Geriatrics

Geriatrics (from Greek γέρ | ων " old " and ἰατρεία " medicine "), even -aged or elderly medicine or dentistry - is the study of the diseases of aging people. This mainly concerns problems from the fields of internal medicine, orthopedics, neurology and psychiatry ( geriatric psychiatry ).

As gerontology or age (s) RESEARCH on the other hand refers to the science that deals with aging processes in all its aspects, including psychological, social, economic, political and social. The word was first used by geriatrics Ignatz Leo Nascher, a Vienna-born doctor, who in the U.S. and later worked as early as 1914 his textbook Geriatrics: The diseases of old age and Their treatment published.

Geriatrics should not be confused with the palliative care that is not for healing but for relief of symptoms. The geriatrics comes in, the old ones, but mainly to help the very old people to a better life. Here, the geriatrician is mainly required if multiple illnesses ( multimorbidity ) are present that overwhelm the individual physician of the respective medical subjects due to many links, but the potential must be present to achieve an improvement. Geriatrics is thus to be understood as an interdisciplinary discipline ( interdisciplinary ).

Doctors can (for example Specialists in internal medicine, general medicine, psychiatry, neurology ) in Germany to acquire the additional designation " geriatrics " in that they are one and a half years working at a further education authorized hospital after specialist training. In other European countries there are higher specializations through to specialist.

Definition

The attempts at a definition of the term " geriatrics " in German-speaking countries include various approaches:

A detailed conceptualization What is geriatric medicine in 1991 carried out by an expert committee of the German Society of Gerontology and Geriatrics and the German Society of Geriatrics, the " 17 dimensions of geriatric medicine " covers. These dimensions medical actions for elderly patients fall into three groups:

The " 17 dimensions of geriatric medicine" include: knowledge modification in general trained doctors, multi-morbidity, risk identification, Senile dementia, capacity to consent and the protection of rights, psychosomatic relationships, hierarchy, rehabilitation, irreversibility ( irreversibility of the process of life ), near death, associated polarity, ensuring the Wide supply, environment relatedness, members work Konsiliarwirkungen, interdisciplinarity, structural- organizational upheaval.

A European definition of " Geriatric Medicine" and " Geriatric patients " became " Geriatric Medicine" formulated by the section of the European Union Geriatric Medicine Society on 3 May 2008 in Malta and consented in Copenhagen on 6 September 2008:

" Geriatric medicine is a medical specialty discipline, with the physical, mental, functional and social conditions of acute, chronic, rehabilitative, preventive treatment and care - even at the end of life - is involved. The group of patients is associated with a high degree of frailty and active multiple diseases that require a holistic approach to treatment.

The disorder in old age can present themselves differently; are often very difficult to diagnose; the response delay occurs to the treatment and there is a regular need for social support.

Geriatric medicine therefore exceeds the organ medically oriented medicine and provides additional treatment options in a multidisciplinary team environment ( milieu; Setting). The main objective is to optimize the functional status of an elderly person as well as to improve quality of life and autonomy.

Geriatric medicine is not specifically age- defined, but it handles the typical morbidity of elderly patients. Most patients are over 65 years of age. Those health problems that can be best addressed through geriatrics as a specialty discipline, are much more common in the age group over 80 - year-old. "

Age-associated diseases

• Arteriosclerosis heart attack
• Stroke
• Arterial occlusive disease

Not every disease that has an old man, is a disease of aging such as loss of teeth. It is mainly characterized by the typical beginning and the continuous increase of their occurrence.

Age Syndrome

This refers to the geriatrics of /:

• Intelligence degradation as a result of the various types of dementia
• Brain disorders with increasing restriction of the senses (sight, hearing, touch, balance, taste, thirst )
• Instability, eg as a result of a stroke or as a result of multiple forms of fraud with the increasing risk of falls
• Incontinence bladder or intestine
• The gradual loss / degradation of tissue fluid ( dehydration )

As a syndrome is defined as the simultaneous co-occurrence of symptoms or characteristics. So age syndrome is called the accumulation of several individual symptoms, although they are in this combination typical of the age group, their cause but in different diseases (simultaneously) can have. It is typical of this insidious course, on the one hand contributes to habituation to the state, on the other hand, different coping strategies ( coping ) produces for subproblems. So it does not lead to early treatment, but a small aggravation can trigger the full decompensation in a final stage. This age syndromes are also known as the "Big I 's " in geriatrics in the English-speaking world by Brocklehurst.

Other age-typical terms of geriatrics: multimorbidity, symptom poverty.

The Geriatric Assessment

The Geriatric Assessment should gradually lead the clarification of unclear symptoms by the doctor, lest interactions of the damage of individual organ systems are overlooked when a single -damaging factor is known. The method is structured to carry out and secured in his goodness. There are various assessment sets that can be used in various treatment environments (at home, in the day hospital, in a clinic, nursing home, among others ).

Definition of assessment (derived from "to ASSESS ": weigh ): Comprehensive geriatric assessment is defined as a multidisciplinary evaluation by the uncovered the multiple problems of older people, described, and - if possible - be explained; the resources and strengths of a person cataloged, the need for offers of help weigh and prepare a coordinated care plan for targeted intervention of the multidimensional problems of a person.

The following recommendations / steps were developed:

• Screening: Using a standardized questionnaire research is undertaken into sacrificing performance or discomfort in the area of vision and hearing, the mobility of the arms and legs, urinary or fecal incontinence, nutrition, cognitive performance, emotional being, social support and various activities. Are problem areas exist, a comprehensive basic assessment should follow.
• Basic Assessment: The actual basis assessment consists of determining the Barthel Index, memory test after Folstein (Mini -Mental State Examination ), the depression test after Yesavage (also GDS), a social questionnaire, the mobility test by Tinetti, Timed up and go test, clock drawing test and the measurement of hand strength.
• Implementation: The time required for the implementation of screening is approximately 5-10 minutes, is for the base -assessment to expect a good half hour. The depression questionnaire can be filled out by the patient himself, the other surveys and the implementation of performance tasks can be after proper instruction to perform by non - medical personnel. The decisive factors are the therapeutic consequences arising from the results of the assessment base.

The geriatric early rehabilitation complex treatment

Settlement -oriented - - treatment procedure (OPS - 8 550.X ) with the name " geriatric early rehabilitation complex treatment " (GRP) have been named in connection with the introduction of the DRG system (DRG ) system in the hospital sector, one is. The procedure makes use of essential elements of geriatric assessment - is by no means to be regarded as congruent with this, but only a specific statement in the DRG system. This complex treatment is indicated for patients who are not yet ready for another rehabilitation facility (for example, geriatric rehabilitation) are suitable, as are other acute medical conditions are present (for example, pneumonia, renal failure, lack of cooperation ).

The geriatric early rehabilitation complex treatment is most frequently performed in patients with:

• Heart failure ( for example by decompensation )
• State after fractures
• Condition after stroke (ischemia and cerebral hemorrhage )
• Chronic obstructive pulmonary disease (COPD)

A GRP is of course not suitable for all patients, but particularly immobile patients often benefit from treatment as prophylaxis regarding contractures or pneumonia.

The CSF treatment by a team (usually a doctor, physiotherapists and occupational therapists, specially trained nurses, clinical psychologist, speech therapist and social services ) performed as necessary and accurate rules.

Geriatrics in everyday life

A future increasingly pressing problem is the supply of geriatric patients not only in hospitals and nursing homes, but also outside this grown institutions. Individual organized solution approaches can be found so far only been in private areas, eg in the form of the establishment of intergenerational residential complexes. Particularly in view of the growing number of single-person households and childless couples without family involvement there will have to supply new solutions to age -down then the people in the coming decades.

One of the Ministry been triggered for Labour, Integration and Social Affairs of the State of North Rhine -Westphalia pilot project started in 2010 in East Westphalia -Lippe. At the planned three-year model of "regional supply management geriatrics " will be shown in the Lippe district, such as new management structures contribute to an efficient healthcare of the future. Here are existing supply structures from the perspective of the health needs of older people systematically collected on site and the weaknesses are addressed. objectives are

• Ensure a comprehensive range of geriatric services and development of region-specific deals with the participation of the health insurance
• Development of models of cooperation between the service providers such as nursing services, general practitioners, hospitals, physiotherapists and Others
• Coordination of treatment in the form of integrated care concepts, eg establishment of a case management to improve the transitions between acute care, rehabilitation and outpatient and inpatient care.

Geriatrics in veterinary medicine

Also in veterinary medicine geriatrics has due to increased life expectancy of pets gained in importance and has become a science that includes tailored to the particular species of treatment as well as preventive measures.