Geriatrics Overview and Definition

Learn geriatrics fundamentals focused on aging health, definitions, and comprehensive care.

Geriatrics Overview and Definition

Learn geriatrics fundamentals focused on aging health, definitions, and comprehensive care.

Geriatrics addresses the health needs of older adults, focusing on frailty, dementia, falls, and chronic disease management.

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Overview and Definition

Geriatrics is the branch of medicine dedicated to the health care of elderly people. It aims to promote health by preventing and treating diseases and disabilities in older adults. While there is no specific age that defines “old,” geriatrics typically focuses on adults aged 65 and older, particularly those over 80 or those navigating complex, overlapping health conditions. A physician who specializes in this field is called a Geriatrician.

The Difference Between Adult Medicine and Geriatrics

General internal medicine treats adults of all ages, but geriatrics is a specialized field. As the body ages, its physiology changes. Organs may not function at 100% capacity, and the way the body processes medications changes significantly. Furthermore, older adults often do not have just one disease; they have multimorbidity the co-occurrence of two or more chronic conditions (e.g., diabetes, hypertension, and arthritis simultaneously). Geriatrics moves beyond treating individual organs to treating the “whole person,” with a strong focus on maintaining independence and Quality of Life (QoL).

Key Concepts in Geriatric Care

Functional Status: In geriatrics, success is often measured not just by curing a disease but by a patient’s ability to perform activities of daily living (ADLs) such as bathing, dressing, and eating.
Frailty: A medical syndrome characterized by decreased reserve and resistance to stressors. A frail older adult is more vulnerable to adverse outcomes (like falls or hospitalization) from minor illnesses.
Gerontology: While geriatrics is the medical care, gerontology is the broader scientific study of aging, including biological, psychological, and sociological aspects.
Homeostasis and Resilience: Aging reduces the body’s ability to bounce back (resilience) after stress. A flu virus that keeps a 30-year-old in bed for two days might hospitalize an 80-year-old for two weeks.

The "Silver Tsunami"

With advancements in healthcare and sanitation, life expectancy has increased dramatically. This demographic shift, often called the “Silver Tsunami,” means the population of older adults is growing faster than any other age group. Geriatrics is becoming one of the most vital fields in modern healthcare to manage this shift effectively.

Symptoms and Causes

In younger adults, symptoms are often clear-cut: chest pain usually means heart trouble; fever usually means infection. In older adults, however, disease presentation is often “atypical.” The aging body and immune system may not respond as expected, making diagnosis challenging. Recognizing these subtle changes is the expertise of the geriatrician.

The "Geriatric Giants" (Geriatric Syndromes)

Geriatricians often categorize significant symptoms into the “Geriatric Giants.” These are not specific diseases but collections of symptoms common in the elderly that have multiple underlying causes.

Immobility: The loss of the ability to move freely. This can lead to muscle wasting (sarcopenia), pressure ulcers (bedsores), and social isolation.
Instability (Falls): Falls are a leading cause of injury and death in the elderly. A fall is rarely just an accident; it is often a symptom of underlying issues like poor vision, balance disorders, medication side effects, or muscle weakness.
Incontinence: The involuntary loss of urine or stool. While common, it is not a normal part of aging and can often be treated.
Intellectual Impairment: This includes:
- Dementia: A chronic, progressive decline in memory and thinking (e.g., Alzheimer’s).
- Delirium: A sudden, acute state of confusion. In the elderly, delirium is often the only sign of a serious medical emergency like a urinary tract infection or pneumonia.
Iatrogenesis: Harm caused by medical treatment. The elderly are highly susceptible to adverse drug reactions due to Polypharmacy (taking multiple medications).

Common Atypical Symptoms

Confusion instead of Fever: An elderly person with pneumonia or a UTI may not run a fever. Instead, they may become suddenly confused, lethargic, or agitated.
Fatigue instead of Chest Pain: A heart attack (myocardial infarction) in an older adult, especially women or those with diabetes, may present as sudden exhaustion or shortness of breath rather than “crushing chest pain.”
Loss of Appetite (Anorexia of Aging): Refusal to eat can be a sign of depression, pain, or worsening heart failure.
Depression: Often presents as somatic complaints (aches and pains) or memory problems (“Pseudodementia”) rather than visible sadness.

Underlying Causes of Aging-Related Health Issues

Cellular Senescence: Over time, cells lose their ability to divide and function. Telomeres (protective caps on DNA) shorten, leading to tissue aging.
Accumulated “Wear and Tear”:
- Osteoarthritis: Decades of joint use wear down cartilage.
- Vascular Stiffening: Arteries become stiffer, leading to hypertension and heart disease.
Sensory Decline: Natural loss of vision (presbyopia, cataracts) and hearing (presbycusis) contributes to isolation and falls.
Social Determinants: Loneliness, loss of a spouse, and lack of transportation can exacerbate physical health conditions.

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Diagnosis and Staging

Diagnosing health issues in the elderly requires a broad, investigative approach. A standard 15-minute medical appointment is rarely sufficient. Instead, Geriatrics relies on the Comprehensive Geriatric Assessment (CGA). This is a multidimensional diagnostic process designed to determine a frail older person’s medical, psychological, and functional capability.

The Comprehensive Geriatric Assessment (CGA)

The CGA evaluates several domains to create a holistic picture of the patient:

Physical Medical Assessment: Reviewing all current medical conditions, nutritional status, and a thorough medication review (reconciliation) to check for drug interactions.
Functional Assessment:
- ADLs (Activities of Daily Living): Can the patient bathe, dress, use the toilet, and feed themselves?
- IADLs (Instrumental Activities of Daily Living): Can they manage finances, shop for groceries, use the phone, and take medications correctly?
Psychological Assessment: Screening for depression (using the Geriatric Depression Scale) and anxiety.
Cognitive Assessment: Testing memory and thinking skills using tools like the MMSE (Mini-Mental State Examination) or MoCA (Montreal Cognitive Assessment) to screen for early signs of dementia.
Social Assessment: Evaluating the patient’s support network, home safety (stairs, rugs), and caregiving needs.

Diagnostic Imaging and Bone Health

DEXA Scan (Dual-Energy X-ray Absorptiometry): The gold standard for diagnosing Osteoporosis (thinning bones). It measures bone mineral density to predict fracture risk.
Brain MRI/CT: Used to investigate cognitive changes, ruling out strokes, tumors, or hydrocephalus as causes of memory loss.
Cardiac Evaluation: Echocardiograms and EKGs are frequently used to monitor heart function, as heart failure and arrhythmias (like Atrial Fibrillation) are common.

Staging Frailty and Cognitive Decline

While “staging” is often associated with cancer, geriatrics stages functional decline to guide care.

Clinical Frailty Scale: A scale ranging from “Very Fit” to “Terminally Ill.” It helps doctors predict how well a patient might recover from surgery or illness.
Global Deterioration Scale (GDS): Used to stage primary degenerative dementia (Alzheimer’s) from Stage 1 (No cognitive decline) to Stage 7 (Very severe decline).
Fall Risk Assessment: “Staging” a patient’s risk of falling using tests like the “Timed Up and Go” (TUG) test, which measures how long it takes to stand up, walk 3 meters, turn, and sit down.

Treatment Details

The goal of geriatric treatment is rarely just “cure,” as many conditions are chronic. Instead, the primary goals are Function, Independence, and Comfort. Treatment plans are highly personalized; a treatment that is right for a 50-year-old might be harmful to an 85-year-old.

Medication Management and Deprescribing

One of the most critical interventions in geriatrics is Deprescribing.

Polypharmacy Management: Older adults often see multiple specialists, leading to a long list of medications. Geriatricians review this list to identify drugs that are no longer necessary, have duplicative effects, or pose high risks (e.g., sedatives that increase fall risk).
“Start Low and Go Slow”: When new medications are needed, they are started at the lowest possible dose and increased slowly, as the aging kidney and liver clear drugs from the body more slowly.

Rehabilitation and Physical Therapy

Movement is medicine in geriatrics.

Fall Prevention Programs: Specific exercises to improve balance (proprioception) and muscle strength reduce the risk of fractures.
Occupational Therapy: Teaching patients how to adapt their environment (e.g., using grab bars in the shower, using a walker) to maintain independence despite physical limitations.
Cognitive Rehabilitation: Engaging in brain-training exercises and social activities to slow the progression of mild cognitive impairment.

Management of Chronic Conditions

Dementia Care: Using medications (like cholinesterase inhibitors) to manage memory symptoms, combined with behavioral strategies to manage agitation or sleep disturbances without heavy sedation.
Osteoporosis Treatment: Using calcium, Vitamin D, and bisphosphonates to strengthen bones and prevent hip/spine fractures.
Nutritional Support: Combating sarcopenia (muscle loss) and malnutrition with high-protein diets and supplements.

Palliative and Supportive Care

Geriatrics works closely with palliative care principles.

Symptom Management: Aggressively treating pain, breathlessness, and nausea.
Advanced Care Planning: Having open, honest conversations with patients and families about their wishes for end-of-life care (living wills, power of attorney) to ensure their dignity and preferences are respected.

The Medical Center

Aging is a journey that deserves dignity, respect, and expert guidance. At Liv Hospital, our Geriatrics Department provides a “Medical Home” for older adults. We understand that our patients have lived full lives and have unique stories. Our medical approach is designed to honor that history by providing care that adds life to years, not just years to life.

Why Choose Liv Hospital for Geriatric Care?

Acute Care for Elders (ACE) Philosophy: We recognize that hospitals can be dangerous places for the elderly (risk of infection, confusion). Our protocols are designed to minimize these risks: early mobilization (getting out of bed quickly), removal of catheters as soon as possible, and sleep-friendly environments.
Multidisciplinary Geriatric Team: Our geriatricians do not work alone. They lead a team including neurologists (for memory), cardiologists, physical therapists, nutritionists, and social workers. This “Round Table” approach ensures that every aspect of the patient’s well-being is addressed.
Polypharmacy Clinics: We offer specialized consultations solely for medication review. Our experts analyze your prescriptions to reduce side effects and drug interactions, often resulting in patients feeling more alert and energetic simply by lowering their pill burden.

Advanced Technology and Facilities

Fall-Safe Design: Our facility is designed with the safety of older adults in mind, featuring non-slip flooring, appropriate lighting, and handrails.
Memory Care Expertise: We use advanced imaging to differentiate dementia subtypes (Alzheimer’s, Lewy Body, Vascular) early, which is crucial for accurate treatment.
Telemedicine Support: We understand that travel can be difficult for seniors. We offer robust telemedicine services for follow-ups, enabling patients to see their doctor from the comfort of their homes.

Family-Centered Approach

In geriatrics, the family is often the patient’s voice.

Caregiver Support: We provide education and support to family members, teaching them to manage dementia-related behaviors, prevent falls at home, and cope with the stress of caregiving.
Continuity of Care: From the clinic to the hospital to home care coordination, Liv Hospital ensures a seamless transition, preventing the confusion that often occurs when moving between healthcare settings.

At Liv Hospital, we believe that aging is not a disease to be cured, but a stage of life to be optimized. We are dedicated to helping our seniors live their golden years with strength, clarity, and independence.

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With patients from across the globe, we bring over three decades of medical expertise and hospitality to every individual who walks through our doors.

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FREQUENTLY ASKED QUESTIONS

What is geriatrics and what does a geriatrician do?

Geriatrics is a medical branch focused on healthcare for older adults. A geriatrician is a doctor who specializes in promoting health and preventing and treating diseases in seniors. They manage complex medical conditions and coordinate care to improve quality of life.

What conditions does geriatrics treat?

Geriatrics treats a vast array of conditions including dementia, Alzheimer’s, osteoporosis, incontinence, and heart disease. They also focus on “geriatric syndromes” like falls, frailty, and dizziness. They manage multiple chronic conditions simultaneously.

What are the main types of geriatric diseases?

The main types include cognitive disorders (like dementia), musculoskeletal issues (like arthritis), and cardiovascular diseases. Other major categories include sensory impairments (vision/hearing) and metabolic disorders like diabetes in the elderly.

When should I see a geriatrician?

You should consider seeing a specialist if you are over 65 and have multiple health conditions. It is also recommended if you take several medications, have noticed memory problems, or feel that your current treatment is not working well for your age.

What is the difference between geriatrics and internal medicine?

Internal medicine focuses on adult diseases in general, while geriatrics focuses specifically on the aging process and older adults. Geriatricians have extra training to handle the complexity of aging bodies, frailty, and multiple interacting diseases.