geriatrics
Overview of Evaluation of the Older Adult
Multiple disorders
On average, older patients have 6 diagnosable disorders. A disorder in one organ system can weaken another system, exacerbating the deterioration of both and leading to disability, dependence, and, without intervention, death. Multiple disorders complicate diagnosis and treatment, and effects of the disorders are magnified by social disadvantage (eg, isolation) and poverty (as patients outlive their resources and supportive peers) and by functional and financial problems. Clinicians should also pay particular attention to certain common geriatric symptoms (eg, Delirium , If patients have multiple disorders, treatments (eg, bed rest, surgery, drugs) must be well-integrated; treating one disorder without treating associated disorders may accelerate decline. Also, careful monitoring is needed to avoid iatrogenic consequences. For example, with complete bed rest, older patients can lose 1 to 3% of muscle mass and strength each day (causing sarcopenia and sharply reduced mobility), and effects of bed rest alone can ultimately result in death. 