Contents
Caring for Our Elders: The Role of Geriatrics in Modern Medicine
The goal of the medical discipline of geriatrics is to provide older people with up-to-date, patient-centered care. Geriatricians are specially trained to focus on the unique issues and concerns that older people suffer. Older adults may be affected by illnesses, diseases, and treatments differently than younger adults, and those over 65 may have overlapping health issues requiring different medications. Care plans tailored to the unique health issues of elder people are created by geriatricians, who also prevent and treat illnesses in this population.
Defining the Golden Years: What is the Geriatrics Age?
The physiology of our bodies varies with age. We respond to drugs differently, and we frequently develop long-term conditions or disabilities that compromise our independence.
Although there isn’t a set age, most patients who see a geriatrician for primary care are 75 years of age or older. Since, patients with chronic illnesses, reduced physical function, memory or cognitive impairment, anxiety or depression, weight loss, balance issues, frequent falls, and urine incontinence will go for treatment.
Some common problems faced by older adults.
- Dementia,
- Delirium,
- Falls,
- Polypharmacy,
- Coordination,
- Confusion
- Agitation,
- Coronary heart disease
Patients should consult a geriatrician if their illness results in significant disability and weakness; if the number of prescription medications they need to take has increased and it is unclear which are appropriate.

From Diagnosis to Recovery: Crucial Assessments in Geriatric Surgery
The Growing Importance of Geriatrics Surgery in Modern Medicine
Geriatric surgery is increasingly vital as the global population ages, with more older people requiring surgical interventions. Advances in medical technology and surgical techniques have made it safer for older people to undergo complex procedures. Special considerations, such as tailored anesthesia and preoperative assessments, ensure that surgeries are conducted with minimal risks. Geriatricians specializing in geriatrics are trained to handle the unique challenges faced by older patients, including managing multiple comorbidities and ensuring optimal postoperative care.
The demand for geriatric surgery is expected to rise, highlighting the need for healthcare systems to adapt. Meanwhile, this includes enhancing surgical facilities, investing in specialized training for healthcare professionals, and promoting research focused on improving surgical outcomes for the older people. Thus, lives of older adults will be improved by this surgery, and they can enhance their independence and well-being through effective medical interventions.
Comprehensive Geriatric Assessment (CGA)
Geriatric surgery will include the interdisciplinary diagnostic approach known as CGA (Comprehensive Geriatric Assessment) assesses a person’s functional, psychological, social, and medical capacities as well as their potential status and several geriatric syndromes. A less complex way to capture the essence of the CGA is to perform whole-body health examinations. Finding patient health deficiencies that might not be evaluated during a routine History and Physical (H&P) can be advantageous when performing a CGA. Furthermore, the CGA employs a multidisciplinary strategy in which medical professionals collaborate to organize patient care and communicate with one another. The outcome is that the patient has a less difficult and perplexing surgery experience.
Preoperative evaluation and detection of any reversible medical issues are essential to avoiding unfavorable postoperative results. By identifying issues early on, CGA can help prevent unfavorable surgical outcomes by making necessary modifications before surgery.
The National Surgical Quality Improvement Program (NAQIP) of the American College of Surgeons (ACS) and the American Geriatrics Society (AGS) have released guidelines that specify the fundamental domains to be evaluated in the CGA. Among them are
- Cognitive function,
- Depression screening,
- Nutritional assessment,
- Functional mobility and falls,
- Frailty,
- Polypharmacy,
- Cardiac and Pulmonary assessments,
- Comorbidities,
- Urinary incontinence,
- Dental needs,
- Visual and hearing impairment and
- Patient’s health goals.
A meta-analysis of 29 trials, identified through a review of the literature, demonstrated that hospitalized older individuals receiving treatment from a CGA team had a higher chance of surviving and remaining in their homes 12 months following surgery and hospitalization.
According to the conclusions of a meta-analysis executed by Kim et al. Patients who completed the CGA demonstrated benefits on
- short-term mortality,
- reduced complications,
- decreased readmissions,
- increased cognitive function, and
- improved physical performance following surgery.
Anesthesia Considerations in Older Adults for Geriatric Surgery
Administering anesthesia to older adults requires special attention due to age-related changes in physiology and the presence of multiple medical conditions. Anesthesiologists carefully assess each patient to choose the safest and most effective anesthesia plan. Basically, this includes adjusting doses, monitoring vital signs closely, and using techniques that minimize stress on the heart and lungs. Thus, proper anesthesia management helps ensure that older adults undergo surgery safely and recover well.
Steps of Preoperative Geriatrics Assessment
Steps to be followed in Geriatric evaluations
- Mini-Cognitive Assessment (MCA): The MCA is a quick and simple screening tool to evaluate cognitive function in older people. Thus, it helps identify any memory or thinking problems that might impact their ability to consent to surgery and follow postoperative care instructions.
- Cardiac and Pulmonary Assessments: Evaluating heart and lung function is essential to ensure patients can tolerate anesthesia and surgery. Therefore, this step involves tests like ECGs, chest X-rays, and pulmonary function tests to identify and manage any risks.
- Nutritional Evaluation: A thorough nutritional assessment identifies any deficiencies or malnutrition, which can impact healing and recovery. So, this step involves evaluating dietary habits, weight changes, and nutrient intake to create a tailored nutrition plan.
Other evaluations process in geriatrics
- Patient Storytime: Taking time to understand the patient’s personal and medical history, preferences, and concerns ensures a holistic approach to their care. Thus, this step fosters a trusting relationship and uncovers important factors that may influence surgical outcomes.
- Depression Screening: Assessing for depression is crucial as it can affect surgical outcomes and recovery. Thus, use of screening tools like the Geriatric Depression Scale (GDS) help identify symptoms of depression, ensuring timely intervention and support.
- Functional Mobility Evaluation: Assessing a patient’s ability to move and perform daily activities helps predict their postoperative mobility and rehabilitation needs. Thus, tools like the Timed Up and Go (TUG) test provide valuable insights into their functional status.
- Frailty Screening: Identifying frailty helps gauge a patient’s vulnerability to adverse surgical outcomes. Then this screening involves evaluating factors like weight loss, exhaustion, and low physical activity, guiding tailored care plans to enhance recovery.
- Polypharmacy Review: Reviewing all medications the patient is taking helps prevent adverse drug interactions and side effects. This step ensures that medication regimens are optimized for safety and effectiveness during the perioperative period.
- Substance Abuse Screening: Identifying any substance abuse issues, including alcohol and prescription drugs, is crucial for managing anesthesia and postoperative care. Hence, this step ensures that appropriate support and interventions are in place.
- Caregiver Needs Assessment: Understanding the support system and caregiver needs helps plan for postoperative care and recovery. Likewise, this step involves evaluating the availability and capability of caregivers to assist the patient after surgery.
- Patient Health Goals Discussion: Discussing and understanding the patient’s health goals and expectations ensures that surgical plans align with their desires. So, this step fosters patient-centered care and helps set realistic outcomes and recovery plans.
Enhanced Recovery After Surgery (ERAS)
ERAS helps to improve recovery for older adults after surgery. These protocols involve a series of evidence-based steps before, during, and after surgery to reduce complications and speed up recovery. Key elements include optimizing nutrition, managing pain with minimal opioids, and encouraging early mobility. By following ERAS guidelines, healthcare providers can help older patients return to their normal activities faster and with fewer complications.
The Nutritional Needs of Older Adults: Insights into Geriatrics Nutrition
Sufficient Caloric Intake
- Older adults often experience a decrease in metabolism and physical activity, leading to a reduced caloric requirement. Consuming enough calories to maintain energy levels and support daily activities while avoiding excessive intake to prevent weight gain and associated health issues is crucial.
Adequate protein Consumption
- Protein helps to maintain muscle mass, which declines with age. Older adults should include high-quality protein sources such as lean meats, fish, eggs, dairy products, legumes, and nuts in their diet to support muscle repair and overall health.
Inclusion of Fiber-Rich Foods
- A diet rich in fiber aids in maintaining digestive health and preventing constipation, a common issue among older adults. Incorporating whole grains, fruits, vegetables, and legumes can help ensure an adequate fiber intake, promoting regular bowel movements and overall gut health.
Ensuring Proper Hydration
- Hydration is vital for all bodily functions and older adults are at a higher risk of dehydration due to a decreased sense of thirst. Thus, drinking adequate amounts of water throughout the day and consuming hydrating foods like fruits and vegetables can help maintain fluid balance.
Importance of Micronutrients
- Vitamins and minerals help in improving overall health. Thus, key nutrients such as calcium, vitamin D, vitamin B12, and magnesium are particularly important for bone health, energy production, and cognitive function. Older adults should focus on nutrient-dense foods to meet their micronutrient needs.
Source
- https://www.mountsinai.org/care/geriatrics/what-is
- https://www.intechopen.com/chapters/87069
- https://synapse.koreamed.org/pdf/10.3346/jkms.2020.35.e34
- https://www.intechopen.com/chapters/87069
- https://www.icliniq.com/articles/ageing/geriatric-nutrition#:~:text=Geriatric%20nutrition%20is%20a%20specialized,can%20impact%20their%20nutritional%20status.
Written by Snegkha S