Geriatric medicine is not necessarily a true speciality; you will have patients suffering from pathology that could be dealt with by cardiology, or respiratory; the key points about geriatric work are:
- Patients unable to care for themselves
- Multiple pathology
- Impaired cognition
A serious problem that main old people suffer from is the fact that all their friends have died, they can’t get out on their own, and they don’t really have anything they can enjoy in their life. Because of this, Social history is very important in the history, as patients cannot be discharged if they are not going to looked after/able to care for themselves when they get home.
Within the social history, mobility should also be included. One of the most important parts of managing elderly patients is being able to assess how much care input is needed. For example, if a patient can't walk very far, they can't go shopping and so will need provisions to overcome this.
The same diseases which affect the adult population as a whole affect the elderly. However, certain conditions are more serious in the elderly, the prime example being falls.
There is a common misconception that geriatric medicine is entirely about dementia. This is not entirely true, although it does make up a large portion of the work:
- Alzheimer’s Disease is the big one, making up to 70% of dementias.
- Vascular dementia is common, often present concurrently with other dementias
- Lewy Body Dementia is probably the most distressing.
- Pick’s Disease is also an important cause of dementia, especially in younger (<60) people.
Other Psychiatric disorders
Depression is very common in geriatric medicine, probably due to reduced mobility/social interaction. Psychotic disorders, unless related to dementia, rarely present in old age. Again, alcohol use tends to decrease with old age, however, misuse can present once people retire, and have more free time to get lashed.
Suicide is more common in the over 60s than in the under 40s, and is especially common in those suffering from physical illness.