geriatrics
Introduction to Geriatrics
Aging
Aging (ie, pure aging) refers to the inevitable, irreversible decline in organ function that occurs over time even in the absence of injury, illness, environmental risks, or poor lifestyle choices (eg, unhealthy diet, lack of exercise, substance abuse). Initially, the changes in organ function (see table Selected Physiologic Age-Related Changes ) do not affect baseline function; the first manifestations are a reduced capacity of each organ to maintain homeostasis under stress (eg, illness, injury). The cardiovascular, renal, and central nervous systems are usually the most vulnerable (the weakest links). Diseases interact with pure aging effects to cause geriatric-specific complications (now referred to as geriatric syndromes), particularly in the weak-link systems—even when those organs are not the primary ones affected by a disease. Typical examples are delirium complicating pneumonia or urinary tract infections and the falls, dizziness, syncope, urinary incontinence, and weight loss that often accompany many minor illnesses in older adults. Aging organs are also more susceptible to injury; eg, intracranial hemorrhage is more common and is triggered by less clinically important injury in older adults. The effects of aging must be taken into account during the diagnosis and treatment of older adults. Clinicians should not Mistake pure aging for disease (eg, slow information retrieval is not dementia) Mistake disease for pure aging (eg, ascribe debilitating arthritis, tremor, or dementia to old age) Ignore the increased risk of adverse drug effects on weak-link systems stressed by illness Forget that older adults often have multiple underlying disorders (eg, hypertension, diabetes, atherosclerosis) that accelerate the potential for harm In addition, clinicians should be alert for diseases and problems that are much more common among older adults (eg, diastolic heart failure, Alzheimer disease, incontinence, atrial fibrillation). This approach enables clinicians to better understand and manage the complexity of the diseases that often coexist in older patients. Understanding the physical changes and geriatric-specific manifestations of disease that accompany advancing age is important to avoid the negative and prejudicial stereotypes about older adults that characterize ageism and can negatively impact patient care and quality of life. Ageismrefers to prejudice against people of older age. Similar to other forms of prejudice (eg, racial, ethnic), ageism is based on negative misconceptions and stereotypes and may be conscious or unconscious, overt or subtle. Unlike many other forms of prejudice, ageism is rarely intentionally malicious but nonetheless can cause emotional distress and has adverse practical consequences (eg, being encouraged to retire from work, not invited to participate in groups or committees). Healthcare providers effectuate age bias by not offering a treatment to an older adult based simply on their age rather than on factors such as expected life expectancy, quality of life, and patient preference. 