Geriatric Medicine - PowerPoint PPT Presentation

Loading...

PPT – Geriatric Medicine PowerPoint presentation | free to download - id: 3c4e6b-ZDkxO



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Geriatric Medicine

Description:

Geriatric Medicine Ming-Shyan Huang, MD, PhD Professor of Faculty of medicine Kaohsiung Medical University ... – PowerPoint PPT presentation

Number of Views:1599
Avg rating:3.0/5.0
Slides: 62
Provided by: wutschDle
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Geriatric Medicine


1
Geriatric Medicine
  • Ming-Shyan Huang, MD, PhD
  • Professor of Faculty of medicine
  • Kaohsiung Medical University

2
????
  • ??????????,???????????????gerontology?
  • Dorland?????????????????????????????????,????????
    ???????????

3
The elderly patient
  • Persons aged 65
  • Growing numbers of elderly person
  • Elderly persons 7 ??? (82??)
  • Cannot go on as we have new approaches are
    needed
  • Taiwan 2004
  • 65 year old 9.48
  • 17-64 year old 71.19

4
2004 TAIWAN
2003 JAPAN Male 77.6 Female 84.4
Male 73.60 Female 79.41
5
(No Transcript)
6
(No Transcript)
7
(No Transcript)
8
(No Transcript)
9
(No Transcript)
10
(No Transcript)
11
(No Transcript)
12
(No Transcript)
13
  • ???????????19.11,????????24.6?
  • ????????????28.76
  • ???????????????????????????

14
(No Transcript)
15
(No Transcript)
16
(No Transcript)
17
(No Transcript)
18
(No Transcript)
19
(No Transcript)
20
(No Transcript)
21
(No Transcript)
22
(No Transcript)
23
??????????????
  • ????????????????????????,?????????,?????????????,?
    ?????????????
  • ????????,???????????????,???????????????
  • ??????????????????,??????????????????????,????????
    ???????,??????????????????????????,??????????????,
    ??????????????,????????????????????,??????????????
    ???,??????

By ???
24
??????????????
  • ????
  • ?????,????
  • ???????????????
  • ??????????

By ???
25
??
  • ???????????????
  • ???????
  • ?????????
  • ?????,
  • ?????????????????????,????????????????????????

26
?????????
  • ????????????????????,?????????????????????????????
    ?????????????????????????,????????????????????????
    ?????????????,??????????????????????????????,?????
    ?????????????????????????????????,????????????????
    ????????

27
Aging
28
  • Aging process is normal, progressive, and
    physiologically irreversible.
  • Aging occurs despite optimal nutrition, genetic
    background, environmental surroundings, and
    activity patterns.
  • Biological aging process, may demonstrate altered
    rates of progression in response to an
    individuals genetic background and daily living
    habits

29
(No Transcript)
30
???????
  • ???????
  • ????????
  • ????????????
  • ???????
  • ??????????
  • ??????????????

31
Goals of Care
  • The usual fix-it model is inadequate for
    geriatric medicine
  • The best possible outcome for an elderly patient
    must be defined by patients preferences and
    values
  • Most treatments are only partially effective and
    carry both burdens and benefits, and reasonable
    persons differ in evaluating these
  • Good decision making requires that the possible
    futures of the patient

32
Age (years)
O2 maximum oxygen uptake MBC
maximum breathing capacity RBF renal blood flow
CI resting cardiac index FBSfasting
blood glucose
33
Major theories on aging
34
Home
Repeat Nursing Home
First Nursing Home
Hospital
Dead
35
Components of assessment of the elderly
36
Aging
Chronic diseases
Acute diseases
37
Initial evaluation of geriatric patient
  • Primary reason for visit
  • Current medical problems
  • Past medical and surgical history
  • Current medications
  • Medication allergies
  • Vaccine status
  • Influenza, pneumococcus, tetanus
  • Social issue
  • Living status
  • Driving
  • Smoking
  • Drinking alcohol

38
Potential difficulties in taking history from
elderly
  • Communication
  • Diminish vision
  • Diminish hearing
  • Slowed psychomotor performance
  • Underreporting of symptoms
  • Health belief, fear, depression, altered physical
    and psychological responses to disease process
  • Cognitive impairment
  • Vague or nonspecific symptoms
  • As above
  • Altered presentation of specific diseases
  • Multiple complaints

39
Important aspects of the history in the elderly
  • Social history
  • Living arrangement, relationships with family and
    friends, expectation of family or other care
    givers, economic status, abilities to perform
    activities of daily living, social activities and
    hobbies, mode of transportation
  • Past medical history
  • Surgical procedures, major illnesses and
    hospitalizations, immunization status, TB,
    medications, perceived beneficial or adverse drug
    effects

40
Purposes and objectives of functional status
measures
  • Description
  • Screening
  • Assessment
  • Monitoring
  • prediction

41
Examples of measures of physical functioning
  • Basic activities of daily living (ADL)
  • Feeding, dressing, ambulation, toileting, bathing
    transfer (from bed and toilet), continence,
    grooming, communication
  • Instrumental activities of daily living (IADL)
  • Writing, reading, cooking, cleaning, shopping,
    doing laundry, climbing stairs, using telephone,
    managing medication, managing money, ability to
    perform paid employment or outside work, ability
    to travel

42
??????
  • ?????
  • ??????
  • ????????
  • ??????? ??????
  • ????
  • ???????? ? ? ?????
  • ???????
  • ???????
  • ?????????
  • 20-3?-3?-3?-3?-3?

43
Geriatric Problems
  • Immobility
  • Instability
  • Incontinence
  • Intellectual impairment
  • Infection
  • Impairment of vision and hearing
  • Irritable colon
  • Isolation (depression)
  • Inanition (malnutrition)
  • Impecunity
  • Iatrogenesis
  • Insomnia
  • Immune deficiency
  • Impotence

44
Confusion
  • 5 of older than 65 y/o, 20 of those older than
    75 y/o
  • As a mental state in which reaction to
    environmental stimuli are inappropriate
  • DD of confusion
  • Delirium (acute)
  • Dementias (more slowly)
  • Impaired cognitive function associated with
    affective disorders and psychoses

45
Depression
  • Biological factor
  • Family history, aging changes in
    neurotransmission
  • Physical
  • Specific diseases, chronic medical conditions,
    sensory deprivation, loss of physical function
  • Psychological
  • Unresolved conflicts, memory loss and dementia,
    personality disorders
  • Social
  • Losses of family and friends, isolation, loss of
    job, loss of income

46
Treatment modalities for depression in the elderly
  • Supportive measures
  • Psychotherapy
  • Drugs
  • Sedative for associated anxiety or agitation
  • Antipsychotics for associated psychoses
  • Electroconvulsive therapy

47
Incontinence
  • Basic causes incontinence
  • Acute causes incontinence
  • Persistent causes incontinence

48
Basic underlying causes
Neurologic
Urologic
Iatrogenic/ Environmental
Functional/ Psychological
49
Acute and reversible forms of urinary incontinence
  • D delirium
  • R restricted mobility, retention
  • I infection, inflammation, impaction
    (fecal)
  • P polyuria, pharmaceuticals

50
Types of persistent incontinence
Stress
Urge
Functional
Overflow
51
Instability and falls
  • Complications of falls in the elderly
  • Injuries
  • Painful soft tissue injuries
  • Fracture hip, femur, humerus, wrist, ribs
  • Subdural hematoma
  • Hospitalization
  • Complications of immobilization
  • Risk of iatrogenic illnesses
  • Disability
  • Impaired mobility due to physical injury
  • Impaired mobility from fear, loss of
    self-confidence, and restriction of ambulation
  • Risk of institutionalization
  • Death

52
Extrinsic factors
Intrinsic factors
Medical and neuropsychiatric conditions
Medications
Improper prescription and/or use of assistive
devices for ambulation
Falls
Impaired vision and hearing
Environmental hazards
Age-related changes In neuromuscular
function, gait and posture reflexes
53
Insomnia
Sedative-hypnotic drug
Morning delirium/lethargy
Fall
Hip fracture
Cascade of drug-induced illness
54
Seizures
Phenytoin
Ataxia
Fall
Hip fracture
Cascade of drug-induced illness
55
Immobility
56
Common causes
  • Musculoskeletal disorders
  • Arthritides, osteoporosis, fractures.
  • Neurological disorders
  • Stroke, parkinsons disease.
  • Cardiovascular diseases
  • CHF (severe), CAD..
  • Pulmonary diseases
  • COPD (severe type)
  • Sensory factors
  • Fear, impairment vision
  • Environmental causes
  • Forced immobility..
  • Others
  • Malnutrition, malignancy, depression

57
Complications
  • Skin pressure sores
  • Musculoskeletal muscular atrophy
  • Cardiovascular thrombosis, embolism
  • Pulmonary pneumonia, atelectasis
  • GI constipation, anorexia, impaction
  • GU incontinence, infection, retention
  • Metabolic impaired glucose tolerance, altered
    drug pharmacokinetics
  • Psychological depression, dementia, delirium

58
General management
  • Iatrogenesis
  • Drug therapy
  • Developing clinical expectations
  • Long-term-care resources
  • Nursing home care

59
(No Transcript)
60
?????
???
61
(No Transcript)
About PowerShow.com