Geriatric Syndromes

[Guest guest]

 

 

 

 

 

 

 

 

 

 

Common Geriatric Syndromes Can Often Be Resolved

ORIGINAL URL: http://healthlink.mcw.edu/article/1031002904.htmlIt is not unusual for an assessment at the Froedtert & the Medical College of Wisconsin Senior Health Program to begin with the phrase "Mom or Dad is just not doing well," says Paul Hankwitz, MD, CMD, FACP, Medical College of Wisconsin Associate Professor of Medicine (Geriatrics). Dr. Hankwitz, who serves as Medical Director of the Program, explains that in frail elderly patients, doctors often find symptoms resulting from a combination of multiple disease processes and risk factors, sometimes referred to as geriatric syndromes. "We have to delve into what is it that leads you to think Mom or Dad is not doing well. A lot of it is identifying that there is a problem and asking the right questions to narrow down the specific causes, then treating whatever we can," Dr. Hankwitz says. "Many times we hear things like, 'Well, Mom is falling.' 'Dad's pain is not under control.' 'Mom has been forgetting things.'" With geriatric syndromes, the primary task of the clinician is to distinguish between issues caused by the normal effects of aging and those that might have secondary causes that can be reversed. Common geriatric issues include:Dementia and depression. Depression affects about 15% of older people, but it is not always identified, Dr. Hankwitz notes. Caregivers or relatives can easily confuse the symptoms of depression with dementia, or attribute the symptoms to poor or declining health. All of Dr. Hankwitz's patients receive mental status and depression screening exams, which assess cognitive function and symptoms of depression. "People who are depressed can appear to have cognitive problems or dementia, but once the depression is under control, they feel better and their memory can improve," he says. "When these patients are treated, they usually feel so much better. Their pain may improve, they become more functional, they get out and socialize, and their overall quality of life improves." Dr. Hankwitz notes that although Alzheimer's disease is the most common cause of dementia in older patients, there are many things that can cause mental confusion. Some are correctible. "Medication side effects can create a pseudo-dementia, as can a deficiency of vitamin B12 or foliate," he says. "Impaired mental status can be associated with many health problems, including Parkinson's disease and thyroid disorders." Falls. In Falls and Hip Fractures Among Older Adults, the CDC reports that falls are leading cause of injury deaths among people 65 years of age and older. According to Dr. Hankwitz, many different situations can lead to falling. "Falls might be caused by a patient having significant arthritis, a neurological disorder, muscle weakness, light-headedness due to blood pressure changes, or as a side effect from medications, which unfortunately is all too common. Once a patient falls, it can create significant fear. Patients will then do whatever they can to prevent it from happening again," says Dr. Hankwitz. Dr. Hankwitz refers many of his patients to therapy for gait or walking assessments. Physical therapists play an important role in assessing whether patients need some type of assistive device to prevent future falls, he says; a cane or walker might be prescribed on a temporary or permanent basis. "They do this in conjunction with therapy to make sure the device can be used in a safe manner. And many patients, when they start therapy and begin to exercise on a regular basis, become stronger and stop falling," he says. "When you rest, you rust." Urinary incontinence. Urinary incontinence affects up to 35% of the elderly and can be caused by a number of conditions, such as involuntary bladder contractions or irritation from a urinary tract infection. "Sometimes it occurs simply because a person has arthritis and can't mobilize to the bathroom in time to avoid an accident," says Dr. Hankwitz. Frequently, these problems can be resolved with medications or training. Maximizing FunctionGeriatric syndromes can be quite complex, and they require specialized areas of knowledge to understand, evaluate, and treat. "I absolutely love being in a geriatric practice and working with patients with complex issues," says Dr. Hankwitz. "A thorough evaluation can identify issues with multiple causes that are potentially treatable.My role is to ask a lot of questions to get down to the core reasons for identified problems. Usually it's not one problem, but a combination, many of which can be treated or resolved," he says. "Our mission is to enhance and maximize older patients' functions from a mental, cognitive, emotional, and physical perspective," says Dr. Hankwitz. "To me, maximizing function in those areas equates to improved quality of life." Lori P. CreedHealthLink Contributing Writer Dr. Hankwitz practices at the Senior Health Program at Community Memorial Medical Commons at North Hills, Menomonee Falls, Wisconsin.

 

13 August 2008Last updated 13 August 2008

 

 

Please Note: MCW HealthLink is provided for educational purposes. The information is not intended as a substitute for medical care, or for the advice of a physician. Please consult your doctor to determine how the information here pertains to you.

 

 

Copyright 2003 Medical College of Wisconsin