Common Geriatric Problems and Their Management

Aging is the progressive, universal decline first in functional reserve and then in function that occurs in organisms over time. Aging is heterogeneous; it is not a disease, however, the risk of developing disease is increased. Geriatric syndrome refers to a symptom presentation that is common in older adults and most are multifactorial in origin.

The Four Geriatric Giants

The four major geriatric giants are characterized by the following conditions:

• Immobility
• Instability (falls)
• Incontinence
• Intellectual impairment

Dementia and Delirium

Dementia is a syndrome of progressive decline in which multiple intellectual abilities deteriorate, causing both cognitive and functional impairment. It is a state of chronic confusion, whereas delirium is an acute state of confusion. It is important to differentiate delirium from dementia, though both are characterized by disorientation, memory impairment, paranoia, hallucinations, emotional lability, and sleep-wake cycle reversal. Key features of delirium include acute onset, impaired attention, and altered level of consciousness.

Care and Management

The main goals of care of a patient with dementia are to improve cognitive and physical functioning. A key goal is to identify and treat reversible causes of cognitive impairment such as:

• Infections and electrolyte abnormalities
• Vitamin deficiencies and thyroid disease
• Substance abuse, medication, and psychiatric illnesses

Falls and Instability

Fall rates and risk of injury from falls increase with age. Annually, approximately 30% of community dwelling adults over 65 years fall, while 50% of individuals over 80 years fall. Most falls are multifactorial. Falling is sometimes a symptom of another disease, such as infections, neurologic disorder, or medication side effect. Age-related physiologic changes also contribute, including decreased proprioception, increased postural sway, and declines in baroreflex sensitivity resulting in orthostatic hypotension.

Risk Factors for Falls

Risk factors for falls include muscle weakness, history of falls, gait or balance abnormality, and the use of a walking aid. Other factors include visual impairment, arthritis, impaired activities of daily living, depression, cognitive impairment, and being over 80 years of age. Drugs also play a significant role, specifically polypharmacy (four or more drugs) and medications such as digoxin, diuretics, benzodiazepines, phenothiazines, antidepressants, and type I anti-arrhythmics.

Sarcopenia: Age-Related Muscle Loss

Sarcopenia is the medical definition for the gradual loss of muscle mass, strength, and function. The main symptom of the condition is muscle weakness. Sarcopenia is a type of muscle atrophy primarily caused by the natural aging process, though being physically inactive and eating an unhealthy diet can contribute to the disease. It can greatly impact your quality of life by reducing your ability to perform daily tasks and can lead to the loss of independence.

Diagnosis of Sarcopenia

A healthcare provider may diagnose sarcopenia using the SARC-F questionnaire, which evaluates the following factors:

• S — Strength
• A — Assistance with walking
• R — Rising from a chair
• C — Climbing stairs
• F — Falls

Tests such as the handgrip test and chair stand test are also used to measure muscle strength.

Urinary Incontinence

Urinary Incontinence (UI) is a major problem for older adults. Up to age 80 years, UI affects women twice as commonly as men. However, after age 80, both sexes are equally affected. Risk factors include advanced age and functional impairment.

Prevalence Data of Geriatric Conditions

The following data outlines the prevalence and impact of conditions based on age groups:

• Falls (65+ years): 30% of community-dwelling adults annually.
• Falls (80+ years): 50% of individuals annually.
• Sarcopenia (60+ years): 5% to 13% of the population.
• Sarcopenia (80+ years): 11% to 50% of the population.
• Muscle Mass Loss: Up to 8% loss per decade between ages 65 and 80.