Geriatrics is defined as "the branch of medicine concerned with the physiological and pathological aspects of the aged, including the clinical problems of senescence and senility."
- 1 Healthy aging
- 2 Common clinical issues
- 2.1 Accidental falls
- 2.2 Caregiver burden
- 2.3 Continuity and coordination of care
- 2.4 Dementia
- 2.5 Depression
- 2.6 End-of-life care
- 2.7 Frailty
- 2.8 Hearing loss
- 2.9 Hospital care
- 2.10 Malnutrition
- 2.11 Medicine use
- 2.12 Urinary incontinence
- 2.13 Vision care
- 3 Interventions
- 4 Prognosis
- 5 References
Maintenance of leisure activities that involve cognitive or physical-activity is associated with reduced risk of dementia.
Common clinical issues
Common and important clinical issues for elders have been proposed. These issues are advance care planning, health maintenance, medication management, difficulty walking/falls, chronic pain, urinary incontinence, depression, hearing loss, visual impairment, malnutrition or weight loss, dementia, and caregiver burden. Protocols for these issues are available.
The ACOVE project has created indicators for the quality of care for 22 impactful issues in geriatrics. These topics include depression, diabetes mellitus type 2, heart failure, hypertension, coronary heart disease, osteoarthritis, osteoporosis, pain management, pneumonia, pressure ulcers, preventive care, stroke and atrial fibrillation. In addition, the list includes the following (with the inclusion of caregiver burden) that are more specific to geriatric care:
Continuity and coordination of care
Frailty can be defined as having three or more of the criteria of Fried:
- Walking speed diminished
- Exhaustion during three days of the prior week
- Grip strength diminished
- Weight loss of 1 kilogram or more in the last three months
- Physical activity in lowest quintile
Reduced walking speed may be the most important marker.
Restraints in the hospital or nursing home
The effect of educating health care providers is not clear. One randomized controlled trial found that an "educational program for nurses combined with consultation with a nurse specialist" did not improve care. However, another controlled trial of a more intensive education program combined with consultation did reduce restraints. However, this study did not account for clustering effect and should be considered a controlled before and after study which is less rigorous. A third trial which used the "A.G.E. dementia care program" (Activities, Guidelines for psychotropic medications, and Educational rounds) showed a reduction in restraints.
A normal hospital diet plus 400-mL oral nutritional supplements daily for 6 week improved quality of life among hospitalized elders.
Adverse drug reaction
Geriatric consultation for inpatients may reduce medications by a variable amount. One study reported significant benefit. Another study reported small benefit, but effect on clinical outcomes is not certain.
Exercise can delay decline, even in institutionalized elders.
Clinical prediction rules, including the Vulnerable Elders-13 Survey (VES-13), are available for predicting longevity based on current health. These have been reviewed(http://www.eprognosis.org/). 
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