I really, really enjoyed Geriatrics. And since medicine is going to practically turn in to geriatrics in a few years when our parents (and maybe you) get older, there are a number of really important things to remember about our elderly loved ones:

• “Elderly.” “Geriatric.” There’s not an age where you become “elderly,” or that you’re “allowed” to see a geriatrician. It’s usually designated as 65, just because that’s when Medicare kicks in, but often it’s a functional status–what can the person do, and what does he or she need assistance doing?
• Falls. Older patients more likely to fall, and their falls are much more dangerous. They are more likely to pass out or faint, because they have less fluid reserves in their bodies, and are often on multiple medications, many of which can cause light-headedness. They also often have less muscle mass, or are in worse shape, or have arthritis making them less steady on their feet. Diabetics can lose nerve sensation, especially in their feet–this includes the nerve sensations that tell their brains where their feet actually are in relation to their legs. And since older folks tend to have more osteoporosis (brittle bones), they’re more likely to break hips, break other bones, rupture veins in their heads, too. Continuing the logic, elderly people are slower to heal and recover, so they have longer hospital stays, more likely to get infections, and more likely to do worse. So we want to keep elderly folks healthy and out of the hospital!
• Incontinence (losing control of your bladder or bowels) is common in the elderly, too–but often can be fixed or improved with medications.
• It’s important to talk about advanced directives with older patients, or durable powers of attorney; this lets doctors, nurses, family members, and friends know what the patient wanted done, and what he or she didn’t want done. This respects the patient’s wishes to the best of our ability, and allows family and friends to have one less thing on their mind during a serious illness or terminal illness.
• Depression is common in the elderly, and can present differently in the elderly than in younger patients. Symptoms can be memory problems, thinking problems, fatigue, loss of interests–which can sometimes be confused with dementia (like Alzheimer’s disease). Isolation can also be a problem–when people lose their loved ones they’ve depended on their entire lives, they may not want to meet new people or leave the house.
• Functioning: it’s important for physicians to try to get a sense of what an older patient can and cannot do. These are known as ADLs (activities of daily living) and include dressing, feeding, showering, toileting, etc. Instrumental ADLs are other activities that are important for daily functioning in our society–going shopping, balancing a checkbook, doing the cleaning, cooking, etc.
• And a ton more. Stay tuned for tomorrow.

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