The medical care of the elderly is known as Geriatric care. Our in house doctor has over 10 years of experience in the UK caring for nursing home patients. In Angsana, our residents are reviewed every fortnightly for pro-active care.
Why is this different from normal adult medicine?
Physiology of the elderly changes: eg kidney filtration reduces so drugs can become toxic at lower doses.
The elderly’ s body (metabolise) handles drugs differently, it is vital to review and prioritise medicine... eg. although aspirin prevents heart attacks and strokes but depending on the person’s risk, it can cause a more serious problem such as a stomach bleeding. A careful balance between harm and benefit must be made.
Multiple chronic diseases affect the elderly, leading to multiple medications which can interact adversely.
Medical care, in this case, is about prioritising function and lifestyle. ‘The best technology and medicine that money can buy’ is not always the best option for the elderly.
Diseases in the elderly present differently from adults: pneumonia can often start with only a slight increase in confusion, no chest symptoms or fever.
Certain diseases are commoner in the elderly. Eg. With changes in bowel habits and anaemia, those above 60 years old, even with no other risk factor to colon cancer should have this rule out as incidence in this age group is highest.
Treatment targets for the elderly are also different from adults, as medication induce side effects are commoner. Eg. for diabetic elderly, HbA1c 7-8 is reasonable, the adult target of 6.5% can cause low sugar (hypoglycaemia) which may not be detected. Repeated hypoglycaemia causes a dementia-like syndrome. Those on insulin must be monitored closely.
Goals of treatment: any treatment is aimed mainly to maximise function and independence for the patient, and to improve quality of life.
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