Geriatric Medicine Book

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Health Concerns in the Elderly

Aka: Health Concerns in the Elderly, Health Maintenance in Older Adults, Geriatrics
  1. See Also
    1. Health Maintenance in Adults
    2. Life Expectancy
  2. Epidemiology
    1. See Life Expectancy
  3. Screening: Common Syndromes in the Elderly
    1. Dementia
    2. Urinary Incontinence
    3. Fall Prevention in the Elderly
    4. Polypharmacy
      1. Also See Medication Use in the Elderly
  4. Screening: Common Medical Conditions affecting patients over age 75
    1. Osteoarthritis and other rheumatologic conditions
      1. See Rheumatologic Conditions in the Elderly
    2. Cardiovascular Disease (36%)
      1. Coronary Artery Disease
      2. Congestive Heart Failure
    3. Diabetes Mellitus (20%)
    4. Hypertension (29%)
    5. Cerebrovascular Disease (14%)
    6. COPD (11%)
    7. Decreased Visual Acquity
    8. Hearing
      1. See Hearing Handicap Inventory for the Elderly
    9. Hypothyroidism
    10. References
      1. Van Lankveld (2004) Arthritis Rheum 51:299 [PubMed]
  5. Screening: Psychosocial Concerns
    1. Geriatric Nutrition Checklist
    2. Activity in the Elderly
      1. Activities of Daily Living
      2. Activities of Daily Living Scale
      3. Instrumental Activities of Daily Living
    3. Long-term care
    4. Advanced Directives
    5. Elder Abuse
  6. Exam: Vitals
    1. Weight
      1. Unintentional Weight Loss (Cancer, Major Depression)
      2. Weight gain (CHF)
    2. Blood Pressure
      1. Orthostasis (Autonomic Dysfunction, Beta Blockers, CAD)
    3. Heart Rate
      1. Bradycardia (Beta Blockers, Heart Block)
      2. Atrial Fibrillation
    4. Respiratory Rate increased >24 (COPD, CHF, Pneumonia)
    5. Temperature high or low Temperature (Infection, Thyroid disorder)
  7. Exam: Head and Neck
    1. Face
      1. Facial asymmetry (e.g. neurovascular disease)
      2. Frontal bossing (Paget's Disease)
    2. Eyes
      1. Vision Loss (Macular Degeneration, Cataracts, Glaucoma)
    3. Ears
      1. Hearing Loss
    4. Mouth
      1. Oral Lesions (denture fit,, Leukoplakia)
      2. Xerostomia (e.g. Diabetes Mellitus, Sjogren's Syndrome, Anticholinergic Medications)
    5. Neck
      1. Carotid Bruit
      2. Thyroid mass
  8. Exam: Trunk
    1. Heart Exam
    2. Lung Exam
    3. Abdomen
      1. Abdominal Aortic Aneurysm
      2. Constipation (drug-related, Colon Cancer, dehydration)
      3. Fecal Incontinence (e.g. Fecal Impaction)
      4. Rectal bleeding
    4. Genitourinary
      1. Vaginal Atrophy
      2. Prostate enlargement
      3. Urinary Incontinence
  9. Exam: Extremity
    1. Feet
      1. Bunions, Callus, and non-healing sores
      2. Peripheral Vascular Disease
      3. Venous Insufficiency
    2. Joints
      1. Painful range of motion
      2. Antalgic Gait
    3. Neurologic
      1. Ataxia
      2. Parkinsonian Tremor
  10. Prevention: Counseling for over age 65 years
    1. Tobacco Cessation
      1. Quitting as late as age 65 still increases Life Expectancy 1-3 years
      2. Taylor (2002) Am J Public Health 92(6): 990-6 [PubMed]
    2. Heart Healthy Diet (e.g. Mediterranean Diet)
    3. Exercise in the Elderly
  11. Prevention: Screening
    1. See Health Maintenance in Adults
    2. Precautions
      1. Take Life Expectancy into account when discussing cancer screening
      2. Breast and Colorectal Cancer Screening is not recommend if <10 year Life Expectancy
      3. Paradoxically, the healthiest patients are screened less than those in with the lowest Life Expectancy
    3. Abdominal Aortic Aneurysm Screening with abdominal Ultrasound
      1. Screen men between ages 65 to 75 if any history of Tobacco abuse (consider in women)
    4. Breast Cancer Screening with Mammograms
      1. Every other year in women up to age 75 AND
      2. May continue based on shared decision making IF at least 10 years Life Expectancy
    5. Cervical Cancer Screening with Pap Smears
      1. May be discontinued after age 65 unless dysplasia history or inadequate prior screening
    6. Colorectal Cancer Screening
      1. See Colon Cancer Screening with Colonoscopy for recommended intervals
      2. Routine screening until age 75 years and may be considered in age 76 to 85 years
      3. Stop screening when Life Expectancy <10 years
    7. Prostate Cancer Screening
      1. Controversial at any age
      2. Avoid screening over age 70 years OR Life Expectancy <10 to 15 years
    8. Osteoporosis Screening
      1. See Osteoporosis Screening
    9. Lung Cancer Screening CT Chest
      1. Adults 55 to 77 years old with >30 pack year history of smoking AND
      2. Currently smoking or quit within last 15 years
  12. Resources
    1. Community Services for the Elderly
  13. References
    1. Dial (2003) AAFP Board Review Lecture, Seattle
    2. Elsawy (2011) Am Fam Physician 83:48-56 [PubMed]
    3. Salzman (2016) Am Fam Physician 93(8): 659-67 [PubMed]
    4. Spalding (2008) Am Fam Physician 78(2): 206-15 [PubMed]

Geriatrics (C0017469)

Definition (NCI) The branch of medical science that deals with diseases and problems specific to elderly people.
Definition (MSH) The branch of medicine concerned with the physiological and pathological aspects of the aged, including the clinical problems of senescence and senility.
Definition (PSY) Medical subdiscipline which deals with the problems of old age and aging.
Concepts Biomedical Occupation or Discipline (T091)
MSH D005853
SnomedCT 394336003, 393386001, 394811001
LNC LP97119-9
Swedish Geriatrik
English Gerontological, geriatrics (field), geriatric medicine (field), geriatric medicine, geriatrics medicine, Geriatric medicine (qualifier value), Geriatric medicine, Gerontology, Gerontology / Geriatrics, Geriatrics, geriatrics
Czech geriatrie
Finnish Geriatria
Russian GERONTOLOGIIA, GERIATRIIA, ГЕРИАТРИЯ, ГЕРОНТОЛОГИЯ
Croatian GERIJATRIJA
Polish Gerontologia, Geriatria
Norwegian Geriatri
Spanish geriatría (calificador), geriatría, Geriatría
French Gériatrie
German Geriatrie
Italian Geriatria
Dutch Geriatrie
Portuguese Geriatria
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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