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Geriatric Syndromes Essay

Geriatric Syndromes Essay

Geriatric syndrome refers to identification of certain clinical conditions in older persons that cannot be included in the categorization of diseases. Currently, geriatrics specialists are aware of six health problems, such as “delirium, falls, frailty, dizziness, syncope and urinary incontinence” (Inouye et al. 780). The selected three health problems listed under geriatric syndromes, namely falls, dizziness, and delirium, can be addressed by nursing staff through effective approaches.Geriatric Syndromes Essay


Falls can be defined as unplanned descent to the floor which leads to unintentional injuries because of inability to maintain the position of the body (Allain et al. 105). Nurses should observe an elderly individual for this health problem in order to prevent injuries. The ways that can be used to assist the patient in preventive illness related to falls include using chairs for moving, asking for help by phone, and using power wheelchair. Moreover, it is possible to use special footwear that will prevent the occurrence of falls through improved balancing of human body.Geriatric Syndromes Essay

Besides, delirium can be defined as “an acute decline in attention and global cognitive functioning” (Inouye et al. 780). Nurses should observe an elderly patient using new technologies, such as video cameras or video monitoring systems. The ways that can be useful in preventing the negative effects of this health problem are using medication, aromatherapy and pet therapy. In addition, there is an alternative of using special computer devices that will help the elderly to make serious decisions.

Finally, dizziness is a common health problem among the elderly. It can be defined as spinning, light-headedness or a loss of balance (Iwasaki & Yamasoba 38). Nurses should observe the elderly on a regular basis through TV control to prevent the negative consequences of this health problem using medication, mats or pillows, call bells or phones within reach. Furthermore, robots can be used to prevent the elderly from negative consequences of dizziness.Geriatric Syndromes Essay

Thus, it is necessary to conclude that three health problems listed under geriatric syndromes, including falls, dizziness and delirium, should be addressed by nurses in the proper way. These health problems have a significant impact on the patient’s quality of life, independence, and overall health status. The use of new technologies combined with medication and other methods can help to prevent the elderly from negative outcomes.

Physical aging is a part of normal biological process involving physiological degeneration of various organs, and requires no treatment. As people are living longer, the prevention of disability forms the basis of healthy aging. Geriatric syndromes refer to “multifactorial health conditions that occur when the accumulated effects of impairments in multiple systems render (an older) person vulnerable to situational changes”. A geriatric syndrome usually involves multiple factors and multiple organ systems, and reporting of unique features of common health problems in older people.These syndromes cross organ systems and discipline-based boundaries, along with their multifactorial nature. For example, an elderly patient having urinary tract infection (UTI) may present to the emergency room with delirium and altered cognitive and neural functions.1The criteria for defining a geriatric syndrome therefore, include: (1) age-related disorder; (2) with functional decline; (3) involving multiple systems; (4) with complex multifactorial etiology, (5) poor outcome; (6) but treatable. ABSTRACTGeriatric syndromes refer to “multifactorial health conditions that cross organ systems and discipline-based boundaries. Five major geriatric syndromes are: (i) Falls; (ii) Urinary incontinence (UI); (iii) Pressure ulcers; (iv) Delirium; (v) Functional decline.Geriatric Syndromes Essay Frailty is the common end product of these geriatric syndromes. The diagnostic workup of geriatric syndromes should consist of a search for both a possible single disease that may have precipitated the symptom(s), and of a multiple risk factor assessment. It includes assessment of several domains, including physical, mental, social, economic, functional and environmental, with the goal of guiding the selection of interventions to restore or preserve health of the aging individual. Correction of reversible precipitants and contributing factors is critical and lifestyle and behavioral modifications are beneficial. Besides this, nutritional assessment and correction and pharmacotherapy and nonpharmacological measures are of immense help. Patient and care giver education and qualtiy nursing care can not be over emphasized.Five major geriatric syndromes are:1. Falls2. Urinary incontinence (UI)3. Pressure ulcers4. Delirium5. Functional decline.The common risk factors of these giants of the geriatric syndromes include: Age Cognitive impairment Functional impairment Impaired mobility.2Frailty is the common end product of these geriatric syndromes. The main feature of frailty is the reduced ability to regain physiological homeostasis after a stressful and destabilizing event. The age-related decline of physiological reserve and function of multiple organ systems, in elderly, renders them inept to cope with the acute stresses. Frailty in turn, may further intensify the shared risk factors and the geriatric syndromes.3FALLSA fall is an unintentional event that results in the person coming to rest on the ground or another lower Dinesh Gupta, Gursimran Kaur, Akriti GuptaGeriatric Syndromes335CHAPTER”Do not go gentle into that good night, old age should burn and rave at close of day; Rage, rage against the dying of the light”–Dylan Thomas335.indd 1753 12/28/2015 1:35:17 PM
Section 301754SECTION 27Geriatricslevel.Geriatric Syndromes Essay Falls can be described in terms of three phases. Initiating events involve extrinsic factors such as environmental hazards; intrinsic factors such as unstable joints, muscle weakness, and unreliable postural reflexes; and physical activities in progress at the time of the fall. The second phase involves a failure of the systems for maintaining upright posture to detect and correct this displacement in time to avoid a fall. This is generally the factor intrinsic to the individual, such as loss of sensory function, impaired central processing, and muscle weakness. The third phase is an impact of the body on environmental surfaces, usually the floor or ground, which results in the transmission of forces to body tissue and organs. This is followed by phase of sequelae, which may be physical, psychological or social—all with disabling prospects. Falls are extremely common among older adults. Each year, about one out of three people older than age 65 years who is living in the community falls; this rate increases with advanced age and is higher among people who are living in institutional settings. Falls cause considerable mortality and morbidity. The risk factors for falls include:Intrinsic risk factors: Gait and balance impairment Peripheral neuropathy Vestibular dysfunction Muscle weakness Vision impairment Medical illness Advanced age Impaired activities of daily living (ADLs) Orthostasis Dementia Drugs.Extrinsic risk factors: Environmental hazards Poor footwear Restraints.Assessment for FallsHistory of previous falls, gait/balance impairment, use of psychoactive medication and decreased muscle strength are the most important predictors of falls.4 The assessment of fall patient includes, a detailed history of the circumstances of the falls, which can point to a specific etiology or narrow down the differential diagnosis. This includes sudden rise from a lying or sitting position (orthostatic hypotension), trip or slip (gait, balance or vision disturbance or an environmental hazard), drop attack (vertebrobasilar insufficiency), looking up or sideways (arterial or carotid sinus compression) and loss of consciousness (syncope or seizure). Geriatric Syndromes Essay History should also be taken for evaluation of risk factors including careful review of medication, functional and environmental assessments. Physical examination should include gait assessment, sensory assessment (including hearing and vision), measurement of orthostatic vital signs, and neurologic and musculoskeletal assessment, as well as depression and cognitive impairment screening. The examination should also include a review of footwear and gait aid appropriateness.Depending on the results of this risk assessment, appropriate multifactorial interventions may be undertaken for preventing ambulatory falls: Home assessment and modification for high-risk individuals Exercise programs that include strength, gait, and balance exercises, such as physiotherapy or Tai Chi Vitamin D supplementation in doses greater than 700 IU/d  Review medications, minimizing psychoactive medications and reducing the total number of medications Management of postural hypotension Expedite cataract surgery on the first affected eye Consider pacing in cardioinhibitory carotid sinus hypersensitivity and recurrent falls Management of foot problems and recommend use of antislip shoe devices for the outdoors  Patient and caregiver education, especially of the importance of specific environmental improvements.5 URINARY INCONTINENCEUrinary incontinence is an involuntary loss of urine that is objectively demonstrable and leads to a social or hygienic problem. UI is a troubling and common disorder among geriatric patients. Additionally, many older and especially frailer persons require caregivers, and UI can lead to caregiver stress and institutionalization of the frail elder. The urinary continence is maintained due to the integrity of the lower urinary tract, the nervous system, the visceral supporting mechanism (pelvic floor) and the urine production mechanism. Also, it requires perception and interpretation of the urge, and physical capacity to go to the toilet and to perform the activity. With aging the lower urinary tract (LUT) undergoes a series of morphological and functional changes, which alter these functions.Some of these alterations include, bladder overactivity and urgency, impaired bladder contractility and increased residual urine, and decreased functional bladder capacity. Prostatic hypertrophy—benign, or due to malignancy may cause UI and LUT symptoms. Estrogen deficiency in women causes increased incidence of atrophic vaginitis and related symptoms, along with increased incidence of recurrent UTIs, which further increase UI. Age-related changes in the actions of central neurotransmitters, their receptors, or the cellular events they stimulate may contribute to the development of UI in frail older persons.6 A practical approach to incontinence in elderly patient is based on its duration (acute or chronic).335.indd 1754 12/28/2015 1:35:17 PM
1755CHAPTER 335 Geriatric SyndromesAcute or transient incontinence refers to cases of short course incontinence (lasting less than four weeks), including those situations in which loss of continence is considered to be functional, without any associated structural disorder. The causes for these include:D Delirium Dementia DiabetesR Restricted mobility RetentionI Infection Inflammation Impaction of stoolP Pharmaceutical agents Psychological causes.Chronic or established incontinence: When the incontinence lasts longer than four weeks and is commonly associated with structural disorders, either in the urinary tract or outside of it (e.g. nervous system). Transient incontinence may eventually be established or chronic in some cases. This established incontinence might be further classified depending on the etiopathogenesis.  Urge incontinence presents as urgency, frequency and nocturia. It is associated with a strong urge to void. It is caused by an overactive detrusor muscle causing excessive involuntary bladder contraction, UI is associated with various neurological conditions including stroke, spinal cord lesions, dementias, and Parkinson’s disease.  Stress incontinence is associated with actions that increase intra-abdominal pressure such as coughing, sneezing, bending, lifting, or laughing. The cause is pelvic muscular weakness causing urethral hyper-mobility, multiparity, hypoestrogenism, obesity, and pelvic surgical procedures like prostatic resection. Overflow incontinence occurs when the bladder muscle is overdistended. May present with stress or urge symptoms. The cause is an underactive bladder muscle, or a bladder outlet or urethral obstruction leading to overdistension and overflow. There are two different mechanisms: bladder outlet obstruction (prostatic hyperplasia, urethral stenosis, fecal impaction) and bladder contractile impairment (spinal cord lesions, peripheral and/or autonomic neuropathy, detrusor myopathy, anticholinergic drugs). Functional incontinence occurs when a physical or psychological impairment impedes continence status despite a competent urinary system.7Mixed type of incontinence, including features of more than one aforementioned type, may also occur.Assessment for Urinary IncontinenceHistory should include UI onset, frequency, volume, timing, and associated factors or events.Geriatric Syndromes Essay Physical examination should include cognitive and functional assessments along with potential comorbid conditions associated with UI. Rectal examination is used to assess for masses, tone, and prostate nodules or firmness in men (not size). The neurologic evaluation should include evaluation of sacral cord integrity with perineal sensation. Vaginal mucosa should be evaluated for severe atrophy, and the pelvic examination should include evaluation for pelvic organ prolapse (cystocele, rectocele, uterine prolapse) with straining. Urine analysis is done to look for hematuria (and glycosuria in diabetics). Pyuria and/or bacteriuria likely represent asymptomatic bacteriuria—in women without dysuria, fever, or other signs of UTI, especially if UI is not acute. Ultrasound or catheterization is used to look for post-void retention, especially in frail elderly with recurrent UTIs and neurological concerns. A clinical stress test, by making a relaxed patient give a single vigorous cough may be helpful in documenting in patients with stress UI. Cystoscopy and urodynamic studies may be used when etiology is questionable and intervention may be required.7 TreatmentCorrection of reversible precipitants and contributing factors is critical. Lifestyle and behavioral modifications that are beneficial include avoiding extremes of fluid intake, especially in the evening for nocturia, minimizing caffeinated beverages, and alcohol; weight loss and smoking cessation. The two main behavioral therapies are bladder training and pelvic muscle exercises, both of which are effective for urge, mixed, and stress UI and are often used in combination.Pharmacologic treatment is largely limited to anti-muscarinic agents for urge UI, overactive bladder, and mixed UI. Of these, oxybutynin (immediate and extended release, and topical patch), tolterodine (immediate and extended release), solifenacin, darifenacin, and trospium have been used widely. Pessaries may benefit women whose stress or urge UI is exacerbated by bladder or uterine prolapse. Duloxetine is used for moderate to severe stress UI, especially in women. Alpha-blockers are beneficial in men with LUT symptoms, but have to be given cautiously due to hemodynamic effects. Desmopressin is avoided in elderly UI due to its propensity to precipitate hyponatremia. Catheterization may be required in the cases of chronic urinary retention or bladder impaired contractility, in which the patient keeps high post-void residual urine. Minimally invasive therapies available for those with urge UI refractory to antimuscarinics, include botulinum toxin injection into the bladder wall and sacral neuromodulation. Surgery may be beneficial in refractory cases, especially in women with stress incontinence.Geriatric Syndromes Essay

As in most parts of the world, the population of Russia is aging. Life expectancy in Russia has increased by 6 years over the past 10 years and was 71.9 years in 2016. In this period of time, population aged 60 years and older increased from 17.1% to 20.3%.1

In Moscow, the capital city of Russia and its biggest city with a population of 12 million (8% of the total Russian population), this situation is even more prominent. Life expectancy in the capital exceeds the all-Russian mean by more than 5 years (77.1 years in Moscow vs 71.9 years in the Russian Federation), and individuals aged 60 years or older comprised 21.5% of the population in 2015.2


Geriatric syndromes (GSs)3,4 are clinical conditions in older adults which do not fit into discrete disease categories.5 Their prevalence increases with age. Conditions such as delirium, pressure ulcers, falls, and incontinence are GSs that have been described in the literature for many years,5,6 but other conditions including functional and cognitive impairment, affective disorders, visual and hearing problems, self-neglect and elder abuse, malnutrition, eating and feeding problems, sleep problems, and even dizziness and syncope also have been included under the heading of GSs.7 GSs can have a significant effect on patients’ quality of life, and, in some cases, there are interventions that can improve the patient’s prognosis. For example, falls occur in one-third of the older population (65 years and older) each year and have a significant effect on increased hospitalization rates, overall costs, disability, and even increased mortality.8 Both single interventions (such as Tai Chi or physiotherapy) and combined interventions have been shown to effectively reduce fall rates.Geriatric Syndromes Essay

Despite their significant prevalence, GSs often remain undiagnosed,10,11 and the number of studies on the prevalence of GSs in Russia is very low.12–16 These isolated studies do not always provide full information as to the condition of older adults aged 65 years and older in Russia. For example, the study by Zakharov,12 which evaluated the rate of cognitive impairment, included a large study population from 33 Russian cities, but this study population was recruited from the patients who came to a neurology clinic. This may be the reason that 83.4% of the study participants complained of cognitive problems and 68.2% were diagnosed with cognitive impairment. Demin14 investigated mobility disorders, but only in the city of Arkhangelsk in northern Russia. In this study, patients who had a previous cerebrovascular accident (CVA), diabetes mellitus, Alzheimer’s disease, Parkinson’s disease, peripheral neuropathy, or vestibular disorders were excluded. It is also not clear how the participants were recruited and from where. Thus, it is difficult to draw conclusions, based on these studies, on the rate of GSs in the general population of older adults in Russia.Geriatric Syndromes Essay

The study by Gurina et al,16 the largest of its kind, was conducted in St Petersburg. It is the only study that provides a broad picture of the rates of GSs in one of the city’s 18 districts. In discussing the limitations of the study, the authors state that caution must be used in generalizing the results of the study to the overall population of St Petersburg because the study district’s population might be different from the populations of the city’s other districts. Furthermore, one should take into consideration that this study was conducted in 2009 and since then the sociodemographic characteristics of the Russian population have changed, including an increase in life expectancy.Geriatric Syndromes Essay

Over the course of recent years, the geriatric services in Russia have undergone a profound reorganization. In the process, geriatric teams have been trained, geriatric guidelines have been updated, and long-term planning is now underway for both the health care system and the social services. This planning process necessitates a renewed assessment of the condition of older adults, including the rates of GSs.

The aim of this study is to analyze the prevalence of GSs among community-dwelling older adults in Moscow, based on the questionnaire and the comprehensive geriatric assessment (CGA). Geriatric Syndromes Essay

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