Training material for JNH, 2018

1. GERICATRIC CARE
Dr Tan Jit Seng
Senior Home Care Physician
Lotus Eldercare Health Services
Lotus Eldercare Private Limited

2. Definition of “Geriatrics”
• γέρων geron meaning "old man”
• ιατρός iatros meaning "healer”

3. Scope of Geriatrics
In 1965, Bernard Isaacs coined the term “Geriatric Giants.”
At that time, he named the geriatric giants as
1. Immobility,
2. Instability,
3. Incontinence, and
4. Impaired intellect/memory.

4. Ageing – Multifactorial, Aggregation of Causes
• Different people “age”
differently
• Normal physiological decline of
organ systems
• Less reserve for external insults
• Increase susceptibility for
diseases and chronic medical
conditions

5. What is Physical Ageing?
• Skin- elasticity , thickness, SubQ fats / Hair –
volume, colour
• Muscles - Sarcopenia
• Bones – Osteoporosis risk
• Endocrine System – remains functional
• Liver Function – remains functional
• Renal Function - Declines
• Respiratory Function – elastic recoil, chest wall
stiffness
• Urology – Urge / Stress incontinence, LUTS
• Cardiac Function – Heart rate decrease, stroke
volume decrease
• Cognition / Cerebral Function - 25% > 85 decline
• Senses
• Vision – illumination and clarity
• Hearing – volume and pitch
• Taste
• Touch – pressure / temperature / pain / vibration /
proprioception
• Smell
• Gastrointestinal Function
• Oral cavity – tooth loss / gums recede, enamel
discolouration
• Gastric – B12 deficiency anemia
• Sexual
• Mental – Dementia / Depression / Anxiety
• https://www.msdmanuals.com/en-
sg/professional/geriatrics/approach-to-the-
geriatric-patient/physical-changes-with-
aging#v1130872

6. Cognitive Ageing
• Complex task and information
• Comprehending new concepts
• Exercise –
• Dexterity
• Balance / Flexibility
• Muscular Strength
• Cardiovascular endurance

7. Changes in mind, body and senses
We tend to:
• Mistake ageing with disease
• Mistake disease with ageing
• Ignored the increase risk of adverse drug effects on weak link system
stressed by illness
• Ignored the fact of multiply underlying disease

8. Break – 10 mins

9. Case Scenario
• 78/Malay/Male
• DM, Hypt, renal failure on dialysis,
bilateral AKA
• Problems / Issues / Concerns?
• 88/Chinese/Female
• Stoke, Hypt, dysphagia on spoon
feeding, uncommunicative
• Problems / Issues / Concerns?

10. Case Scenario Discussions
• Medical concerns
• Chronic disease management
• Symptoms control
• Pain
• Itch
• SOB
• Lethargy
• Prevention of complication
• Immunization
• Functional concerns
• Nutritional concerns
• Financial concerns
• Meaning of Life???

11. Summary & Take Home Pointers
•Decrease in Functional
Reserve
•Gentle nursing !!!
•Sensory and cognitive
decline to note
•Atypical presentation –
weakest link theory
• Females overall >5 years than
males

12. Questions?
www.lotuseldercare.com.sg