66-614: Liberton Hospital is a facility for geriatric medicine on Lasswade Road in Edinburgh , Scotland. It is managed by NHS Lothian . It is scheduled to close in 2025. The hospital, which was designed by John Dick Peddie and George Washington Browne, opened in 1906. It operated in partnership with the Longmore Hospital and the two hospitals together became known as the Royal Edinburgh Hospital for Incurables. The hospital joined
132-610: A 15 and 25% loss of body water. Mild dehydration usually resolves with oral rehydration , but severe cases may need intravenous fluids. Dehydration can cause hypernatremia (high levels of sodium ions in the blood). This is distinct from hypovolemia (loss of blood volume , particularly blood plasma ). Chronic dehydration can cause kidney stones as well as the development of chronic kidney disease . The hallmarks of dehydration include thirst and neurological changes such as headaches , general discomfort , loss of appetite , nausea , decreased urine volume (unless polyuria
198-1287: 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
264-529: 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
330-975: 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
396-421: A dehydrated state is accomplished by the replenishment of necessary water and electrolytes (through oral rehydration therapy , or fluid replacement by intravenous therapy ). As oral rehydration is less painful, non-invasive, inexpensive, and easier to provide, it is the treatment of choice for mild dehydration. Solutions used for intravenous rehydration may be isotonic , hypertonic , or hypotonic depending on
462-443: 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
528-486: A side effect from many different types of drugs and medications. In the elderly, blunted response to thirst or inadequate ability to access free water in the face of excess free water losses (especially hyperglycemia related) seem to be the main causes of dehydration. Excess free water or hypotonic water can leave the body in two ways – sensible loss such as osmotic diuresis , sweating , vomiting and diarrhea , and insensible water loss, occurring mainly through
594-493: Is a stub . You can help Misplaced Pages by expanding it . Geriatric medicine Geriatrics , or geriatric medicine , 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
660-448: 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
726-631: Is a lack of total body water that disrupts metabolic processes . It occurs when free water loss exceeds free water intake. This is usually due to excessive sweating, disease, or a lack of access to water. Mild dehydration can also be caused by immersion diuresis , which may increase risk of decompression sickness in divers . Most people can tolerate a 3-4% decrease in total body water without difficulty or adverse health effects. A 5-8% decrease can cause fatigue and dizziness . Loss of over 10% of total body water can cause physical and mental deterioration, accompanied by severe thirst . Death occurs with
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#1732845171576792-644: 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
858-458: 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
924-497: Is contained within the cells. This consists of approximately 40% of the total body water. Fluid inside the cells has high concentrations of potassium, magnesium, phosphate, and proteins. Extracellular fluid consists of all fluid outside of the cells, and it includes blood and interstitial fluid. This makes up approximately 60% of the total body water. The most common ions in extracellular fluid include sodium, chloride, and bicarbonate. The concentration of dissolved molecules and ions in
990-464: 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
1056-448: 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
1122-440: 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
1188-611: Is no defined age at which patients may be under the care of a geriatrician , or geriatric physician , 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
1254-402: 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
1320-470: 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
1386-676: Is required. Fluids containing a proper balance of replacement electrolytes are given orally or intravenously with continuing assessment of electrolyte status; complete resolution is normal in all but the most extreme cases. The prognosis for dehydration depends on the cause and extent of dehydration. Mild dehydration normally resolves with oral hydration. Chronic dehydration, such as from physically demanding jobs or decreased thirst, can lead to chronic kidney disease . Elderly people with dehydration are at higher risk of confusion, urinary tract infections , falls, and even delayed wound healing. In children with mild to moderate dehydration, oral hydration
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#17328451715761452-515: Is the cause of dehydration), confusion , unexplained tiredness , purple fingernails, and seizures . The symptoms of dehydration become increasingly severe with greater total body water loss. A body water loss of 1-2%, considered mild dehydration, is shown to impair cognitive performance. While in people over age 50, the body's thirst sensation diminishes with age, a study found that there was no difference in fluid intake between young and old people. Many older people have symptoms of dehydration, with
1518-422: Is typically seen in dehydration due to free water loss. A urinalysis, which is a test that performs chemical and microscopic analysis of urine, may find darker color or foul odor with severe dehydration. Urinary sodium also provides information about the type of dehydration. For hyponatremic dehydration, such as from vomiting or diarrhea, urinary sodium will be less than 10mmol/L due to increased sodium retention by
1584-461: 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
1650-483: 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
1716-534: The National Health Service in 1948 and a new four‑storey geriatric facility was built on the site in 1963. In 2014, the health board considered proposals to demolish the hospital and three others, with a view to replacing these facilities with care villages which would consist of buildings more suited to social care. In April 2023 it was announced that Edinburgh Council had bought the hospital site and grounds from NHS Lothian for £14.8m. The deal includes
1782-429: The skin and respiratory tract . In humans, dehydration can be caused by a wide range of diseases and states that impair water homeostasis in the body. These occur primarily through either impaired thirst/water access or sodium excess. Water makes up approximately 60% of the human body by mass. Within the body, water is classified as intracellular fluid or extracellular fluid. Intracellular fluid refers to water that
1848-517: 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
1914-788: 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
1980-722: 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
2046-542: 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
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2112-472: 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
2178-449: 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
2244-527: 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
2310-411: The cause of dehydration as well as the sodium concentration in the blood. Pure water injected into the veins will cause the breakdown ( lysis ) of red blood cells ( erythrocytes ). When fresh water is unavailable (e.g. at sea or in a desert), seawater or drinks with significant alcohol concentration will worsen dehydration. Urine contains a lower solute concentration than seawater; this requires
2376-529: 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
2442-415: 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
2508-527: 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
2574-435: The fluid is described as Osmolarity and is measured in osmoles per liter (Osm/L). When the body experiences a free water deficit, the concentration of solutes is increased. This leads to a higher serum osmolarity. When serum osmolarity is elevated, this is detected by osmoreceptors in the hypothalamus. These receptors trigger the release of antidiuretic hormone (ADH). ADH resists dehydration by increasing water absorption in
2640-477: The former Blood Transfusion Centre, The council plans to build around 400 homes, a number of which will be accessible and for social or mid-market rent. The 1960s buildings are to be demolished and original Edwardian-era buildings redeveloped. The aim is to create an accessible neighbourhood of low-carbon housing. The NHS is to occupy the premises until March 2025 to allow the hospital’s remaining services to be relocated. This United Kingdom hospital article
2706-610: The heat. When such large amounts of water are being lost through perspiration, electrolytes , especially sodium, are also being lost. In most athletes exercising and sweating for 4–5 hours with a sweat sodium concentration of less than 50 mmol/L, the total sodium lost is less than 10% of total body stores (total stores are approximately 2,500 mmol, or 58 g for a 70-kg person). These losses appear to be well tolerated by most people. The inclusion of sodium in fluid replacement drinks has some theoretical benefits and poses little or no risk, so long as these fluids are hypotonic (since
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2772-405: 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
2838-568: 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
2904-813: The kidneys and constricting blood vessels. It acts on the V2 receptors in the cells of the collecting tubule of the nephron to increase expression of aquaporin. In more extreme cases of low blood pressure, the hypothalamus releases higher amounts of ADH which also acts on V1 receptors. These receptors cause contractions in the peripheral vascular smooth muscle. This increases systemic vascular resistance and raises blood pressure. Dehydration occurs when water intake does not replace free water lost due to normal physiologic processes, including breathing , urination , perspiration , or other causes, including diarrhea , and vomiting . Dehydration can be life-threatening when severe and lead to seizures or respiratory arrest, and also carries
2970-490: The kidneys in an effort to conserve water. In dehydrated patients with sodium loss due to diuretics or renal dysfunction, urinary sodium may be elevated above 20 mmol/L. Patients may also have elevated serum levels of blood urea nitrogen (BUN) and creatinine . Both of these molecules are normally excreted by the kidney, but when the circulating blood volume is low, the kidney can become injured. This causes decreased kidney function and results in elevated BUN and creatinine in
3036-416: The kidneys to create more urine to remove the excess salt, causing more water to be lost than was consumed from seawater. If a person is dehydrated and taken to a medical facility, IVs can also be used. For severe cases of dehydration where fainting , unconsciousness , or other severely inhibiting symptoms are present (the patient is incapable of standing upright or thinking clearly), emergency attention
3102-673: 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
3168-583: The mainstay of dehydration prevention is the replacement of free water losses). The most effective treatment for minor dehydration is widely considered to be drinking water and reducing fluid loss. Plain water restores only the volume of the blood plasma, inhibiting the thirst mechanism before solute levels can be replenished. Consumption of solid foods can also contribute to hydration. It is estimated approximately 22% of American water intake comes from food. Urine concentration and frequency will return to normal as dehydration resolves. In some cases, correction of
3234-460: The most common being fatigue. Dehydration contributes to morbidity in the elderly population, especially during conditions that promote insensible free water losses, such as hot weather. Risk factors for dehydration include but are not limited to: exerting oneself in hot and humid weather, habitation at high altitudes, endurance athletics, elderly adults, infants, children and people living with chronic illnesses. Dehydration can also come as
3300-483: 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
3366-436: The patient's body, in a location such as the forearm or the back of the hand, and watching to see how quickly it returns to its normal position. The skin turgor test can be unreliable in patients who have reduced skin elasticity, such as the elderly. While there is no single gold standard test to diagnose dehydration, evidence can be seen in multiple laboratory tests involving blood and urine. Serum osmolarity above 295 mOsm/kg
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#17328451715763432-579: 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
3498-642: 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. Dehydration In physiology, dehydration
3564-476: 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
3630-712: 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
3696-668: The risk of osmotic cerebral edema if rehydration is overly rapid. The term "dehydration" has sometimes been used incorrectly as a proxy for the separate, related condition of hypovolemia , which specifically refers to a decrease in volume of blood plasma . The two are regulated through independent mechanisms in humans; the distinction is important in guiding treatment. Common exam findings of dehydration include dry mucous membranes, dry axillae, increased capillary refill time, sunken eyes, and poor skin turgor. More extreme cases of dehydration can lead to orthostatic hypotension, dizziness, weakness, and altered mental status. Depending on
3762-449: 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
3828-418: 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
3894-498: The serum. For routine activities, thirst is normally an adequate guide to maintain proper hydration. Minimum water intake will vary individually depending on weight, energy expenditure, age, sex, physical activity, environment, diet, and genetics. With exercise, exposure to hot environments, or a decreased thirst response , additional water may be required. In athletes in competition, drinking to thirst optimizes performance and safety, despite weight loss, and as of 2010, there
3960-401: 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
4026-545: 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
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#17328451715764092-555: 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
4158-405: The underlying cause of dehydration, other symptoms may be present as well. Excessive sweating from exercise may be associated with muscle cramps. Patients with gastrointestinal water loss from vomiting or diarrhea may also have fever or other systemic signs of infection. The skin turgor test can be used to support the diagnosis of dehydration. The skin turgor test is conducted by pinching skin on
4224-438: 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
4290-431: Was no scientific study showing that it is beneficial to stay ahead of thirst and maintain weight during exercise. In warm or humid weather, or during heavy exertion, water loss can increase markedly, because humans have a large and widely variable capacity for sweating. Whole-body sweat losses in men can exceed 2 L/h during competitive sport , with rates of 3–4 L/h observed during short-duration, high-intensity exercise in
4356-552: 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
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