Geriatric syndromes
D. Greyling
Geriatric syndromes
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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
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
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
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
Delirium
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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.
Clinical
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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
Precipitating factors
• D – Drugs
• I – Infections
• M- Metabolic ( electolytes,glucose,acid base)
• T- Toxins
• O – Oxygen deficiency
• P – Psychiatric ( Bereavement, Emotional
stress)
Falls
• 35 - 40 % of persons over 65 fall in a given year and
increases with age.
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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
Assessment
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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
Sleep disorders
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50 % of elderly persons complain of sleep difficulty
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1. Sleep disordered breathing
Hypopneas or apneas during sleep
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2. Restless legs syndrome : Cluster of repeated leg jerks every 20 – 40 seconds
during sleep
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3. Circadian rhythm sleep disorders: Sleep wake cycle
- sleepy early in the evening and waking up early
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4. Insomnia : low quantity and or quality of sleep
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5. Rapid eye movement sleep behavior disorders :
A dissociated state during which complex motoric behaviors occur
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
Causes
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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
Syncope
• Rapid onset of transient loss of consciousness
and spontaneous complete recovery
• Caused by blunted baroreceptor sensitivity
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 ?
Syncope examination
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Orthostatic hypotension
Use of devices for mobilty
Vision
5 item recall
Gait
Balance
Neuromuscular: Quadriceps strenght
Rigidity,Tremor, Bradikinesai
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
Stage 1
• Skin intact with redness over a bony
prominence
Stage 2 : Loss of the dermis with a
shallow ulcer
Stage 3: Full tissue loss
Stage 4: Full thickness with exposed
tendon/muscle/bone
Incontinence
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Any involuntary leakage of urine.
“DRIIIPP”
D – Delirium
R- Restricted mobility
I – Infection ( UTI) ,Inflammation ( Atrophic
vaginitis), Impaction of feaces
• P- Pharmaceuticals
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)
Elderly mistreatment
• The willful infliction of pain, injury or causing
mental anguish to an elder person.
• Very common – Physical abuse
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Neglect
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Financial or material abuse
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Psychological and verbal abuse
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Violation of a trusting
relationship
Risk factors for elderly abuse
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Disability
Cognitive impairment
Abusers likely to abuse alcohol/drugs
Abuser dependency
Living arrangement
External stress
Social isolation
History of violence of the abuser
Dementia
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
Mild cognitive impairment
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Memory complaint
Memory impairment for age and education
Preserved general cognitive function
Intact social and occupational function
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)