GERIATRIC CARE

Module 1: WHY DO WE NEED TO LEARN MORE ABOUT OLDER PEOPLE?

Learning Objectives:
At the end of the lesson, the students are expected to:
1. Define Ageing
2. Differentiate Geriatrics and Gerontology
3. Enumerate the 10 basics in Geriatrics
4. Explain the challenges in caring for the elderly and
describe the role of health care workers in supporting the
elderly
Ageing is the progressive and generalized impairment of
functions resulting in the loss of adaptive response to stress and
in an increasing risk of age-related diseases. It is a complex interaction between an individual
and the environment over time. The overall effect of these interactions is an increase in the
probability of dying, which is evident from the rise in age-specific death rates in the
population.
Geriatrics and Gerontology are often used to mean the same thing.
Geriatrics is the branch of medicine that deals with the illness and care of the aged. Geriatric
nursing focuses on the care of the sick elderly.
Gerontology is the study of factors affecting the normal aging process and the effects of
aging on persons of all ages. Gerontologic nursing includes not only the care of the sick
elderly, but also health maintenance, illness prevention, and the promotion of quality of life
to assist the person to grow to an ideal state of health and well-being.
BASICS IN GERIATRICS “BIG 10”
1. Aging is not a disease
a. Aging occurs at different rates
 Between individuals
 Within individuals in different organ systems
b. Aging alone does not generally cause symptoms
c. Aging increases susceptibility to many diseases and conditions (“homeostenosis”)
d. Aging people are heterogeneous – some are very healthy, some are very ill

2. Medical conditions in geriatric patients are commonly chronic, multiple and

multifactorial
a. Older individuals commonly have multiple chronic conditions, making management
complex and challenging
b. Acute illnesses are superimposed on chronic conditions and their management
c. Treatment for one chronic or acute illness can influence the management of other
underlying conditions
 d. Multiple factors are generally involved in the pathogenesis of geriatric conditions
3. Reversible and treatable conditions are often underdiagnosed and undertreated in
geriatric patients
a. Older individuals, caregivers, and health professionals mistakenly attribute symptoms
to “old age”
b. Many conditions present atypically in the geriatric population
c. Systematic screening for common geriatric conditions can help avoid undiagnosed,
treatable conditions
d. Geriatric “syndromes” are commonly undiagnosed and therefore not managed
optimally, such as: delirium, gait instability and falls, urinary incontinence, pain, and
malnutrition
4. Functional ability and quality of life are critical outcomes in the geriatric population
a. Functional capacity, in combination with social supports, is critical in determining
living situation and overall quality of life
b. Small changes in functional capability (e.g., the ability to transfer) can make a critical
difference for quality of life of older patients and their caregivers
c. Standard tools can be used to measure basic and instrumental activities of daily living
and overall quality of life
5. Social history, social support, and patient preferences are essential aspects of
managing geriatric patients
a. Understanding the patient’s life history and preferences for care are critical (place of
birth, education, occupation, family relationships, spirituality, resources, willingness
to take risks and utilize resources for care, etc)
b. Living circumstances is critical to managing frail older patients
c. Caregiver availability, health, and resources are critical determinants of care planning
for frail older patients

6. Geriatric care is commonly multidisciplinary

a. Interdisciplinary respect, collaboration, and communication are essential in the care of
geriatric patients and their caregivers
b. Various disciplines play an important role in geriatric care, e.g. nursing, rehabilitation
therapists, dieticians, pharmacists, social workers, etc.
7. Cognitive and affective disorders are highly prevalent and commonly undiagnosed at
early stages
a. Aging is associated with changes in cognitive function
b. Common causes of cognitive impairment include delirium, Alzheimer’s Disease,
multi-infarct dementia
c. Geriatric depression is often undiagnosed
d. Screening tools for dementia, delirium, and depression should be used routinely
8. Iatrogenic illnesses are common and many are preventable
 a. Polypharmacy, adverse drug reactions, drug-disease interactions, drug-drug
interactions, inappropriate medications all common
b. Complications of hospitalization, such as falls, immobility and deconditioning can be
serious and life-threatening
9. Geriatric care is provided in a variety of settings ranging from the home to long-term
care institutions
a. There are specific definitions and criteria for admission to different types of care
settings
b. Funding for care in different settings varies and depends on many factors c.
Transitions between care settings must be coordinated in order to avoid unnecessary
duplication, medical errors, and patient injuries
c. Integrated, multi-level systems provide the most coordinated care for complex
geriatric patients
10. Ethical issues and end-of-life care are critical aspects of the practice of geriatrics
a. Ethical issues arise almost every day in geriatric are
b. Advance directives are critical for preventing some ethical dilemmas
c. Principles of palliative care and end-of-life care are essential for high quality geriatric
care
Challenges facing health care for the elderly:
With the change in the composition of the population and advances in medicine and
public health practices, the morbidity and mortality pattern in most developing countries
including India has changed considerably. A major shift from acute communicable diseases
with high mortality to chronic non-communicable diseases with high disability has been
observed all over the world. These transformations in morbidity and mortality figures require
that public health programs for non-communicable diseases be initiated while continuing
control and surveillance of infectious diseases.
As non-communicable diseases are more frequent in older individuals, the focus of most
public health activity will gradually shift towards older people. It is important that:

 Health care workers have to be aware of the complexity of care of the older people.
 Health care needs of the elderly are different from those of the other age groups.
 Health workers understand that the structural, functional, mental and emotional status
of an older patient is not same as a younger adult.
 Manifestations and course of the disease are varied and requires specialized training
and care.
 The goals of health interventions are more often to care then cure. Consequently;
restoration of function and improvement of quality of life gets priority over
eradication of disease.
Role of health care workers in supporting the elderly
 The community health worker as a member of the team of health professionals has to
understand his or her role in care of the older people very clearly; which include:
 Support: Help older people in staying independent and functional
 Knowledge: Know the age related norms of body structure and function
 Awareness: Differentiate age related changes from pathological states
 Identification: Detect new risk factors and deficiencies in activities of daily living of
the older person quickly as markers of new disease
 Monitoring: Regular monitoring of existing health problems
 Evaluation: Monitoring the effectiveness and side effects of medication
 Risk Reduction: Assist older people in health promotion and disease prevention.

Module 1 Activities: (Write your answers in a 1 whole yellow pad paper)

1. What is ageing?
2. Differentiate geriatrics from gerontology
3. Why is geriatric care important to you:
a. As a Midwifery Student
b. As a child
c. As an Individual?
References:
Electronic sources:
Geriatric Age Specific Self Learning Module For Clinical Staff. UCLA Health System.
https://www.uclahealth.org/hr/workfiles/agespecificslm-geriatric.pdf
Date retrieved: August 28, 2020
Eskildsen & Price, 2008. Geriatric Medicine First Edition. 171 Second Street, Suite 300, San
Francisco, California, 94105, USA. https://pogoe.org/sites/default/files/CBL
%20workbook.pdf
Date retrieved: August 28, 2020
Dey & Krishnaswamy, 2009. Ensuring Better Health Care for the Elderly Training Manual
for Physicians. http://www.nrhmorissa.gov.in/writereaddata/Upload/Documents/Physican
%20manual%20for%20Elderly%20Health.pdf
Date retrieved: August 28, 2020
Dey & Krishnaswamy, 2009. Ensuring Better Health Care for the Elderly Training Manual
for Physicians. http://www.nrhmorissa.gov.in/writereaddata/Upload/Documents/Community
%20Health%20Worker%20Manual.pdf
Date retrieved: August 28, 2020