Geriatric Syndromes


A syndrome is a collection or cluster of symptoms that often happen together and may or have a common source or sources (“multifactorial”), or at least common risk factors. A syndrome is not a disease, but it is something the medical world has to address and which can reduce the quality of life for patients. Geriatric syndromes are those often experienced by the elderly, but not exclusively by elderly.

Characteristic conditions of old people like cognitive impairment, gait abnormalities, and sensory impairment (declines in vision and hearing) are geriatric syndromes. One challenge for the elderly is how to manage being ill but not sick.

Gait abnormality is a deviation from normal walking (gait). Watching a patient walk is the most important part of the neurological examination. Normal gait requires that many systems, including strength, sensation and coordination, function in an integrated fashion.

Others include

  • Sleep problems
  • Bladder control syndromes - which affects an estimated 15 million Americans
  • Unintentional weight loss / malnutrition
  • Sarcopenia
  • Frailty syndrome
  • Falls
  • Depression (if you count this as a syndrome)
  • Self-neglect (this is related to apathy)
  • Orthostatic hypotension (blood running out of your head when you stand)
  • Social and behavioral syndromes: polypharmacy and social isolation.

Many of the most common conditions cared for by geriatricians, including delirium, falls, frailty, dizziness, and syncope (loss of consciousness caused by low blood pressure), are classified as geriatric syndromes. Nevertheless, the concept of the geriatric syndrome remains poorly defined.

Vision impairment can often be attributed to specific disease: presbyopia, glaucoma, retinopathy, cataracts, and age-related macular degeneration. Presbycusis is the disease name for most hearing loss, and it affects over 30 percent of people past age 65 (and over 40 percent of people past age 75).

While heterogeneous, geriatric syndromes share many common features. They are highly prevalent in older adults, especially the frail elderly. Their impact on quality of life and disability is substantial. Multiple underlying factors, often involving several organ systems, contribute to and define geriatric syndromes. A comprehensive geriatric assessment is a method doctors employ to characterize a person's aging and health.

Failure to thrive has become a common problem in old age. Timely diagnosis and individualized treatment approach can improve the condition and alleviate the symptoms. A combination of family support, a good caregiver, treatment compliance, and the aspiration to live life to the fullest can help the elderly person to battle the disorder.

Health conditions - whether diseases or otherwise - often create some sort of disability. The disability level can be minor or it can make the person dependent on a technology or caregiver. If a person has more than one condition, the odds of functional dependence increases. According to one study, the percentage of people with one impairment who are functionally dependent is 7 percent, but that percentage increases to 14 percent for people with two impairments, 28 percent for people with three impairments, and 60 percent with four impairments.

Treating Geriatric Syndromes

Most geriatric syndromes can be handled by a general practitioner or family doctor. Geriatricians are useful for the very old in some cases.

Important geriatric syndromes

Bedsores

Pressure ulcers or decubitus ulcers happen when a person doesn’t move much. They happen often to people who are bedridden or in wheelchairs. The skin where the person’s weight rests on the underlying chair or bed can become damaged over time. It’s easy to avoid bedsores with simple movement or shift in position, but even those can be difficult for many people. One thing nurses who takes care of the disabled do is shift bodies to cut down on the number and severity of bedsores.

Incontinence

Unintentional release of urine (urinary incontinence) and feces (fecal incontinence) can be embarrassing for the patient and anyone around him or her and degrade quality of life. If cleaned quickly incontinence doesn’t do lasting harm, but if the waste is allowed to remain on the patient’s body and clothing, diseases can fester.

Falls

Old people fall a lot because the sense of balance declines with age. Kids fall a lot, too, but the added problem old people have is that they are less able to recover from injuries. Bones become more brittle in old age, whether the person officially has osteoporosis or not. Frequent falls are a risk factor for death.

Disability in the Elderly

Disability just means some limit in carrying out day-to-day functional activities. There is a wide range of severity from mild disability to total and from temporary to permanent. 10 to 15 percent of US adults have some disability. In young adults, disability is caused by accidents or obvious diseases. In the elderly there is less often a precipitating event. It is a consequence of increasing severity of chronic diseases. This is why age-related disability is called a “syndrome”. Disability in the elderly is often transient or episodic. A person may have a set back that makes them dependent but after a period of recovery may regain independence and ability to take care of themselves.

If you look at the leading causes of death, most are diseases people can live with if they are not too severe. These conditions cause disability in people who live with them. Heart disease, cancer, diabetes, lower respiratory diseases, and dementia contribute to many cases of elderly disability as do conditions that are not usually classified as a cause of death but which degrade quality of life: osteoporosis, obesity, presbycusis, presbyopia, and depression.

Delirium

Delirium is not the same as dementia, although sometimes people with dementia experience delirium. Delirium is short-term, a temporary “losing your mind” with mental confusion and emotional stress. Delirious people often have reduced short-term memory capacity and move more slowly (hyperactive delirium) or in some cases more quickly than normal (hypoactive delirium).

Delirium can happen at any age but it is more common in the eldery.

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Polypharmacy

Polypharmacy just refers to when people take a lot of different drugs. There is no firm definition, but it is known that taking many different medicines is associated with an increase in the severity of side effects, the appearance of new side effects, and possible diminishment in efficacy of some drugs.

Related to polypharmacy is multimorbidity, which means a person has more than one chronic health condition. More diseases usually means more medicines. In addition to the risk of drug-drug interactions, polypharmacy in a person with multiple conditions increases the chances of a drug making another disease (not the one it is intended to treat) worse. Pharmacodynamics - how a medicine affects a person given different biochemistries and genetic profiles - is difficult enough for experts to work out when it is just one medicine and one condition. Factoring in different medicines and different conditions makes it all the more complex.

The bodies of older people are less efficient at processing drugs through the body. Renal and hepatic function can be reduced. So any medicine is more fraught with risk in the elderly than in younger people.

There is no firm definition of polypharmacy, but the American Family Physician website mentions the use of five drugs as a benchmark. These can be prescription or over-the-counter drugs. People see multiple doctors so end up with many prescriptions, sometimes working at cross purposes to each other. Which is why occasional assessment of a patient's overall drug regimen is recommended. The American Geriatrics Society has a webpage explaining the Beers Criteria.

Compliance is defined as the degree to which a patient correctly follows medical advice. Although the terms are related, compliance suggests that the patient is passively following the physician’s orders, while adherence acknowledges that the patient is part of the decision-making process, making this the preferred term. Another frequently encountered word is “persistence,” defined as the duration of time over which a patient continues to fill the prescription.

Sarcopenia

Muscle makes up 30 to 40 percent of the mass of an adult man and 20 to 30 percent of the mass of an adult woman. Ir turns over fast - muscle is always being created and broken down - and it responds to external factors by increasing or diminishing in mass. In normal aging, a loss of 0.5–1.0 percent muscle mass per year occurs. When people get cachexia, the loss can be 1 percent per day. Muscle wasting is different from sarcopenia. Muscle wasting causes rapid loss of mucle tissue. Sarcopenia is slower.

The European Working Group on Sarcopenia in Older People (EWGSOP) defines sarcopenia as "a syndrome characterised by progressive and generalised loss of skeletal muscle mass and strength, with a risk of adverse outcomes such as physical disability, poor quality of life and high mortality."

Many people get sarcopenia, although it is rarely formally diagnosed. There is a push to get doctors to recognize this syndrome.

Heart Diseases