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GeriatricsGeriatrics

DR RAHIM IQBALDR RAHIM IQBALMBBS(Pb).MPH(H.S.A) MBBS(Pb).MPH(H.S.A) Senior DemonstratorSenior Demonstrator

Rawalpindi Medical college Rawalpindi Medical college RawalpindiRawalpindi

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GeriatricsGeriatrics

• GeriatricsGeriatrics is the branch of is the branch of internal medicineinternal medicine that focuses on that focuses on

health care of the elderly. It aims to health care of the elderly. It aims to promote promote healthhealth and to and to preventprevent and and treat treat diseasesdiseases and and disabilitiesdisabilities in in

older adultsolder adults..

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GeriatricsGeriatrics

• There is no set age at which patients may be There is no set age at which patients may be under the care of a under the care of a geriatriciangeriatrician. Rather, this . Rather, this is determined by a profile of the typical is determined by a profile of the typical problems that geriatrics focuses on. This problems that geriatrics focuses on. This includes the so-called 'geriatric giants' of includes the so-called 'geriatric giants' of immobility, instability, immobility, instability, incontinenceincontinence and and impaired intellect/memoryimpaired intellect/memory. Health issues in . Health issues in older adults may also include older adults may also include elderly careelderly care, , deliriumdelirium, , use of multiple medicationsuse of multiple medications, , impaired visionimpaired vision and and hearinghearing..

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GeriatricsGeriatrics

•The branch of medicine that The branch of medicine that is concerned with clinical is concerned with clinical study and treatment of old study and treatment of old age and its manifestationage and its manifestation

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GerontologyGerontology

• This is the study of the This is the study of the agingaging process process itself. The term comes from the itself. The term comes from the GreekGreek gerongeron meaning "old man" and meaning "old man" and iatrosiatros meaning "healer". meaning "healer".

• The study of physical and The study of physical and psychological changes which are psychological changes which are incident to the old age is call incident to the old age is call gerontologygerontology

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GeriatricsGeriatrics(Facts about old age)(Facts about old age)

• Old age is an incurable disease.Old age is an incurable disease.

• We can not cure old age.We can not cure old age.

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GeriatricsGeriatricsThen what can be done for Then what can be done for

the old age peoplethe old age people

• You can protect their life.You can protect their life.

• You can promote their health.You can promote their health.

• You can extend their life.You can extend their life.

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GeriatricsGeriatrics (History)(History)

• The term geriatrics was proposed in The term geriatrics was proposed in 1909 by Dr. 1909 by Dr. Ignatz Leo NascherIgnatz Leo Nascher, , former Chief of Clinic in the former Chief of Clinic in the Mount Sinai HospitalMount Sinai Hospital Outpatient Outpatient Department (New York City) and a Department (New York City) and a "Father" of geriatrics in the United "Father" of geriatrics in the United States.States.

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GeriatricsGeriatrics (History)(History)

• The famous The famous Arabic physicianArabic physician, , Ibn Al-Ibn Al-JazzarJazzar Al- Al-Qayrawani (Algizar, circa 898-980), also wrote Qayrawani (Algizar, circa 898-980), also wrote a special book on the medicine and health of a special book on the medicine and health of the elderly, entitled the elderly, entitled Kitab Tibb al-MachayikhKitab Tibb al-Machayikh[6][6] or or Teb al-Mashaikh wa hefz sehatahomTeb al-Mashaikh wa hefz sehatahom..[7][7] He also wrote a book on He also wrote a book on sleep disorderssleep disorders and and another one on another one on forgetfulnessforgetfulness and how to and how to strengthen strengthen memorymemory, entitled , entitled Kitab al-Nissian Kitab al-Nissian wa Toroq Taqwiati Adhakirawa Toroq Taqwiati Adhakira,,[8][8][9][9][10][10] and a and a treatise on causes of treatise on causes of mortalitymortality entitled entitled Rissala Fi Asbab al-WafahRissala Fi Asbab al-Wafah..[11][11]

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GeriatricsGeriatrics (History)(History)

• Another Arabic physician in the 9th Another Arabic physician in the 9th century, Ishaq ibn Hunayn (died century, Ishaq ibn Hunayn (died 910), the son of 910), the son of HunaynHunayn Ibn Ibn IshaqIshaq, , wrote a wrote a Treatise on Drugs for Treatise on Drugs for ForgetfulnessForgetfulness ( (Risalah al-Shafiyah fi Risalah al-Shafiyah fi adwiyat al-nisyanadwiyat al-nisyan).).[12][12]

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GeriatricsGeriatrics (History)(History)

• The Canon of MedicineThe Canon of Medicine,,[2][2] written by written by Abu Ali Ibn SinaAbu Ali Ibn Sina (Avicenna) in 1025, was the first book to offer (Avicenna) in 1025, was the first book to offer instruction for the care of the instruction for the care of the agedaged, foreshadowing , foreshadowing modern modern gerontologygerontology and geriatrics. In a chapter and geriatrics. In a chapter entitled "Regimen of Old Age", Avicenna was entitled "Regimen of Old Age", Avicenna was concerned with how "old folk need plenty of sleep", concerned with how "old folk need plenty of sleep", how their bodies should be how their bodies should be anointedanointed with with oiloil, and , and recommended recommended exercisesexercises such as such as walkingwalking or or horse-ridinghorse-riding. Thesis III of the . Thesis III of the CanonCanon discussed the discussed the diet suitable for old people, and dedicated several diet suitable for old people, and dedicated several sections to elderly patients who become constipated.sections to elderly patients who become constipated.[3][4][5][3][4][5]

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GeriatricsGeriatrics (History)(History)

• Modern geriatrics in the United Kingdom Modern geriatrics in the United Kingdom really began with the "Mother" of Geriatrics, really began with the "Mother" of Geriatrics, Dr. Marjorie Warren. Warren emphasized Dr. Marjorie Warren. Warren emphasized that rehabilitation was essential to the care that rehabilitation was essential to the care of older people. She took her experiences of older people. She took her experiences as a physician in a London Workhouse as a physician in a London Workhouse infirmary and developed the concept that infirmary and developed the concept that merely keeping older people fed until they merely keeping older people fed until they died was not enough- they needed died was not enough- they needed diagnosis, treatment, care and support. She diagnosis, treatment, care and support. She found that patients, some of whom had found that patients, some of whom had previously been bedridden, were able to previously been bedridden, were able to gain some degree of independence with the gain some degree of independence with the correct assessment and treatment.correct assessment and treatment.

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GeriatricsGeriatrics(Important subjects (Important subjects

involved)involved)• Pharmacology Pharmacology

• PsychologyPsychology

• Polypharmacy Polypharmacy

• OrthogeriatricsOrthogeriatrics

• Cardio geriatricsCardio geriatrics

• psychogeriatricspsychogeriatrics

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GeriatricsGeriatrics(Important subjects (Important subjects

involved)involved)• Pharmacology Pharmacology

• Changes in physiology with aging may alter the Changes in physiology with aging may alter the absorption, the effectiveness and the side effect absorption, the effectiveness and the side effect profile of many drugs. These changes may occur in profile of many drugs. These changes may occur in oral protective reflexes (dryness of the mouth oral protective reflexes (dryness of the mouth caused by diminished salivary glands), in the caused by diminished salivary glands), in the gastrointestinal system (such as with delayed gastrointestinal system (such as with delayed emptying of solids and liquids possibly restricting emptying of solids and liquids possibly restricting speed of absorption), and in the distribution of speed of absorption), and in the distribution of drugs with changes in body fat and muscle and drugs with changes in body fat and muscle and drug elimination.drug elimination.

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GeriatricsGeriatrics(Important subjects (Important subjects

involved)involved)• PsychologyPsychology• Psychological consideration is that of elderly persons Psychological consideration is that of elderly persons

(particularly those experiencing substantial problems (particularly those experiencing substantial problems of memory loss or other types of cognitive of memory loss or other types of cognitive impairment) being able to adequately monitor and impairment) being able to adequately monitor and adhere to their own scheduled pharmacological adhere to their own scheduled pharmacological administration. One study (Hutchinson et al, 2006) administration. One study (Hutchinson et al, 2006) found that 25% of participants studied admitted to found that 25% of participants studied admitted to skipping doses or cutting them in half. Self-reported skipping doses or cutting them in half. Self-reported noncompliance with adherence to medication noncompliance with adherence to medication schedule was reported by a striking one-third of the schedule was reported by a striking one-third of the participants. Further development of methods which participants. Further development of methods which might possibly help monitor and regulate dosage might possibly help monitor and regulate dosage administration and scheduling is an area that administration and scheduling is an area that deserves further attention.deserves further attention.

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GeriatricsGeriatrics (Important subjects (Important subjects

involved)involved)• Polypharmacy Polypharmacy

• It is often a predictive factor (Cannon It is often a predictive factor (Cannon et al, 2006). Research done on et al, 2006). Research done on home/community health care found home/community health care found that "nearly 1 of 3 medical regimens that "nearly 1 of 3 medical regimens contain a potential medication error" contain a potential medication error" (Choi et al, 2006). (Choi et al, 2006).

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GeriatricsGeriatricsHealth problems of the Health problems of the

agedaged•Due to ageing process.Due to ageing process.

Senile cataractSenile cataractGlaucomaGlaucomaBony changes affecting mobilityBony changes affecting mobilityNerve deafnessNerve deafnessEmphysemaEmphysemaFailure of special sensesFailure of special sensesChanges in mental out lookChanges in mental out look

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GeriatricsGeriatrics Health problems of the Health problems of the

agedaged• Problems associated with long term-Problems associated with long term-

illnessillness• Genitourinary systemGenitourinary system

• Respiratory illnessRespiratory illness• DiabetesDiabetes• CancerCancer

• accidentsaccidents

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GeriatricsGeriatricsHealth problems of the Health problems of the

agedaged• Psychological Problems; 3 corners Psychological Problems; 3 corners 1.1. Mental changesMental changes2.2. Sexual adjustmentsSexual adjustments3.3. Emotional disordersEmotional disorders• irritabilityirritability• JealousyJealousy• BitternessBitterness• DepressionDepression• DementiaDementia• suicidesuicide

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GeriatricsGeriatricsMost common diseases of old ageMost common diseases of old age

((A study result)A study result)Men 45-64 years Men 45-64 years Men 45-64 years Men 45-64 years

High blood pressureHigh blood pressure arthritisarthritis

arthritisarthritis High blood pressureHigh blood pressure

Hearing impairmentHearing impairment Chronic sinusitisChronic sinusitis

deafnessdeafness Hearing impairmentHearing impairment

Hay fever without Hay fever without asthmaasthma

Varicose veinsVaricose veins

hemorrhoidshemorrhoids HaemorroidsHaemorroids

Visual impairmentVisual impairment chronic bronchitischronic bronchitis

diabetesdiabetes diabetesdiabetes

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Primary preventionPrimary prevention

• Health habitatsHealth habitats• SmokingSmoking• Alcohol abuseAlcohol abuse• ObesityObesity• NutritionNutrition• sleepsleep

• Coronary heart diseaseCoronary heart disease• ImmunizationImmunization• InfluenzaInfluenza• PneumovaxPneumovax• tetanustetanus

• Injury preventionInjury prevention• Osteoporosis preventionOsteoporosis prevention

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Secondary preventionSecondary prevention

• (A) Searching for(A) Searching for• HypertensionHypertension• DiabetesDiabetes• Dental diseasesDental diseases• Colorectal cancerColorectal cancer• breast cancerbreast cancer• Prostatic cancer Prostatic cancer • anemiaanemia• DepressionDepression• IncontinenceIncontinence• Fall riskFall risk• TBTB• SyphilisSyphilis• (B)(B)Stroke preventionStroke prevention

• (C)(C)Myocardial infarctionMyocardial infarction

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Tertiary preventionTertiary prevention

• RehabilitationRehabilitation• Physical deficitsPhysical deficits

• Cognitive defectsCognitive defects

• Functional defectsFunctional defects

• Care taker supportCare taker support

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ISLAM and GeriatricsISLAM and Geriatrics

• Holy QuarnHoly Quarn

• Hadees shreefHadees shreef

• Great people sayingsGreat people sayings

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GeriatricsGeriatrics

ReferencesReferences• Barton A, Mulley G. History of the development of geriatric Barton A, Mulley G. History of the development of geriatric

medicine in the UK. medicine in the UK. Postgrad Med JPostgrad Med J 2003;79:229-34. Fulltext. PMID 2003;79:229-34. Fulltext. PMID 12743345. 12743345.

• Cannon, K.T., Choi, M.M., Zuniga, M.M. (2006). Potentially Cannon, K.T., Choi, M.M., Zuniga, M.M. (2006). Potentially inappropriate medication use in elderly patients receiving home inappropriate medication use in elderly patients receiving home health care: a retrospective data analysis. The American Journal of health care: a retrospective data analysis. The American Journal of Geriatric Pharmacotherapy, 4, 134-143. Geriatric Pharmacotherapy, 4, 134-143.

• Gidal, B.E. (2006). Drug Absorption in the Elderly: Gidal, B.E. (2006). Drug Absorption in the Elderly: Biopharmaceutical Considerations for the Antiepileptic Drugs. Biopharmaceutical Considerations for the Antiepileptic Drugs. Epilepsy Research, 68S, S65-S69. Hutchison, L.C., Jones, S.K., Epilepsy Research, 68S, S65-S69. Hutchison, L.C., Jones, S.K., West, D.S., Wei, J.Y. (2006). Assessment of Medication West, D.S., Wei, J.Y. (2006). Assessment of Medication Management by Community-Living Elderly Persons with Two Management by Community-Living Elderly Persons with Two Standardized Assessment Tools: A Cross-Sectional Study. The Standardized Assessment Tools: A Cross-Sectional Study. The American Journal of Geriatric Pharmacotherapy, 4, 144-153. American Journal of Geriatric Pharmacotherapy, 4, 144-153.

• Isaacs B. Isaacs B. An introduction to geriatrics.An introduction to geriatrics. London: Balliere, Tindall London: Balliere, Tindall and Cassell, 1965. and Cassell, 1965.

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Success or FailureSuccess or Failure

Failure of SuccessFailure of Success

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Chinese lok Chinese lok dastandastan

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Thank youThank you

Very MuchVery Much