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Principles of Geriatric Care

INTRODUCTION

Key Clinical Questions

  • image How do differences between hospitalized older adults and younger individuals alter the approach to this patient population?

  • image What are the risk factors for functional decline and the development of geriatric syndromes during hospitalization?

  • image What are the essential components of the initial hospital evaluation and how is this information used to trigger preventative measures? What are the essential components of daily rounds?

From 2010 to 2030, the total US population is expected to grow by 20%, while the segment of population aged 65 years and older is projected to increase by 79%. Older adults account for a disproportionate fraction of hospital discharges. In 2008, they made up 35% of hospital discharges while accounting for only 13% of the total population. As a result of aging demographics and greater utilization of hospital care by this age group, hospitalists will be caring for an increasing number of older patients.

Optimal geriatric hospital care uses a dedicated systematic approach that takes into account key differences between older and younger patients regardless of the admitting diagnosis. This chapter begins with a description of clinically significant differences between older and younger hospital patients; describes the importance of self-care function among older adults; summarizes key features of well-studied acute geriatric interventions; provides tips for care of the older patient on admission day, daily work rounds, and discharge; and finishes with information about prognosis.

DECREASED PHYSIOLOGIC RESERVE

Physiologic changes of normal aging affect all organ systems (Table 165-1). Aging is the consequence of varying genetic, environmental, and lifestyle influences, and age alone is not an accurate predictor of outcomes of hospitalization. Aging results in a loss of physiological resilience, a reduced ability of the body to maintain normal function when confronted with an external stressor.

TABLE 165-1Selected Physiological Changes That Occur with Normal Aging

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