Geriatric syndromes

1. Geriatric syndromes D. Greyling

2. Geriatric syndromes • 1. Frailty • 2. Delirium • 3. Falls • 4. Sleep disorders • 5.Dizziness • 6. Syncope • 7. Pressure sores • 8. Incontinence • 9. Elder mistreatment • 10.Dementia • 11. Parkinson's

3. Frailty • A clinical syndrome of increased vulnerability and decreased ability to maintain homeostasis that is age related and centrally characterized by decline in functional reserves across multiple physiological systems

4. Frailty • Suspect if : • 1. Unintentional weight loss of more than 4,5 kg in the past year • 2. Feeling exhausted • 3.Weakness ( Poor grip strength ) • 4. Slow walking speed • 5. Low physical activity

5. Frailty • Associated with a high risk of falls, dependency disability, institutionalization, hospitalization, risk of iatrogenesis and side effects of medical interventions and death. • Frailty is part of a single or multiple clinical syndromes

6. Delirium • CAM( Confusion Assessment Method): • 1. Acute onset and fluctuating course • 2.Inattention • 3.Disorganized thinking • 4.Altered level of consciousness: From lethargic, stupor to coma.

7. Clinical • History: Precipitating factors • Ask and determine: • 1. Level of consciousness • 2.Orientation • 3.Memory • 4.Attention • 5.Perceptual problems : delusions • 6. Pschycomotor behavior • 7.Sleep –wake cycle

8. Precipitating factors • D – Drugs • I – Infections • M- Metabolic ( electolytes,glucose,acid base) • T- Toxins • O – Oxygen deficiency • P – Psychiatric ( Bereavement, Emotional stress)

9. Falls • 35 - 40 % of persons over 65 fall in a given year and increases with age. • Risk factors for falls: • 1. Muscle weakness • 2. Gait Deficit • 3.Balance deficit • 4.Use of assistive device • 5.Visual deficit • 6.Impaired Daily Activity of living • 7.Cognitive impairment • 8.Age more than 80

10. Assessment • 1. History • 2.Medications • 3.Vision • 4.Gait and Balance : Standing on one leg for 5 sec • Bending • 5.Lower limb joints • 6.Neurological • 7.Cardiovascular: Orthostatic hypotension • Pulse rate and rhythm

11. Sleep disorders • 50 % of elderly persons complain of sleep difficulty • 1. Sleep disordered breathing • Hypopneas or apneas during sleep • 2. Restless legs syndrome : Cluster of repeated leg jerks every 20 – 40 seconds during sleep • 3. Circadian rhythm sleep disorders: Sleep wake cycle • - sleepy early in the evening and waking up early • 4. Insomnia : low quantity and or quality of sleep • 5. Rapid eye movement sleep behavior disorders : • A dissociated state during which complex motoric behaviors occur

12. Dizziness • A broad term to describe various abnormal sensations arising from perceptions of the bodies relationship to space and of unsteadiness. • Older than 65 years 10 % in crease for every 5 years

13. Causes • 1. Vestibular causes • 2.Central nervous system causes( TIA / Stroke) • 3.Psychiatric disorders( Depression/ Anxiety) • 4.Cervical spine( Vertebral artery occlusion) • 5.Systemic causes( DM, HT, CAD, Low Hb, Hypothyroidism,CCF) • 6.Orthostatic hypotension • 7. Post prandial hypotension • 8 Drugs

14. Syncope • Rapid onset of transient loss of consciousness and spontaneous complete recovery • Caused by blunted baroreceptor sensitivity

15. Evaluation • Three questions: • 1. ? Loss of consciousness attributable to the syncope(Trauma, Epilepsy , Vascular, Conversion) • 2. ? Heart disease • 3. Are there important clinical features that suggest the etiology ?

16. Syncope examination • Orthostatic hypotension • Use of devices for mobilty • Vision • 5 item recall • Gait • Balance • Neuromuscular: Quadriceps strenght • Rigidity,Tremor, Bradikinesai

17. Pressure ulcers • Areas of local tissue trauma developing where soft tissue are compressed between bony prominences and any external surface for long periods of time. • Most common : Sacrum, Ischial tuberosities , throchanters and heels

18. Stage 1 • Skin intact with redness over a bony prominence

19. Stage 2 : Loss of the dermis with a shallow ulcer

20. Stage 3: Full tissue loss

21. Stage 4: Full thickness with exposed tendon/muscle/bone

22. Incontinence • Any involuntary leakage of urine. • “DRIIIPP” • D – Delirium • R- Restricted mobility • I – Infection ( UTI) ,Inflammation ( Atrophic vaginitis), Impaction of feaces • P- Pharmaceuticals

23. Types of incontinence • Stress: Loss of urine with increase of intra – abdominal pressure • Urge : Inability to delay voiding after sensation of bladder fullness is perceived • Mixed: Combination of above • Overflow: Due to mechanical forces on an over distended bladder( Urinary retention/ Abnormal bladder and sphincter function)

24. Elderly mistreatment • The willful infliction of pain, injury or causing mental anguish to an elder person. • Very common – Physical abuse • Neglect • Financial or material abuse • Psychological and verbal abuse • Violation of a trusting relationship

25. Risk factors for elderly abuse • Disability • Cognitive impairment • Abusers likely to abuse alcohol/drugs • Abuser dependency • Living arrangement • External stress • Social isolation • History of violence of the abuser

26. Dementia

27. Dementia • Progressive cognitive and behavioral deficits accompanied by structural abnormalities of the brain. • DSM IV criteria: • 1. Memory impairment • 2. One of the following disturbances: • - Language disturbance • -Impaired ability to carry out motoric activities • - Failure to identify objects • - Disturbance in executive functioning • 3.Significant impairment in social and occupational functioning • 4.Do not occur during the course of delirium

28. Mild cognitive impairment • Memory complaint • Memory impairment for age and education • Preserved general cognitive function • Intact social and occupational function

29. Parkinson’s Disease • Any combination of six independent motoric features: • 1.Rest tremor • 2.Bradykinesia • 3.Rigidity • 4.Loss of postural reflexes • 5.Flexed posture • 6.Freezing phenomenon( Feet glued to the ground)