What are the significant and upcoming changes in the field of geriatric medicine? Several factors could directly impact the field, including polypharmacy, dementia, and dizziness. Let's discuss some of them. The Specialty Board's discussion helped identify knowledge areas that would benefit from more formal recognition in the MOC system. Moreover, it highlighted new activities medical schools and healthcare systems developed to improve the recognition of knowledge and skills.
The onset of aging is often accompanied by symptoms that may suggest other underlying conditions. However, there are still challenges to treating older patients, including polypharmacy and behavioral symptoms of dementia. Additionally, aging affects cardiovascular health, dysfunction, falls, and dizziness. The following are a few of the essential issues facing geriatricians in 2022. The most common form of dementia is Alzheimer's disease. In this condition, abnormal proteins build up in the brain and disrupt the communication between nerve cells. As the brain loses oxygen and nutrients, these damaged cells die, leading to symptoms such as confusion, trouble with memory, and behavioral changes. Alzheimer's affects around 60 to 80% of people over age 85. Symptoms of this disease may vary depending on the area of the affected brain. Neurologists will perform neuroimaging tests to identify the disease's cause and symptoms. These tests include memory, problem-solving, language, and math skills. Other tests will determine whether a patient's symptoms are related to a mental health problem or depression. Genetic tests may also be conducted to assess whether a person has a gene for dementia or another condition. Family members should discuss this option with a doctor. The disease concept is often the focus of modern geriatrics research. While this approach has resulted in numerous medical advances, it has not successfully determined the underlying causes of many age-related chronic conditions. Similarly, the disease construct fails to explain the wide variability in illness presentations. Hence, new approaches are needed to improve the senior medicine field. Polypharmacy in geriatric medicine is a problem that disproportionately affects seniors. While elderly patients need to take fewer medications, many are no more than five at one time. This is a severe problem because it increases the risk of adverse drug interactions. For example, a study found that nearly half of all seniors prescribed five or more prescription drugs had at least one drug interaction. The adverse effects of polypharmacy are often subtle, but they can still lead to severe consequences. For example, aging diabetics often require extra help with their medications because the risk of too much insulin can lead to low blood glucose, resulting in ER visits and hospitalization. A study from the University of Leicester found a correlation between the risk of falls and polypharmacy. People taking more prescriptions had a 21% higher risk of falling than those taking fewer medications. Those taking more than three medications were twice as likely to fail. If you're an older adult, you may experience frequent bouts of dizziness. The most common cause is benign paroxysmal positional vertigo (BPPV), which occurs when calcium carbonate crystals in the otolithic organs of the inner ear dislodge and cause intense dizziness. These symptoms can be caused by many factors, including poor circulation, infection, or injury. The prevalence of dizziness in elderly patients in family practice is unknown. In a recent study, physicians described the clinical features of dizzy and non-dizzy patients with the same symptoms. The study found that a higher prevalence of BPPV was associated with dizziness. Additionally, patients with a lower level of education, being alone at home, and having preexisting hypertension and cerebrovascular disease were more likely to be dizzy. The symptoms of urinary infections (UTIs) can range from mild to life-threatening and can cause fevers, upper back pain, nausea, and vomiting. In some cases, infections may spread to the kidneys and result in a life-threatening infection. Bacteria commonly reside in the bladder, vagina, and skin. When shed in the urine, they enter the urinary tract and travel up to the kidney, where they can infect the kidneys. The number of uropathogens is significantly higher in the elderly than in the younger adult population, and culture testing of all patients suffering from a UTI is essential. While Escherichia coli is the most common culprit in younger patients, this organism is responsible for only half of the cases in the elderly. Gram-negative organisms are also common, and Candida is frequently isolated in elderly patients. Because these infections are polymicrobial, they require additional treatment options that can target the source of the infection.
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