The Beers Criteria for Potentially Inappropriate Medication Use in Older Adults , commonly called the Beers List , are guidelines published by the American Geriatrics Society (AGS) for healthcare professionals to help improve the safety of prescribing medications for adults 65 years and older in all except palliative settings. They emphasize deprescribing medications that are unnecessary , which helps to reduce the problems of polypharmacy , drug interactions , and adverse drug reactions , thereby improving the risk–benefit ratio of medication regimens in at-risk people.
85-530: The criteria are used in geriatrics clinical care to monitor and improve the quality of care. They are also used in training, research, and healthcare policy to assist in developing performance measures and document outcomes. These criteria include lists of medications in which the potential risks may be greater than the potential benefits for people 65 and older. By considering this information, practitioners may be able to reduce harmful side effects caused by such medications. The Beers Criteria are intended to serve as
170-1287: A combination of physiologic, pathologic, psychologic and socioeconomic factors, it can be difficult to identify effective interventions. Physiologic factors include reduced smell and taste, and a decreased metabolic rate affecting nutritional food intake. Unintentional weight loss can result from pathologic factors, including a wide range of chronic diseases that affect cognitive function, directly impact digestion (e.g. poor dentition, gastrointestinal cancers , gastroesophageal reflux disease) or may be managed with dietary restrictions (e.g. congestive heart failure, diabetes mellitus, hypertension ). Psychologic factors include conditions including depression, anorexia, and grief. Functional abilities, independence and quality of life issues are of great concern to geriatricians and their patients. Elderly people generally want to live independently as long as possible, which requires them to be able to engage in self-care and other activities of daily living . A geriatrician may be able to provide information about elder care options, and refers people to home care services, skilled nursing facilities , assisted living facilities , and hospice as appropriate. Frail elderly people may choose to decline some kinds of medical care, because
255-737: A commercial partnership to authorize the release of a software application applying its official criteria. In 2011, the American Geriatrics Society (AGS) convened an eleven-member multidisciplinary panel of experts in geriatric medicine, nursing, and pharmacotherapy to develop the 2012 edition of the American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults . The 2012 AGS Beers Criteria differ from previous editions in several ways. In addition to using
340-529: A community, including cooking, housekeeping, managing one's finances and medications. Routine monitoring of ADL and IADL is an important functional assessment used by clinicians to determine the extent of support and care to provide to elderly adults and their caregivers. It serves as a qualitative measurement of function over time and predicts the need for alternative living arrangements or models of care, including senior housing apartments, skilled nursing facilities, palliative, hospice or home-based care. Falls are
425-455: A condition marked by serious mental and physical debilitation. Therefore, rather than lumping together all people who have been defined as old, some gerontologists have recognized the diversity of old age by defining sub-groups. One study distinguishes the young-old (60 to 69), the middle-old (70 to 79), and the very old (80+). Another study's sub-grouping is young-old (65 to 74), middle-old (75 to 84), and oldest-old (85+). A third sub-grouping
510-906: A consensus was reached on minimum competencies (learning outcomes) that graduating medical students needed to assure competent care by new interns to older patients. Twenty-six (26) Minimum Geriatric Competencies in eight content domains were endorsed by the American Geriatrics Society (AGS), the American Medical Association (AMA), and the Association of Directors of Geriatric Academic Programs (ADGAP). The domains are: cognitive and behavioral disorders; medication management; self-care capacity; falls, balance, gait disorders; atypical presentation of disease; palliative care; hospital care for elders, and health care planning and promotion. Each content domain specifies three or more observable, measurable competencies. Changes in physiology with aging may alter
595-416: A continuity of self-concept. In their interviews, Johnson and Barer found that 24% of the 85+ had no face-to-face family relationships; many have outlived their families. Second, that contrary to popular notions, the interviews revealed that the reduced activity and socializing of the over-85s does not harm their well-being; they "welcome increased detachment". Third, rather than a continuity of self-concept, as
680-503: A fifth dimension: developmental. Chronological age may differ considerably from a person's functional age. The distinguishing marks of old age normally occur in all five senses at different times and at different rates for different people. In addition to chronological age, people can be considered old because of the other dimensions of old age. For example, people may be considered old when they become grandparents or when they begin to do less or different work in retirement. Senior citizen
765-494: A guide for clinicians and not as a substitute for professional judgment in prescribing decisions. The criteria may be used in conjunction with other information to guide clinicians about safe prescribing in older adults.. The criteria are frequently used internationally although they were only intended for use in the United States. Some countries have adapted the criteria to their own context. Others countries have observed that
850-443: A medication schedule was reported by a striking one-third of the participants. Further development of methods that might possibly help monitor and regulate dosage administration and scheduling is an area that deserves attention. Another important area is the potential for improper administration and use of potentially inappropriate medications, and the possibility of errors that could result in dangerous drug interactions. Polypharmacy
935-418: A modified Delphi process for building consensus, the expert panel followed the evidence-based approach that AGS has used since it developed its first practice guideline on persistent pain in 1998. The Institute of Medicine (IOM) in its 2011 report, Clinical Practice Guidelines We Can Trust , recommended that all guideline developers complete a systematic review of the evidence. Following the recommendation of
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#17328763151321020-502: A physician who specializes in the care of older people. Rather, this decision is guided by individual patient need and the caregiving structures available to them. This care may benefit those who are managing multiple chronic conditions or experiencing significant age-related complications that threaten quality of daily life. Geriatric care may be indicated if caregiving responsibilities become increasingly stressful or medically complex for family and caregivers to manage independently. There
1105-403: A pioneering study of Life Beyond 85 Years by interviews over a six-year period. In talking with 85-year-olds and older, they found some popular conceptions about old age to be erroneous. Such erroneous conceptions include (1) people in old age have at least one family member for support, (2) old age well-being requires social activity, and (3) "successful adaptation" to age-related changes demands
1190-407: A pleasant time; children are grown, work is over, and there is time to pursue other interests. Many old people are also willing to get involved in community and activist organizations to promote their well-being. In contrast, perceptions of old age by writers 80+ years old tend to be negative. Georges Minois [ Wikidata ] writes that the first man known to talk about his old age
1275-643: A special " senior discount card " or other proof of age needs to be produced to show entitlement. In the United States , the standard retirement age is currently 66 (gradually increasing to 67). The AARP allows couples in which one spouse has reached the age of 50 to join, regardless of the age of the other spouse. In Canada , the Old Age Security (OAS) pension is available at 65 (the Conservative government of Stephen Harper had planned to gradually increase
1360-465: A vis Old". Blind Spot: Hidden Biases of Good People , a book about the test, reports that 80% of Americans have an "automatic preference for the young over old" and that attitude is true worldwide. The young are "consistent in their negative attitude" toward the old. Ageism documents that Americans generally have "little tolerance for older persons and very few reservations about harboring negative attitudes" about them. Despite its prevalence, ageism
1445-704: Is a common euphemism for an old person used in American English , and sometimes in British English . It implies that the person being referred to is retired. This in turn usually implies that the person is over the retirement age , which varies according to country. Synonyms include old age pensioner or pensioner in British English, and retiree and senior in American English. Some dictionaries describe widespread use of "senior citizen" for people over
1530-448: Is a distinction between geriatrics and gerontology . Gerontology is the multidisciplinary study of the aging process, defined as the decline in organ function over time in the absence of injury, illness, environmental risks or behavioral risk factors. However, geriatrics is sometimes called medical gerontology . Geriatric providers receive specialized training in caring for elderly patients and promoting healthy aging. The care provided
1615-477: Is a medical specialty focused on providing care for the unique health needs of the elderly . The term geriatrics originates from the Greek γέρων geron meaning "old man", and ιατρός iatros meaning "healer". It aims to promote health by preventing , diagnosing and treating disease in older adults . There is no defined age at which patients may be under the care of a geriatrician , or geriatric physician ,
1700-644: Is associated with an acquired difficulty in performing basic everyday tasks resulting in an increased dependence of other individuals and/or medical devices. These tasks are sub-divided into basic activities of daily living (ADL) and instrumental activities of daily living (IADL) and are commonly used as an indicator of a person's functional status. Activities of daily living (ADL) are fundamental skills needed to care for oneself, including feeding, personal hygiene, toileting, transferring and ambulating. Instrumental activities of daily living (IADL) describe more complex skills needed to allow oneself to live independently in
1785-650: Is bewildered: They refuse to follow her advice, they are obsessed with the past, they avoid risk, and they live at a "glacial pace". In her The Denial of Aging , Dr. Muriel R. Gillick, a baby boomer , accuses her contemporaries of believing that by proper exercise and diet they can avoid the scourges of old age and proceed from middle age to death. Studies find that many people in the 65–84 range can postpone morbidity by practicing healthy lifestyles. However, at about age 85, most people experience similar morbidity. Even with healthy lifestyles, most 85+ people will undergo extended "frailty and disability". Early old age can be
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#17328763151321870-458: Is common for elderly adults to be managing multiple medical conditions, or, multi-morbidity. Age-associated changes in physiology drive a compounded increase in susceptibility to illness, disease-associated morbidity, and death. Furthermore, common diseases may present atypically in elderly patients, adding further diagnostic and therapeutical complexity in patient care. Geriatrics is highly interdisciplinary consisting of specialty providers from
1955-544: Is context-sensitive. The United Nations, for example, considers old age to be 60 years or older. In contrast, a 2001 joint report by the U.S. National Institute on Aging and the World Health Organization [WHO] Regional Office for Africa set the beginning of old age in Sub-Saharan Africa at 50. This lower threshold stems primarily from a different way of thinking about old age in developing nations. Unlike in
2040-709: Is forgetful and cannot recall yesterday. The bone suffers old age. Good is become evil. All taste is gone. What old age does to men is evil in every respect. Minois comments that the scribe's "cry shows that nothing has changed in the drama of decrepitude between the age of the Pharaoh and the atomic age" and "expresses all the anguish of old people in the past and the present". Lillian Rubin , active in her 80s as an author, sociologist, and psychotherapist, opens her book 60 on Up: The Truth about Aging in America with "getting old sucks. It always has, it always will." Dr. Rubin contrasts
2125-464: Is happening to them, whether this is due to long-term dementia or to a short-term, correctable problem, such as delirium from a fever. Geriatricians must respect the patients' privacy while seeing that they receive appropriate and necessary services. More than most specialties, they must consider whether the patient has the legal responsibility and competence to understand the facts and make decisions. They must support informed consent and resist
2210-448: Is informed by these age-related changes. Geriatric syndromes is a term used to describe a group of clinical conditions that are highly prevalent in elderly people. These syndromes are not caused by specific pathology or disease, rather, are a manifestation of multifactorial conditions affecting several organ systems. Common conditions include frailty, functional decline, falls, loss in continence and malnutrition, amongst others. Frailty
2295-440: Is marked by a decline in physiological reserve, increased vulnerability to physiological and emotional stressors, and loss of function. This may present as progressive and unintentional weight loss, fatigue, muscular weakness and decreased mobility. It is associated with increased injuries, hospitalization and adverse clinical outcomes. Functional disability can arise from a decline in physical function and/or cognitive function. It
2380-402: Is often a predictive factor (Cannon et al., 2006). Research done on home/community health care found that "nearly 1 of 3 medical regimens contain a potential medication error" (Choi et al., 2006). Elderly persons sometimes cannot make decisions for themselves. They may have previously prepared a power of attorney and advance directives to provide guidance if they are unable to understand what
2465-507: Is often preferred over "decrepitude, because death means deliverance". "The problem of the ambiguity of old age has ... been with us since the stage of primitive society ; it was both the source of wisdom and of infirmity, experience and decrepitude, of prestige and suffering." In the Classical period of Greek and Roman cultures, old age was denigrated as a time of "decline and decrepitude". "Beauty and strength" were esteemed and old age
2550-414: Is one largely based on shared-decision making and is driven by patient goals and preferences, which can vary from preserving function, improving quality of life, or prolonging years of life. A guiding mnemonic commonly used by geriatricians in the United States and Canada is the 5 M's of Geriatrics which describes mind, mobility, multicomplexity, medications and matters most to elicit patient values. It
2635-402: Is seldom the subject of public discourse. Simone de Beauvoir wrote that "there is one form of experience that belongs only to those that are old – that of old age itself". Nevertheless, simulations of old age attempt to help younger people gain some understanding. Texas A&M University offers a plan for an "Aging Simulation" workshop. The workshop is adapted from Sensitizing People to
Beers criteria - Misplaced Pages Continue
2720-463: Is the range of ages for people nearing and surpassing life expectancy . People of old age are also referred to as: old people , elderly , elders , senior citizens , seniors or older adults . Old age is not a definite biological stage: the chronological age denoted as "old age" varies culturally and historically. Some disciplines and domains focus on the aging and the aged, such as the organic processes of aging ( senescence ), medical studies of
2805-452: Is usually associated with an age at which pensions or medical benefits for the elderly become available. In commercial contexts, where it may serve as a marketing device to attract customers, the age is often significantly lower. In commerce, some businesses offer customers of a certain age a " senior discount ". The age at which these discounts are available varies from 55, 60, 62 or 65 upwards, and other criteria may also apply. Sometimes
2890-701: Is young-old (65 to 74), old (74 to 84), and old-old (85+). Describing sub-groups in the 65+ population enables a more accurate portrayal of significant life changes. Two British scholars, Paul Higgs and Chris Gilleard, have added a "fourth age" sub-group. In British English, the "third age" is "the period in life of active retirement, following middle age". Higgs and Gilleard describe the fourth age as "an arena of inactive, unhealthy, unproductive, and ultimately unsuccessful ageing". Key Concepts in Social Gerontology lists four dimensions: chronological, biological, psychological, and social. Wattis and Curran add
2975-461: The Byzantine Empire studied geriatrics, with doctors like Aëtius of Amida evidently specializing in the field. Alexander of Tralles viewed the process of aging as a natural and inevitable form of marasmus , caused by the loss of moisture in body tissue. The works of Aëtius describe the mental and physical symptoms of aging. Theophilus Protospatharius and Joannes Actuarius also discussed
3060-483: The Canon discussed the diet suitable for old people , and dedicated several sections to elderly patients who become constipated . The Arab physician Algizar ( c. 898 –980) wrote a book on the medicine and health of the elderly. He also wrote a book on sleep disorders and another one on forgetfulness and how to strengthen memory , and a treatise on causes of mortality . Another Arab physician in
3145-549: The United Nations proposed a human-rights convention to protect old people. Definitions of old age include official definitions, sub-group definitions, and four dimensions as follows. Most developed Western countries set the retirement age around the age of 65; this is also generally considered to mark the transition from middle to old age. Reaching this age is commonly a requirement to become eligible for senior social programs. Old age cannot be universally defined because it
3230-662: The "real old age" with the "rosy pictures" painted by middle-age writers. Writing at the age of 87, Mary C. Morrison describes the "heroism" required by old age: to live through the disintegration of one's own body or that of someone you love. Morrison concludes, "old age is not for the fainthearted". In the book Life Beyond 85 Years , the 150 interviewees had to cope with physical and mental debilitation and with losses of loved ones. One interviewee described living in old age as "pure hell". Research has shown that in high-income countries, on average, one in four people over 60 and one in three over 75 feels lonely. Johnson and Barer did
3315-517: The 9th century, Ishaq ibn Hunayn (died 910), the son of Nestorian Christian scholar Hunayn Ibn Ishaq , wrote a Treatise on Drugs for Forgetfulness . George Day published the Diseases of Advanced Life in 1849, one of the first publications on the subject of geriatric medicine. The first modern geriatric hospital was founded in Belgrade, Serbia, in 1881 by doctor Laza Lazarević . The term geriatrics
3400-788: The Department of Geriatric Medicine, with rotations in Internal medicine, medical subspecialties etc. but in certain institutions, are limited to 2-year training in Internal medicine and subspecialities followed by one year of exclusive training in Geriatric Medicine. In July 2007, the Association of American Medical Colleges (AAMC) and the John A. Hartford Foundation hosted a National Consensus Conference on Competencies in Geriatric Education where
3485-577: The IOM, AGS added a public comment period that occurred in parallel to its standard invited external peer review process . In a significant departure from previous versions of the criteria, each recommendation is rated for quality of both the evidence supporting the panel's recommendations and the strength of their recommendations. In another departure from the 2003 criteria, the 2012 AGS Beers Criteria identify and group medications that may be inappropriate for older adults into three different categories instead of
Beers criteria - Misplaced Pages Continue
3570-667: The UK has been advanced by the implementation of the National Service Frameworks for Older People, which outlines key areas for attention. In the United States , geriatricians are primary-care physicians ( D.O . or M.D. ) who are board-certified in either family medicine or internal medicine and who have also acquired the additional training necessary to obtain the Certificate of Added Qualifications (CAQ) in geriatric medicine. Geriatricians have developed an expanded expertise in
3655-542: The UK is also one with a rich multidisciplinary history. It values all the professions, not just medicine, for their contributions in optimizing the well-being and independence of older people. Another innovator of British geriatrics is Bernard Isaacs, who described the "giants" of geriatrics mentioned above: immobility and instability, incontinence , and impaired intellect . Isaacs asserted that, if examined closely enough, all common problems with older people relate to one or more of these giants. The care of older people in
3740-472: The United Kingdom, most geriatricians are hospital physicians, whereas others focus on community geriatrics in particular. Although originally a distinct clinical specialty, it has been integrated as a specialization of general medicine since the late 1970s. Most geriatricians are, therefore, accredited for both. Unlike in the United States, geriatric medicine is a major specialty in the United Kingdom and are
3825-758: The United States, being healthy, physically, and socially active are signs of a good old age. On the other hand, Africans focus more on food and material security and a helpful family when describing old age well-being. Additionally, Koreans are more anxious about aging and more scared of old people than Americans are. Research on age-related attitudes consistently finds that negative attitudes exceed positive attitudes toward old people because of their looks and behavior. In his study Aging and Old Age , Posner discovers "resentment and disdain of older people" in American society. Harvard University's implicit-association test measures implicit "attitudes and beliefs" about "Young vis
3910-449: The absorption, the effectiveness and the side effect profile of many drugs. These changes may occur in oral protective reflexes (dryness of the mouth caused by diminished salivary glands), in the gastrointestinal system (such as with delayed emptying of solids and liquids possibly restricting speed of absorption), and in the distribution of drugs with changes in body fat and muscle and drug elimination. Psychological considerations include
3995-461: The age of 65. When defined in a legal context, senior citizen is often used for legal or policy-related reasons in determining who is eligible for certain benefits available to the age group. It is used in general usage instead of traditional terms such as "old person", "old-age pensioner", or "elderly" as a courtesy and to signify continuing relevance of and respect for this population group as " citizens " of society, of senior "rank". The term
4080-659: The age of eligibility to 67, starting in the years 2023–2029, although the Liberal government of Justin Trudeau is considering leaving it at 65), and the Canada Pension Plan (CPP) as early as age 60. The distinguishing characteristics of old age are both physical and mental. The marks of old age are so unlike the marks of middle age that legal scholar Richard Posner suggests that, as an individual transitions into old age, that person can be thought of as different people "time-sharing"
4165-410: The aged have coexisted in complex relationships throughout history. "Old people were respected or despised, honoured or put to death according to circumstance." In ancient times, those who were frail were seen as a burden and ignored or, in extreme cases, killed. People were defined as "old" because of their inability to perform useful tasks rather than their years. Although he was skeptical of
4250-450: The aging process ( gerontology ), diseases that afflict older adults ( geriatrics ), technology to support the aging society ( gerontechnology ), and leisure and sport activities adapted to older people (such as senior sport ). Old people often have limited regenerative abilities and are more susceptible to illness and injury than younger adults. They face social problems that relate to retirement , loneliness , and ageism . In 2011,
4335-527: The aging process, the impact of aging on illness patterns, drug therapy in seniors, health maintenance, and rehabilitation . They serve in a variety of roles including hospital care, long-term care, home care, and terminal care. They are frequently involved in ethics consultations to represent the unique health and diseases patterns seen in seniors. The model of care practiced by geriatricians is heavily focused on working closely with other disciplines such as nurses, pharmacists , therapists, and social workers. In
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#17328763151324420-598: The benchmark for senior citizenship in numerous countries. This convention originated from Chancellor Otto von Bismarck's introduction of the pension system in Germany during the late 19th century. Bismarck's legislation set the retirement age at 70, with 65 as the age at which individuals could start receiving a pension. This age standard gradually gained acceptance in other nations and has since become deeply entrenched in public consciousness. The age which qualifies for senior citizen status varies widely. In governmental contexts, it
4505-444: The context, but the state of being elderly was often thought as being 60 years of age or older in many respects. Gerontologists have recognized that people experience very different conditions as they approach old age. In developed countries, many people in their later 60s and 70s (frequently called "early old age") are still fit, active, and able to care for themselves. However, after 80, they generally become increasingly frail ,
4590-454: The developed world, where chronological age determines retirement, societies in developing countries determine old age according to a person's ability to make active contributions to society. This number is also significantly affected by lower life expectancy throughout the developing world. Dating back to the Middle Ages and prior, what certain scholars thought of as old age varied depending on
4675-455: The elderly are a happier age group than their younger counterparts. Physical marks of old age include the following: Mental marks of old age include the following: Many books written by authors in middle adulthood depict a few common perceptions on old age. One writer notices the change in his parents: They move slowly, they have less strength, they repeat stories, their minds wander, and they fret. Another writer sees her aged parents and
4760-529: The elderly develop some kinds of diseases and have more complications from mild problems (such as dehydration from a mild gastroenteritis ). Multiple problems may compound: A mild fever in elderly persons may cause confusion , which may lead to a fall and to a fracture of the neck of the femur ("broken hip"). The presentation of disease in elderly persons may be vague and non-specific, or it may include delirium or falls. ( Pneumonia , for example, may present with low-grade fever and confusion , rather than
4845-415: The fact that elderly persons (in particular, those experiencing substantial memory loss or other types of cognitive impairment) are unlikely to be able to adequately monitor and adhere to their own scheduled pharmacological administration. One study (Hutchinson et al., 2006) found that 25% of participants studied admitted to skipping doses or cutting them in half. Self-reported noncompliance with adherence to
4930-527: The fields of medicine, nursing, pharmacy, social work, physical and occupational therapy. Elderly patients can receive care related to medication management, pain management, psychiatric and memory care, rehabilitation, long-term nursing care, nutrition and different forms of therapy including physical, occupational and speech. Non-medical considerations include social services, transitional care, advanced directives, power of attorney and other legal considerations. The decline in physiological reserve in organs makes
5015-451: The gods, Aristotle concurred in the dislike of old people. In his Ethics , he wrote that "old people are miserly; they do not acknowledge disinterested friendship; only seeking for what can satisfy their selfish needs". The Medieval and Renaissance periods depicted old age as "cruel or weak". The 16th-century Utopians Thomas More and Antonio de Guevara allowed no decrepit old people in their fictional lands. For Thomas More, on
5100-405: The high fever and cough seen in younger people.) Some elderly people may find it hard to describe their symptoms in words, especially if the disease is causing confusion, or if they have cognitive impairment . Delirium in the elderly may be caused by a minor problem such as constipation or by something as serious and life-threatening as a heart attack . Many of these problems are treatable, if
5185-568: The hospital, and are three times as likely to be discharged to a skilled nursing facility instead of to their own homes. Frail elderly patients (score of 4 or 5) who were living at home before the surgery have even worse outcomes, with the risk of being discharged to a nursing home rising to twenty times the rate for non-frail elderly people. Some diseases commonly seen in elderly are rare in adults, e.g., dementia, delirium, falls. As societies aged, many specialized geriatric- and geriatrics-related services emerged including: A number of physicians in
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#17328763151325270-414: The interviewees faced new situations they changed their "cognitive and emotional processes" and reconstituted their "self–representation". Based on his survey of old age in history, Georges Minois concludes that "it is clear that always and everywhere youth has been preferred to old age". In Western thought, "old age is an evil, an infirmity and a dreary time of preparation for death". Furthermore, death
5355-492: The island of Utopia , when people are so old as to have "out-lived themselves" and are terminally ill, in pain, and a burden to everyone, the priests exhort them about choosing to die. The priests assure them that "they shall be happy after death". If they choose to die, they end their lives by starvation or by taking opium. Antonio de Guevara 's utopian nation "had a custom, not to live longer than sixty five years". At that age, they practiced self-immolation. Rather than condemn
5440-673: The leading cause of emergency department admissions and hospitalizations in adults age 65 and older, many of which result in significant injury and permanent disability. As certain risk factors can be modifiable for the purpose of reducing falls, this highlights an opportunity for intervention and risk reduction. Modifiable factors include: Urinary incontinence or overactive bladder symptoms is defined as unintentionally urinating oneself. These symptoms can be caused by medications that increase urine output and frequency (e.g. anti-hypertensives and diuretics), urinary tract infections, pelvic organ prolapse, pelvic floor dysfunction, and diseases that damage
5525-578: The listed medications may not be applicable in their country. Geriatrician Mark H. Beers formulated the Beers Criteria through a consensus panel of experts using the Delphi method . The criteria were originally published in the Archives of Internal Medicine in 1991 and updated in 1997, 2003, 2012, 2015, 2019, and 2023. The AGS has registered a trademark for the term "AGS Beers Criteria" and in 2018, it formed
5610-483: The nerves that regulate bladder emptying. Other musculoskeletal conditions affecting mobility should be considered, as these can make accessing bathrooms difficult. Malnutrition and poor nutritional status is an area of concern, affecting 12% to 50% of hospitalized elderly patients and 23% to 50% of institutionalized elderly patients living in long-term care facilities such as assisted living communities and skilled nursing facilities. As malnutrition can occur due to
5695-579: The patient's face looks—can help older patients make fully informed choices about their options. Assessment of older patients before elective surgeries can accurately predict the patients' recovery trajectories. One frailty scale uses five items: unintentional weight loss, muscle weakness , exhaustion, low physical activity, and slowed walking speed. A healthy person scores 0; a very frail person scores 5. Compared to non-frail elderly people, people with intermediate frailty scores (2 or 3) are twice as likely to have post-surgical complications, spend 50% more time in
5780-620: The person or the estate. Elder abuse occurs increasingly when caregivers of elderly relatives have a mental illness. These instances of abuse can be prevented by engaging these individuals with mental illness in mental health treatment. Additionally, interventions aimed at decreasing elder reliance on relatives may help decrease conflict and abuse. Family education and support programs conducted by mental health professionals may also be beneficial for elderly patients to learn how to set limits with relatives with psychiatric disorders without causing conflict that leads to abuse. Old age Old age
5865-480: The practice, Bishop Guevara called it a "golden world" in which people "have overcome the natural appetite to desire to live". In the modern period, the cultural status of old people has declined in many cultures. Joan Erikson observed that "aged individuals are often ostracized, neglected, and overlooked; elders are seen no longer as bearers of wisdom but as embodiments of shame". Attitudes toward old age well-being vary somewhat between cultures. For example, in
5950-447: The previous two. The first category includes medications that are potentially inappropriate for older people because they either pose high risks of adverse effects or appear to have limited effectiveness in older patients, and because there are alternatives to these medications. The second category includes medications that are potentially inappropriate for older people who have certain diseases or disorders because these drugs may exacerbate
6035-476: The process of aging and their role in the presence of older patients and residents. In India, Geriatrics is a relatively new speciality offering. A three-year post graduate residency (M.D) training can be joined for after completing the 5.5-year undergraduate training of MBBS (Bachelor of Medicine and Bachelor of Surgery). Unfortunately, only eight major institutes provide M.D in Geriatric Medicine and subsequent training. Training in some institutes are exclusive in
6120-712: The risk of drug interactions or adverse drug reactions . Pharmacokinetic and pharmacodynamic changes arise with older age, impairing their ability to metabolize and respond to drugs. Each of the four pharmacokinetic mechanisms (absorption, distribution, metabolism, excretion) are disrupted by age-related physiologic changes. For example, overall decreased hepatic function can interfere with clearance or metabolism of drugs and reductions in kidney function can affect renal elimination. Pharmacodynamic changes lead altered sensitivity to drugs in geriatric patients, such as increased pain relief with morphine use. Therefore, geriatric individuals require specialized pharmacological care that
6205-449: The risk-benefit ratio is different. For example, frail elderly women routinely stop screening mammograms , because breast cancer is typically a slowly growing disease that would cause them no pain, impairment, or loss of life before they would die of other causes. Frail people are also at significant risk of post-surgical complications and the need for extended care, and an accurate prediction—based on validated measures, rather than how old
6290-418: The root cause can be discovered. Elderly people require specific attention to medications . Elderly people particularly are subjected to polypharmacy (taking multiple medications) given their accumulation of multiple chronic diseases. Many of these individuals have also self-prescribed many herbal medications and over-the-counter drugs . This polypharmacy, in combination with geriatric status, may increase
6375-534: The same identity. These marks do not occur at the same chronological age for everyone. Also, they occur at different rates and order for different people. Marks of old age can easily vary between people of the same chronological age. A basic mark of old age that affects both body and mind is "slowness of behavior". The term describes a correlation between advancing age and slowness of reaction and physical and mental task performance. However, studies from Buffalo University and Northwestern University have shown that
6460-401: The single most numerous internal medicine specialists. In Canada , there are two pathways that can be followed in order to work as a physician in a geriatric setting. Many universities across Canada also offer gerontology training programs for the general public, such that nurses and other health care professionals can pursue further education in the discipline in order to better understand
6545-582: The specified health problems. The third category includes medications that, although they may be associated with more risks than benefits in general, may be the best choice for a particular individual if administered with caution. The 2012 AGS Beers Criteria was released in February 2012 via publication in the early online edition of the Journal of the American Geriatrics Society . The Beers Criteria
6630-545: The temptation to manipulate the patient by withholding information, such as the dismal prognosis for a condition or the likelihood of recovering from surgery at home. Elder abuse is the physical, financial, emotional, sexual, or other type of abuse of an older dependent. Adequate training, services, and support can reduce the likelihood of elder abuse, and proper attention can often identify it. For elderly people who are unable to care for themselves, geriatricians may recommend legal guardianship or conservatorship to care for
6715-555: The topic in their medical works. Byzantine physicians typically drew on the works of Oribasius and recommended that elderly patients consume a diet rich in foods that provide "heat and moisture". They also recommended frequent bathing, massaging, rest, and low-intensity exercise regimens. In The Canon of Medicine , written by Avicenna in 1025, the author was concerned with how "old folk need plenty of sleep" and how their bodies should be anointed with oil , and recommended exercises such as walking or horse-riding . Thesis III of
6800-403: Was an Egyptian scribe who lived 4,500 years ago. The scribe addressed God with a prayer of lament: O Sovereign my Lord! Oldness has come; old age has descended. Feebleness has arrived; dotage is here anew. The heart sleeps wearily every day. The eyes are weak, the ears are deaf, the strength is disappearing because of weariness of the heart and the mouth is silent and cannot speak. The heart
6885-445: Was apparently coined in 1938 during a political campaign. Famed caricaturist Al Hirschfeld claimed on several occasions that his father Isaac Hirschfeld invented the term "senior citizen". It has come into widespread use in recent decades in legislation, commerce, and common speech. Especially in less formal contexts, it is often abbreviated as "senior(s)", which is also used as an adjective . The age of 65 has long been considered
6970-438: Was essential to the care of older people. Using her experiences as a physician in a London Workhouse infirmary, she believed that merely keeping older people fed until they died was not enough; they needed diagnosis, treatment, care, and support. She found that patients, some of whom had previously been bedridden, were able to gain some degree of independence with the correct assessment and treatment. The practice of geriatrics in
7055-552: Was proposed in 1908 by Ilya Ilyich Mechnikov , Laurate of the Nobel Prize for Medicine and later by 1909 by Ignatz Leo Nascher , former Chief of Clinic in the Mount Sinai Hospital Outpatient Department (New York City) and a "father" of geriatrics in the United States. Modern geriatrics in the United Kingdom began with the "mother" of geriatrics, Marjory Warren . Warren emphasized that rehabilitation
7140-644: Was updated in 2019 and 2023. Drugs listed on the Beers List are categorized according to risks for negative outcomes. The tables include medications that have cautions, should be avoided, should be avoided with concomitant medical conditions, and are contraindicated and relatively contraindicated in the elderly population. An example of an included drug is diphenhydramine (Benadryl), a first-generation H1 antagonist with anticholinergic properties, which may increase sedation and lead to confusion or falls. Geriatrics Geriatrics , or geriatric medicine ,
7225-510: Was viewed as defiling and ugly. Old age was reckoned as one of the unanswerable "great mysteries" along with evil, pain, and suffering. "Decrepitude, which shrivels heroes, seemed worse than death." Historical periods reveal a mixed picture of the "position and status" of old people, but there has never been a "golden age of aging". Studies have challenged the popular belief that in the past old people were venerated by society and cared for by their families. Veneration for and antagonism toward
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