The Geriatric

Patient
Definition of Health

a multi-dimensional concept:
the World Health Organization defines it
as a state of complete physical, mental,
and social well-being, and not merely as
the absence of disease or infirmity
Healthy Aging

 the
process of developing and
maintaining the functional ability that
enables well-being in older age
ADL’s vs IADL’s

 “Activities of daily living” (ADLs) are selfcare tasks that

include bathing, dressing, toileting, transferring (e.g. in
and out of bed), and eating.

 Instrumental activities of daily living” (IADLs) are

independent living skills related to a person’s ability to
cope with his/her environment, and include tasks such as
shopping, cooking, housekeeping, use of transportation,
managing money, managing medication, and
telephone use.
Categories of Physical Health Index
Measuring Physical Competence
Physical Health ADL IADL
Bed days Feeding Cooking
Restricted – activity days Bathing Cleaning
Hospitilization Tolieting Using Telephone
Physician visits Dressing Writing
Pain and discomfort Ambulation Reading
Signs on Exam Transfer from Bed Shopping
Physiologic Indicators Transfer from Toilet Managing Medication
Permanent Impairment Bowel, Bladder Control Walking Outdoors
Disease/Diagnosis Grooming Managing Money
IADL’s

Many disabilities related to IADLs stem from physical frailty:

for example, doing laundry and general housework may
require more energy or strength then a person has. But
other tasks, such as paying bills, preparing food and
managing medications may be more related to cognitive
health.
Disablity

 Disability status is frequently assessed using ADL and IADL

measures in combination, and can stem from physical as
well as cognitive impairment.

 The ADA defines a person with a disability as a person

who has a physical or mental impairment that
substantially limits one or more major life activity. This
includes people who have a record of such an
impairment, even if they do not currently have a
disability.
Disability- Severity

 Severity can be measured by:

 Does not perform activity at all
 Can only perform activity with the help of another
person or if a person is available (but does not
actually give aid)
 Can perform the activity with help of special
equipment
Disability- Coding

 Five degrees of Severity

 No disability
 At least one IADL disability no ADL disabilities
 1 or 2 ADL disabilities
 3 or 4 ADL disabilities
 5 to 6 ADL disabilities
Fraility

 a progressive age-related decline in physiological

systems, resulting in decreased reserves of intrinsic
capacity, which confers extreme vulnerability to stressors
and increases the risk of a range of adverse health
outcomes
Disuse

 Changes in aging coinciding with those associated with physical

inactivity
 Can be due to
 Bed Rest
 Insufficient exercise
 Lack of Gravity
Disuse - Reduces

 VO2 max
 Resting and maximum cardiac output
 Sense of balance
 Body water and sodium
 Blood cell mass
 Lean body mass
 Glucose tolerance test
 Immune Responses
 Thermoregulation
 Sympathetic Activity and Neurotransmitters
Disuse- Increases
 Systolic Blood Pressure
 Vestibular Sensitivity
 Serum Total Cholesterol
 Urinary Nitrogen and Creatinine
 Bone Calcium Loss
Baseline- Evaluation for a Senior

 Should include:
 Evaluation of mental function
 Evaluation of socioeconomic health
 Nutritional status
 Risks to health including fall risk, drug history, screened
for senior related disorders
 Various testing
General Strategy Examining
Seniors
 Consider
 Most common conditions
 Atypical presentations
 Symptoms from drug interactions
 Screen for cancer “if red flags noted”
Aging

Associated with increased incidence and severity of diseases,

accidents and stress
Disease

 Selective
 Instrinsic and Extrinsic factors
 Discontinous
 Occasionally deleterious
 Often Treatable
General Characteristics of Disease
in Eldery
 Chronic vs Acute
 Debilitating
 Altered Response to treatment
 Increased danger of medically induced morbidity an/or
mortality
 Symptoms
 Subtle
 Vague
 Atypical
 Unreported
Diseases of Elderly

Limited to Aging Associated with Aging

Osteoporosis Known Etiology Septicemia
Osteoarthritis Pneumonia
Prostatic Cerebrovascular Disease
Adenocarcinoma
Polymyalgia Rheumatica Myocardial infarction
Temporal Arteritis Unknown Etiology Type II Diabetes
Hypertension
Alzheimer’s Disease
Parkinson’s Disease
Emphysema