Geriatric Syndromes Require Special Care

As we age, we become more likely to develop several co-occurring health problems that feed each other. These are called ‘geriatric syndromes’

By Deborah Jeanne Sergeant

Each individual’s health differs; however, “geriatric syndromes” describe a group of health concerns experienced by many older adults that often have multiple causes and involve different bodily parts and systems.

These can include continence, sleep issues, cognitive issues, falls, osteoporosis and weight loss/frailty.

For an older adult, incontinence could contribute to sleep issues and falls. Or weight loss and frailty from poor eating is often linked to osteoporosis, which would worsen the effect of a fall and lead to further frailty after a hip fracture.

Physician Sharon Brangman serves as chief of the department of geriatrics at Upstate University Hospital. She said that a general practitioner may not connect the syndromes as causal or even relational, but view them as separate conditions.

“Geriatric syndromes aren’t associated with any one system and often overlap,” Brangman said. “You have a very complex issue you have to evaluate. It needs a comprehensive approach.”

She offered falls as an example. High blood pressure medication that’s too strong may lower seniors’ blood pressure to the point where they’re at fall risk. Older people don’t metabolize medication the same way as younger people do. Poor vision may affect their ability to stay on their feet. Taking a water pill may make them use the bathroom at night, which raises fall risk since they must navigate in low lighting at a time when most people feel at least a little disoriented. Most falls by elderly people occur in bedrooms and bathrooms. People who sit a lot may lose strength in their legs and experience more balance issues.

Brangman said that geriatricians tend to look at the bigger picture, such as how medication affects seniors, how not eating and drinking properly may affect balance — do memory issues affect their compliance with taking medication or using a walker as needed?

Treating all of these facets as separate issues may reduce the overall effectiveness of the care provided to patients. It can also contribute to secondary issues as more medications bring more side effects.

Geriatricians receive training to recognize the relationships among various geriatric syndromes and the issues involved. Not every senior can see a geriatrician because the US lacks geriatricians and not all general practitioners or internists possess training for geriatrics.

“Geriatricians are the No. 1 specialty for head hunters and recruiters in medicine,” Brangman said.

She also wants more general providers and non-geriatric specialists to receive more training in geriatric issues to handle basic issues, “so geriatricians can take care of more complex cases,” Brangman said.

With more providers looking for measurable symptoms like falls and osteoporosis, non-geriatricians can help patients prevent more complicated medical issues and, as needed, refer patients to geriatricians for more complex cases, where conservative measures seem less effective.

Physician Az Tahir practices holistic integrative medicine at High Point Wellness in Syracuse. He believes that family members and caregivers should understand the concept of geriatric syndromes as well. For example, many different factors can influence an older person to fall. Tahir listed cataracts, muscle weakness and slower reaction time. He added that the outcome of falls can also relate to many other health concerns, such as broken bones because of osteoporosis, bedsores and further frailty.

“Falls are major cause of fractures and mortality and morbidity in old people,” Tahir said. “It’s important to prevent falls.”

This can involve many aspects of care, too, such as reducing environmental hazards, balance improvement programs, eye exams and bone density testing.

While some of these issues may be part of the normal aging process, geriatric syndromes aren’t, according to Natina Reed, bachelor’s trained nurse specializing in gerontology at St. Joseph Health.

When not treated properly, a seemingly small and unrelated issue can cause what Reed calls a “waterfall of issues,” since it affects so many things.

“A urinary tract infection or pneumonia can cause a total lifestyle change due to decreased mobility, changes in cognition and frailty,” said Reed. “After suffering a fall, one can experience sleep issues, incontinence, trying to get to the restroom safely and changes in nutrition which can increase how frail they become. After a fall a person can also experience chronic pain and changes in mobility which often changes their daily activities.”

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