Geriatric Medicine

Inocencio Alejandro
Aging vs. Disease vs. Disuse
A 61 y/o female teacher comes for general medical checkup.
Which of the following is due to normal aging?
A. Predominant parabasal cells on pap smear
B. Large Q-waves on leads II, III, aVF
C. Hard irregular right breast mass
D. Exaggerated thoracic kyphosis with loss in height
Comprehensive Geriatric Assessment

A form of evaluation, usually by interdisciplinary team

Designed to promote improved function

Includes medical, sensory, functional, psychological,

and social dimensions

CGA Key Components

Target patients likely to benefit

Evaluate and recommend

Implement recommendations

Monitor outcomes
CGA Benefits in Clinical Trials
Decreased:

Nursing home admission rates

Medication use

Annual medical care costs

Mortality rates
Increased:

Diagnostic accuracy

Independent function

Patient satisfaction
CGA Benefits: Long-Term

Fewer permanent nursing home stays

Improved survival without decreased quality of life

Increased independent function

Geriatric Screening in Primary Care

Vision
o Do you have difficulty driving or watching
television or reading or doing any of your
daily activities because of your eyesight?
o If yes, then: Test each eye with Snellen
chart while patient wears corrective lenses
(if applicable).

Hearing
o Use audioscope set at 40dB. Test hearing
using 1000 and 2000 Hz.
o Positive screen: Inability to hear 1000 or
2000 Hz in both ears; or inability to hear
frequencies in either ear.
o Sensitivity = 0.94
Specificity = 0.72

Leg mobility
o Time the patient after asking:
Rise from the chair. Walk 20 feet briskly,
turn, walk back to the chair and sit down.
o Positive screen: Unable to complete task in
15 seconds

Urinary incontinence
o Ask: In the past year, have you ever lost
your urine and gotten wet?
o If yes, then ask: Have you lost urine on at
least 6 separate days?
o Positive screen: Yes to both questions.
Nutrition, weight loss
o Ask: Have you lost 10 lbs. over the past 6
months without trying to do so?
o Weigh the patient.
o Positive screen: Yes to the question or
weight <100 lb.
Memory
o Three-item recall
o Positive screen: Unable to remember all
three items after 1 minute.
Physical disability
o Are you able to

do strenuous activities?

do heavy work around the house

?

go shopping for groceries or

clothes?

get to places out of walking

distance?

bathe?

dress
Depression
o Ask: Do you often feel sad or depressed?
o Positive screen: Yes to the question

Geriatric Syndromes

Dementia, delirium, depression

Urinary incontinence

Hearing and visual impairment

Malnutrition and feeding priblems

Polypharmacy

Falls

Osteoporosis and hip fractures

Dizziness

Syncope

Pressure ulcers

Sleep problems
Characteristics of a Geriatric Program

Geriatric fellowship programs

o Internal medicine, family medicine,
neurology-psychiatry

Geriatric block rotation for IM/FM residents

Selective courses for M-1 and M-3 ambulatory-care

clerkships

rainwater@mymelody.com || 2nd semester, AY 2011-2012