Geriatric Syndromes and Management

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Geriatric Syndromes and Management

• Prof. Timothy Kwok
• Medicine Therapeutics
• CUHK

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Need for Geriatric Approach

• Increasing number of older patients
• Complexity
• Common problems unaddressed
• Dementia, malnutrition, incontinence, falls,
  immobility
• Ageism
• patient, family, professional
• Limitation of disease orientated approach

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Modern Medicine
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Characteristics of older patients

• Physiological decline
• Atypical presentation
• Late presentation
• Multiple pathology
• Drug therapy
• polypharmacy
• side effects
• non-compliance

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Rich and Poor are equally affected, But Outcomes
can be very different
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Management of Older Patients

• Holistic
• Multiple
• Family
• Multidisciplinary
• Inter sectoral
• Continuity

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Geriatric Giants (syndromes)

• Immobility
• Instability
• Intellectual decline
• Incontinence
• Isolation
• Iatrogenesis

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Clinical Approach to Older Patients

• Diagnosis
• Multiple
• Problem based
• Geriatric giants
• Identify the last straw

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History taking

• Communication problem
• Deafness, confusion, speech defect, dialect
• Multiple or lack of complaints
• Social history
• accommodation, function, network, finance
• Drug history

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Physical examination

• Vision
• Hearing
• Mental state
• Nutritional status
• Feet
• Joints, Back
• Rectum

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Management of Older Patients

• Holistic
• Multiple
• Family
• Multidisciplinary
• Inter sectoral
• Continuity

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• Intellectual decline
• Immobility
• Instability
• Incontinence
• Isolation
• Iatrogenesis

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Result of multidisciplinary interventions