrics American Geriatrics Society www americangeriatrics org Retrieved 29 August 2022 What is Gerontology www geron org Retrieved 12 September 2022 Molnar Frank Frank Christopher C January 2019 Optimizing geriatric care with the GERIATRIC 5Ms Canadian Family Physician 65 1 39 ISSN 0008 350X PMC 6347324 PMID 30674512 Dagli Rushabh J Sharma Akanksha 2014 Polypharmacy A Global Risk Factor for Elderly People Journal of International Oral Health 6 6 i ii ISSN 0976 7428 PMC 4295469 PMID 25628499 Pharmacokinetics in Older Adults Geriatrics Merck Manuals Professional Edition Retrieved 12 September 2022 Mangoni A A Jackson S H D January 2004 Age related changes in pharmacokinetics and pharmacodynamics basic principles and practical applications British Journal of Clinical Pharmacology 57 1 6 14 doi 10 1046 j 1365 2125 2003 02007 x ISSN 0306 5251 PMC 1884408 PMID 14678335 Geriatric Syndrome an overview ScienceDirect Topics www sciencedirect com Retrieved 1 March 2023 Mallappallil Mary Friedman Eli A Delano Barbara G McFarlane Samy I Salifu Moro O 2014 Chronic kidney disease in the elderly evaluation and management Clinical Practice London England 11 5 525 535 doi 10 2217 cpr 14 46 ISSN 2044 9038 PMC 4291282 PMID 25589951 Pal Laura M Manning Lisa June 2014 Palliative care for frail older people Clinical Medicine 14 3 292 295 doi 10 7861 clinmedicine 14 3 292 ISSN 1470 2118 PMC 4952544 PMID 24889576 a b Edemekong Peter F Bomgaars Deb L Sukumaran Sukesh Schoo Caroline 2022 Activities of Daily Living StatPearls Treasure Island FL StatPearls Publishing PMID 29261878 retrieved 12 September 2022 Aliberti Marlon J R Covinsky Kenneth E 1 February 2019 Home Modifications to Reduce Disability in Older Adults With Functional Disability JAMA Internal Medicine 179 2 211 212 doi 10 1001 jamainternmed 2018 6414 ISSN 2168 6106 PMID 30615064 S2CID 58561131 CDC 16 December 2020 Keep on Your Feet Centers for Disease Control and Prevention Retrieved 12 September 2022 Urinary Incontinence in Older Adults National Institute on Aging Retrieved 12 September 2022 a b Evans Carol 2005 Malnutrition in the Elderly A Multifactorial Failure to Thrive The Permanente Journal 9 3 38 41 doi 10 7812 TPP 05 056 ISSN 1552 5767 PMC 3396084 PMID 22811627 Evans Carol Summer 2005 Malnutrition in the Elderly A Multifactorial Failure to Thrive The Permanente Journal 9 3 38 41 doi 10 7812 tpp 05 056 PMC 3396084 PMID 22811627 a b Makary MA Segev DL Pronovost PJ Syin D Bandeen Roche K Patel P et al June 2010 Frailty as a predictor of surgical outcomes in older patients Journal of the American College of Surgeons 210 6 901 908 doi 10 1016 j jamcollsurg 2010 01 028 PMID 20510798 Burton JR 2008 Geriatrics for Specialists Initiative GSI PDF The American Geriatrics Society AGS Archived from the original PDF on 25 March 2009 Retrieved 9 February 2016 Increasing Geriatrics Expertise in Surgical and Related Medical Specialties Solomon DH Burton JR Lundebjerg NE Eisner J June 2000 The new frontier increasing geriatrics expertise in surgical and medical specialties PDF Journal of the American Geriatrics Society 48 6 702 4 doi 10 1111 j 1532 5415 2000 tb04734 x PMID 10855612 S2CID 19434523 Archived from the original PDF on 25 March 2009 Editorial Board amp Review Team of Medindia The Eight Branches of Ayurveda Medindia Retrieved 16 August 2022 Devi D Srivastava R Dwivedi BK October 2010 A critical review of concept of aging in Ayurveda Ayu 31 4 516 519 doi 10 4103 0974 8520 82030 PMC 3202253 PMID 22048551 Schafer Daniel 2002 That Senescence Itself is an Illness A Transitional Medical Concept of Age and Ageing in the Eighteenth Century Medical History 46 4 525 548 doi 10 1017 S0025727300069726 PMC 1044563 PMID 12408094 Lascaratos J Poulacou Rebelacou E 2000 The roots of geriatric medicine care of the aged in Byzantine times 324 1453 AD Gerontology 46 1 2 6 doi 10 1159 000022125 PMID 11111221 S2CID 29651187 Howell TH January 1987 Avicenna and his regimen of old age Age and Ageing 16 1 58 59 doi 10 1093 ageing 16 1 58 PMID 3551552 Howell TH 1972 Avicenna and the care of the aged The Gerontologist 12 4 424 426 doi 10 1093 geront 12 4 424 PMID 4569393 Pitskhelauri GZ Dzhorbenadze DA 1970 Gerontology and geriatrics in the works of Abu Ali Ibn Sina Avicenna on the 950th anniversary of the manuscript Canon of Medical Science Sovetskoe Zdravookhranenie in Russian 29 10 68 71 PMID 4931547 a b Al Jazzar www islam org Archived from the original on 6 July 2008 Ammar S June 1998 Ibn Al Jazzar and the Kairouan medical school of the tenth century AD PDF Vesalius Acta Internationales Historiae Medicinae 4 1 3 4 PMID 11620335 Algizar medarus org in French Archived from the original on 7 April 2016 Islamic Medical Manuscripts Bio Bibliographies I www nlm nih gov Bos G 1995 Ibn al Jazzar on forgetfulness and its treatment critical edition of the Arabic text and the Hebrew translations with commentary and translation into English London Royal Asiatic Society of Great Britain and Ireland ISBN 978 0 947593 12 4 Islamic Culture and the Medical Arts Specialized Literature www nlm nih gov a b Barton A Mulley G April 2003 History of the development of geriatric medicine in the UK Postgraduate Medical Journal 79 930 229 234 doi 10 1136 pmj 79 930 229 PMC 1742667 PMID 12743345 Kanjuh V Pavlovic B 2002 New bibliography of scientific papers by Dr Laza K Lazarevic Glas SANU Medicinske Nauke 46 37 51 Archived from the original on 25 March 2012 Nascher Manning Award Archived from the original on 20 October 2012 Retrieved 1 November 2012 Achenbaum WA Albert DM 1995 Ignatz Leo Nascher Profiles in Gerontology A Biographical Dictionary Greenwood p 256 ISBN 9780313292743 Denham MJ August 2011 Dr Marjory Warren CBE MRCS LRCP 1897 1960 the mother of British geriatric medicine Journal of Medical Biography 19 3 105 110 doi 10 1258 jmb 2010 010030 PMID 21810847 S2CID 6847487 Vignette Marjory Warren 1897 1960 MDDUS Retrieved 16 August 2022 A giant of geriatric medicine Professor Bernard Isaacs 1924 1995 British Geriatrics Society Retrieved 23 October 2018 Isaacs B 1965 An introduction to geriatrics London Balliere Tindall and Cassell Older People s information Department of Health Archived from the original on 3 January 2007 Barton A Mulley G April 2003 History of the development of geriatric medicine in the UK Postgraduate Medical Journal 79 930 229 34 quiz 233 4 doi 10 1136 pmj 79 930 229 PMC 1742667 PMID 12743345 The John A Hartford Foundation www jhartfound org Labrum T 2017 Factors related to abuse of older persons by relatives with psychiatric disorders Archives of Gerontology and Geriatrics 68 126 134 doi 10 1016 j archger 2016 09 007 PMID 27810660 Further reading EditAtchley RC Baxter SL Blanchard J Brady K Comfort WE Egbert AB 2009 Working with seniors Health financial and social issues Denver CO Society of Certified Senior Advisors Cannon KT Choi MM Zuniga MA June 2006 Potentially inappropriate medication use in elderly patients receiving home health care a retrospective data analysis The American Journal of Geriatric Pharmacotherapy 4 2 134 143 doi 10 1016 j amjopharm 2006 06 010 PMID 16860260 Gidal BE January 2006 Drug absorption in the elderly biopharmaceutical considerations for the antiepileptic drugs Epilepsy Research 68 Suppl 1 S65 S69 doi 10 1016 j eplepsyres 2005 07 018 PMID 16413756 S2CID 39671722 Hutchison LC Jones SK West DS Wei JY June 2006 Assessment of medication management by community living elderly persons with two standardized assessment tools a cross sectional study The American Journal of Geriatric Pharmacotherapy 4 2 144 153 doi 10 1016 j amjopharm 2006 06 009 PMID 16860261 External links EditMerck Manual of Geriatrics Minimum Geriatric Competencies Portal of Geriatric Online Education Health EU Portal Care for the elderly in the EU American Geriatrics Society Retrieved from https en wikipedia org w index php title Geriatrics amp oldid 1142319908, wikipedia, wiki, book, books, library,

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