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INTRODUCTION

Populations are aging worldwide. This demographic shift will dominate the health care landscape of the 21st century. As the number of older persons continues to grow, it becomes increasingly important to know how to help everyone age well, preserving independence, dignity, and purpose. As health care providers, we all have a responsibility to learn the unique aspects of medical care for older persons that will maximize their health and well-being, as defined and redefined by each individual as they age.

Many scientific discoveries, educational advances, and health system innovations have led to improvements in medical and social care for older persons. Such advances guide us today in caring for those with chronic illness, as well as their caregivers. For example, we now have best practices in managing polypharmacy, transitions across health care settings, and falls. We are increasingly aware of the impact of loneliness, iatrogenesis, and caregiver burden. Advances also guide us in optimizing the health and well-being of older persons in good health through health promotion activities. Furthermore, we have become knowledgeable about ways to avoid the hazards of medical care. For example, models such as the acute care for elders (ACE) hospital units are designed to increase mobility in the hospital and prevent delirium so that more older persons can return directly home after a hospital stay.

Yet, there remains much to be done to improve the health and well-being of older persons. Currently, there are fewer than 7000 US geriatricians, and there remain many gaps between science, practice, and what is important to patients. Across the globe, the World Health Organization has designated 10 priorities for a decade of actions on healthy aging, including supporting innovation, collecting data, promoting research, aligning health care systems, combating ageism, and developing age-friendly cities and communities. The field of geriatrics aims to support these actions and bridge the gaps, helping clinicians incorporate the fundamental principles of geriatric medicine into their care of older persons. In this chapter, we describe guiding principles and clinical practice frameworks to assist all clinicians who care for older persons across the world in home care, ambulatory, hospital, long-term care, and end-of-life settings.

GUIDING PRINCIPLES

Three principles guide the care of older persons.

A. Complexity, Multimorbidity, and Physiologic Reserve

A holistic, interprofessional, team-based approach is necessary in caring for older persons with complex psychosocial circumstances and multiple medical conditions. In addition, older persons have lower physiologic reserve in each organ system when compared with younger adults, placing them at risk for more rapid decline when faced with acute or chronic illness. Some examples include decreases in muscle mass and strength, bone density, exercise capacity, respiratory function, thirst and nutrition, and ability to mount effective immune responses. For these reasons, older persons are often more vulnerable to periods of bedrest and inactivity, external temperature fluctuations, and complications ...

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