The world is getting older, leading to a greater need for elder care. This article offers top advice for informed senior living. It pulls insights from the best sources, covering the latest in elderly care and geriatric medicine1.
Johns Hopkins Division of Geriatric Medicine and Gerontology is a leader in elder care1. The Beacham Center welcomes patients for outpatient services. You can make appointments by phone at 410-550-09251. If you want to know more about their research, call 410-550-3240 or email [email protected]1.
COAH at Johns Hopkins is dedicated to aging research and training, seeking to boost health in elders1. You can reach them at 410-955-0491 or through [email protected]1. JHOME in Baltimore does home visits for the elderly with long-term illnesses1. For details, dial 410-550-0931.
Key Takeaways
- Comprehensive approach to elderly care and geriatric medicine
- Access to innovative patient care and research at Johns Hopkins
- Resources for outpatient services, home-based care, and specialized programs
- Focus on optimizing health and quality of life for older adults
- Importance of understanding the unique needs of the aging population
Understanding the Aging Process
The aging process involves many changes in our bodies as we get older2. People over 65 are grouped into the young-old (65-74), middle-old (75-84), and old-old (85 and up)2. As we age, we might have memory issues, find it harder to move, or face other health problems2.
Physiological Changes in Aging
Our body’s functions start to slow down as we age2. Breathing, muscles, and our immune system all weaken2. This can make us more likely to get sick or have other health troubles.
Cognitive and Mental Health Aspects
Our thinking and mental health can also change as we get older2. The way our brains work might slow down, affecting memory and other skills2. Health problems like Alzheimer’s can be tough, both for seniors and those who care for them2. It’s key to focus on brain health and mental well-being to stay sharp and independent2.
“The aging process is a natural and complex phenomenon that involves a range of physiological changes in the human body, leading to various geriatric symptoms and challenges for older adults.”
| Physiological Changes in Aging | Cognitive and Mental Health Aspects |
|---|---|
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Understanding aging means grasping both the physical and mental shifts2. It’s important for health experts to optimize life as we age2. Their work helps older adults stay independent and healthy2.
Frailty and Geriatric Syndromes
Frailty is a major issue for the elderly, making them more prone to negative health effects. In England, 44% of older adults face frailty and disability3. China reports a 35.5% rate of cognitive frailty among its elderly3. In Europe, frailty’s prevalence in the population varies from 4.5% to 17.8%, with an even higher rate, 17.2% in middle-aged and older Europeans living in communities3.
Geriatric syndromes, like falls and pressure ulcers, commonly happen with frailty. They greatly affect older people’s health and independence. Moscow found geriatric syndromes in over half of its older population, at 63.4%3. These issues significantly lower the elderly’s quality of life3.
Older adults often have multiple health issues, which can lead to frailty. Taking many medications (Polypharmacy) is also a concern. They require careful management to improve health3.
Frailty significantly reduces the life quality of the elderly living in communities. It’s much worse for those facing frailty. Evidence shows frailty and its syndromes decrease these individuals’ life quality significantly3.
| Characteristic | Prevalence |
|---|---|
| Frailty among Medicare Advantage enrollees aged 65+ | 12%4 |
| Average geriatric syndromes for “frail” patients | 4.85 out of 104 |
| Average geriatric syndromes for non-frail patients | 2.35 out of 104 |
| Most common geriatric syndrome pattern among “frail” patients | Walking difficulty, lack of social support, falls, and weight loss4 |
To help the elderly, we must deal with frailty and its syndromes. Knowing the rates and impacts is key to aiding them effectively and comprehensively.
Multimorbidity in Older Adults
As people get older, they often have many chronic conditions at the same time. This is called multimorbidity5. The chance of having many health issues is about 90% for those over 855. It’s crucial to manage conditions like heart disease, diabetes, and arthritis to keep seniors healthy5. We need plans that focus on the patient to tackle their various health needs.
Managing Chronic Conditions
Older adults with multimorbidity need special care for their many conditions5. Gathering detailed medical history and noting the organs most at risk can help predict who is at higher risk5. Also, a special measure, created by Min and team, is better than standard methods at telling how likely older ICU patients are to survive5.
Studies have shown that some health conditions tend to go together and affect care outcomes differently5. For example, men and women might face different clusters of issues, such as more breathing problems in men and more bone and nerve issues in women5. Yet, only a few of the many ways to look at multimorbidity help predict if someone might need hospital care or not. More work is needed to understand and treat multimorbidity in practice5.
Polypharmacy Challenges
Being on many medications is a big issue for older adults with several health problems6. Those in the Transitional Aged Care Program (TACP) have a higher chance of going back to the hospital if they have more health issues. The risk goes up by 37% for each new problem on the Charlson Comorbidity Index (CCI)6. The CCI can also show who’s more likely to return to the hospital within 30 days. The chance increases by 43% with each new health issue6.
Taking many medications can lead to bad reactions, drug mixing issues, and other drug-related problems7. More people were taking at least ten drugs by 2010 compared to 1995. This shows that more and more medications are being used over time7. It’s vital to manage medicines carefully by checking and adjusting doses often. This can help avoid the downsides of taking many drugs as you get older7.
“Polypharmacy may have adverse effects like reduced adherence, adverse drug reactions, and potentially harmful interactions, impacting patient outcomes and healthcare system burden.”7
Elderly Care and Geriatric Medicine
Geriatric Assessment and Care Planning
Comprehensive geriatric assessment (CGA) pinpoints health, emotional, and ability limits in elders8. This process guides tailored care plans and allows for specific interventions8. Ensuring the best results for seniors relies on thorough assessment and planning8.
Geriatricians specialize in senior patient care9. Their work may span from outpatient clinics to inpatient hospital care settings9. Studies reveal a brighter recovery path for those supervised by geriatricians, increasing the chances of going directly home post-hospitalization9.
The U-M Geriatrics Center excels in serving those 70 and above. It’s recognized as a leader in geriatric care by U.S. News and World Report8. Their Turner Clinic boasts expert evaluation and management of senior health by certified geriatricians8. This center handles various health issues common in the aging population8.
UCLA Health stands at the cutting edge, ranking 4th nationally in geriatrics10. Their Alzheimer’s and Dementia Care Program has offered vital support to over 3,000 patients and families since 201110. Additionally, their local home care initiative caters to West Los Angeles and Santa Monica residents10.
When picking a geriatrician, review their training, availability, and care approach9. The renowned Johns Hopkins network includes comprehensive Medicare Advantage plans and in-house care for those 65+ unable to travel for visits9. These doctors are dedicated to managing chronic diseases and promoting overall health9.
In addition to individual care, the Geriatrics Center runs an active program for elder community well-being8. This includes a joint effort with St. Joseph Mercy Ann Arbor at their 10 East Medicine Unit8.
“Effective geriatric assessment and care planning are essential for ensuring optimal outcomes for older adults.”
Optimizing Medication Use in Seniors
As we grow older, our bodies change. This affects how we react to medications11. So, when doctors give medicines to older people, they must think about these changes. They need to adjust the doses and watch closely to make sure the medicines are safe and work well11.
Pharmacokinetic and Pharmacodynamic Changes
Pharmacokinetic changes are related to how drugs move through the body. Things like less stomach acid or more body fat can change how drugs are absorbed or spread11. Also, our liver and kidney functions slow down with age. This affects how our body breaks down and gets rid of drugs11.
Pharmacodynamic changes are about how drugs act on the body. For some drugs, older adults might feel their effects more. This happens because how our bodies respond to drugs changes as we age11. And sometimes, it’s harder for older people to remember when and how to take their medicine11.
- Polypharmacy, the use of five or more medications, is common in older adults11.
- As we age, the chance of bad drug reactions goes up11.
- Many older people have several health issues, so they need more than one medicine. This can make drug interactions more likely11.
- Some may find it hard to take their medicine correctly, leading to skipping doses11.
To help seniors use medicine better, healthcare workers need to know about these body changes. They also need to check the medicine lists and teach older adults. Making sure the right doses are given is key to good care11.
| Geriatric Medication Management Strategies | Description |
|---|---|
| Geriatrics 5Ms Framework | A comprehensive approach that focuses on Medication, Mind, Mobility, Multimorbidity, and What Matters Most to the patient. |
| American Geriatrics Society Beers Criteria | A guide to find medicines that might not be good for older adults. It helps avoid bad side effects. |
| Deprescribing | Stopping or cutting back on drugs that aren’t needed. This is very important in caring for older people. |
| Medication Reconciliation | Always making sure the medicine list is up-to-date. This is especially important when patients move from one place to another. |
| Patient Education | Telling patients how and when to take their medicine, and what to watch out for. It’s a critical part of care. |
| Medication Regimen Simplification | Trying to give as few medicines as possible. This makes it easier for patients to stick to their treatment and lowers the risk of bad interactions. |
| Technology Utilization | Using devices or phone apps to help patients remember to take their medicine. This can improve how well they follow their treatment. |
Knowing how our bodies change as we get older can help improve the way we use drugs. Doctors, nurses, and pharmacists can use this knowledge to look after the elderly better111213.
Kidney and Liver Function in Aging
As we get older, our kidneys and liver don’t work as well. This change can make it harder for our bodies to use and break down medicines. So, doctors must be careful when giving medicines to older people.
Dosage Adjustments for Impaired Organ Function
As we age, our kidneys and liver slow down. A study found that about 6% of older people have nonalcoholic fatty liver disease14. Also, the liver’s blood flow can drop by about 10% as we get older14. Plus, in the liver, cells that fight infections increase by 15% in older adults14.
Our kidneys also change with age. The parts that filter our blood can shrink, and the blood vessels in the kidneys can harden. This can make it harder for the kidneys to clean the blood slowly. This makes older adults more likely to have kidney or bladder issues, like problems with passing urine15.
Doctors need to check the liver and kidney health of older patients before giving them medicine16. This is very important for medicines that the kidneys or liver mostly get rid of. Bad liver or kidney health can cause the medicine to not work well or to make problems.
The Geriatric Kidney Disease Clinic at Michigan Medicine helps older people with kidney issues16. The team includes kidney doctors, social workers, and experts in elderly care. They work together to give the best care for each older patient. This ensures their kidney and related health problems are managed safely and well.
“Appropriate dosage adjustments based on an individual’s renal and hepatic status are crucial to prevent adverse drug events and optimize therapeutic outcomes in older adults.”
Knowing how aging changes kidney and liver functions helps doctors give the right amount of medicine. This makes medicine safer and more effective for older adults.
Transitions of Care for Older Patients
It’s vital for older adults to smoothly move from hospitals to nursing homes and homes17. By doing things like checking medications and coordinating care, we can make these transitions better. This kind of help improves their care flow during big transitions17.
Leaving the emergency department makes older patients more at risk. They might face lowered function and worse health17. A study found almost 1 in 5 Medicare patients experienced problems after leaving the ER. These were because of bad drug interactions from their new prescriptions17. But, a study showed that having a pharmacist review their meds can help a lot17.
If older patients have trouble thinking, they might not understand their aftercare instructions well17. Health pros stress how important it is to leave the ER safely, especially for older folks17.
How someone leaves the hospital matters, whether they’re sent home with care or to a nursing facility17. Staying less time in a nursing place could cause some problems. Also, how much someone pays for nursing care affects their recovery after leaving the hospital17.
Teamwork among health workers can really make a difference when someone leaves a nursing place to go home17. Creating a good plan when someone is leaving has shown success. It reduces the times patients have to go back to the hospital. Sometimes, it can lower this risk by a quarter for those with heart problems18.
Making leaving the hospital smoother for older patients can lead to better results, as one research found18. But, we still need better ways to guess who might end up back in the hospital18.
| Metric | Value |
|---|---|
| Rehospitalization rate among Medicare fee-for-service patients | 20.7%18 |
| Reduction in rehospitalization through a reengineered hospital discharge program | Up to 50%18 |
| Improvement in clinical outcomes for chronic heart failure patients with comprehensive discharge planning | Significant18 |
| Reduction in hospital readmission rates through comprehensive discharge planning interventions | Up to 25%18 |
| Health literacy among Medicare enrollees in a managed care organization | 42%18 |
COVID-19 has mixed things up in how older adults transition in care, a Quebec study shows19. They looked at 690 elders after ER trips, with balanced genders. While the ER care was mostly praised, worries on communication and professionalism came up. Home care feedback changed from good to okay, likely because of slower services19.
In short, making sure older patients move between care settings smoothly is key. It helps avoid bad events, errors in medicine, and going back to the hospital. Good plans, checking medicines, and working together can really support older adults when they need it most1718.
Fall Prevention and Safety Measures
As we grow older, staying safe and independent at home is key. Falls are a big issue, leading to both injury and death for many seniors20. Shockingly, 1 in 3 older adults living in the community falls yearly. Among those, 24% face serious harm, like fractures20. The cost to the U.S. healthcare system is set to hit nearly $55 billion by 2020 because of these falls20.
Home Modifications for Aging in Place
Thankfully, there are ways to cut back on falls and help seniors stay at home safely. It’s important to spot and fix any dangers in the living area21. Adding grab bars, handrails, and non-slip floors can lower the fall risk a lot21. Good lighting, including night lights, is essential to prevent tripping in the dark21.
It also helps to use tools like canes, walkers, and mobility aids. These can make seniors sturdier and less likely to fall21. Occupational therapists offer advice on customized changes to the home. This can keep seniors safe and self-sufficient21.
Staying active is key in stopping falls before they happen. Working out regularly improves strength, flexibility, and balance, cutting down the fall risk21. Watching out for bad medication side effects is also important. Doctors should carefully check how different drugs might mix and cause falls21.
Putting together all these steps in a fall prevention program works well. Studies show it can drop fall rates by 25% to 40% for older adults living on their own20. Making fall safety a top concern helps seniors live confidently in their own homes, keeping their life quality high20.
“Screening and assessment for fall risk are considered paramount priorities due to the devastating effects falls have on patients and the increased burden on family members and the healthcare system.”
With an aging population, preventing falls is crucial. It not only keeps older adults independent but also eases the pressure on healthcare20. By doing this, we can make homes a safer place for our elders to enjoy202122.,,
Palliative and End-of-Life Care
When older adults face serious illness or the end of their lives, they need special care. That’s where palliative and hospice care come in. These types of care focus on reducing pain, offering emotional and spiritual support, and helping with big end-of-life talks and choices.
The George Washington (GW) Medical Faculty Associates (MFA) has a team just for this. They look after people with complex health needs. This includes help with preventing health issues, memory care, and advice on handling serious illnesses23.
They also support future doctors in learning about caring for the elderly and those nearing the end of their lives. They offer a range of learning experiences, from fellowships to medical school courses. This shows their deep dedication to teaching others about this kind of healthcare23.
GW’s work doesn’t stop there. They have special clinics and programs for older folks. From check-ups at home to memory help, their goal is to give top-notch care to older adults23.
Research is a big focus at GW too. They have groups working on spirituality and health, aging, and better ways to care for the elderly. By working on new ideas and sharing what they find, they’re helping to improve care for older adults and those nearing the end of their lives23.
One article, “Superior Guidance on Elderly Care and Geriatric Medicine for Informed Senior Living,” talks about caring for the elderly. It’s written by different experts like Albers et al., Bellamy et al., and Braude et al24. These experts believe in working together. They say it’s really important for different kinds of caregivers and doctors to team up24.
Recent studies focus on how to better care for those at the end of their lives. For example, Bellamy et al. looked at how choosing care plans helps. They did this in 201824. The World Health Organization also mentioned in 2004 that we need to do better for the elderly. Policymakers are looking at new ways to help older people live their best lives, even at the end25.
As the world’s population gets older, the need for this care is increasing. Institutions like GW are meeting this challenge head-on. They provide everything from direct care to teaching future doctors and researching new ways to help. Their commitment ensures that older adults get the care and support they deserve during this critical time23.
| Year | Relevant Study or Event |
|---|---|
| 2004 | World Health Organization highlighted the need for better palliative care for older people25. |
| 2015 | Study comparing end-of-life care for older people living at home versus in residential homes in the Netherlands25. |
| 2017 | Cluster randomized controlled trial to improve comfort around dying in elderly people25. |
| 2022 | Nationwide study among Australian general practitioners comparing end-of-life care for people living in home settings versus residential aged care facilities25. |
| 2023 | Sustainability journal study on knowledge and attitude toward end-of-life care of nursing students25. |
“Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.” – World Health Organization
More people are living longer than ever before. This means more demand for end-of-life care. GW and other institutions are stepping up. They are making sure that older adults get the best possible care and support. This is essential during the last stages of their lives23.
Palliative and hospice care focuses on what’s important. They help in relieving pain, keeping life quality high, and respecting what’s important to older people23.
Caregiver Support and Resources
Caring for older adults is fulfilling but hard work. It can be tough both physically and emotionally. Luckily, there are many support resources and breaks available for family caregivers. This helps them deal with the hard parts of caring for someone26.
Respite Care Options
Respite care is a much-needed break for caregivers. It lets them step back from their care duties for a short time. Options for this break can include help at home, adult day programs, or even stays in nursing homes for a brief time27.
Caregivers can find help to not get too overwhelmed and keep giving their best. Such support is crucial for their own well-being and for the ones they care for27.
The way to pay for respite care can be different depending on what you use. Home health services by Medicare are somewhat limited,27 but Medicaid has wider coverage. Yet, this can change depending on your state.27 Long-term care insurance and some private health insurances might also help27. Also, don’t forget that volunteer services cost nothing for you,27 like having a friendly visitor27.
If you need a meal delivered, Medicare usually doesn’t pay for this,27 but Medicaid might, if the person meets certain criteria.27 Some meal services are free, others you have to pay for27. Regarding emergency alerts, Medicare doesn’t help here either,27 but Medicaid and some insurances might assist,27 along with long-term care insurance27.
If you’re an AARP member, there are extra benefits. You can get discounts on healthy meals or free shipping28. Plus, you save on caregiving services at home with CareLinx28.
Looking for help with caregiving can truly change things for the better. With these resources, caregivers can handle their duties better. They can avoid getting too tired and ensure their loved ones receive the best care26.
“Self-care for caregivers is crucial as they may experience stress and burden; balancing caregiving duties with self-care is essential.”
Conclusion
Understanding elderly care and geriatric medicine can feel overwhelming. Yet, this guide offers important insights and strategies for better senior living29. It covers topics like managing frailty and multiple illnesses, handling medications, and ensuring smooth care changes. These tips help everyone involved work towards improving older adults’ health, safety, and happiness3031.
To keep up with the needs of our older citizens, research and thinking about patients first are crucial29. Tools like the AARP Long-Term Services & Supports State Scorecard and the CDC’s program are invaluable for anyone working with seniors29. Plus, support foundations and useful sites are out there, like the Family Caregiver Alliance and Next Avenue, to make sure seniors get top-notch care.
The need for expert geriatric care and a deep understanding of aging seniors’ needs will keep on increasing. By keeping up-to-date, using proven methods, and working together, we can tackle the challenges of elderly care and geriatric medicine. Our goal is to help seniors enjoy a dignified, independent life as they age.
FAQ
What are the key physiological changes associated with the aging process?
How does cognitive decline and mental health issues impact older adults?
What is frailty and how does it impact the health of older adults?
What is multimorbidity, and how does it affect the care of older adults?
What are the key considerations for managing polypharmacy in older adults?
How can comprehensive geriatric assessment and care planning improve outcomes for older adults?
What are the key considerations for optimizing medication use in seniors?
How do declines in kidney and liver function impact medication management in older adults?
What are the key strategies for ensuring seamless transitions of care for older patients?
What are the essential elements of a comprehensive fall prevention program for older adults?
How can palliative and end-of-life care support older adults and their families?
What resources are available to support caregivers of older adults?
Source Links
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- https://www.decent.com/blog/understanding-adult-vs-geriatric-care-a-comprehensive-guide – Understanding Adult Vs Geriatric Care: A Comprehensive Guide | Decent
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9819361/ – The Impact of Frailty and Geriatric Syndromes on the Quality of Life of Older Adults Receiving Home-Based Healthcare: A Cross-Sectional Survey
- https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-017-0645-7 – Comparing clinician descriptions of frailty and geriatric syndromes using electronic health records: a retrospective cohort study – BMC Geriatrics
- https://ccforum.biomedcentral.com/articles/10.1186/s13054-021-03750-y – The management of multi-morbidity in elderly patients: Ready yet for precision medicine in intensive care? – Critical Care
- https://link.springer.com/article/10.1007/s41999-023-00770-5 – Higher levels of multimorbidity are associated with increased risk of readmission for older people during post-acute transitional care – European Geriatric Medicine
- https://www.mdpi.com/2308-3417/5/4/85 – Multi-Morbidity and Polypharmacy in Older People: Challenges and Opportunities for Clinical Practice
- https://www.uofmhealth.org/conditions-treatments/adult-primary-care/elderly-care-geriatrics – Elderly Care (Geriatrics) | University of Michigan Health
- https://www.hopkinsmedicine.org/health/wellness-and-prevention/specialists-in-aging-do-you-need-a-geriatrician – Specialists in Aging: Do You Need a Geriatrician?
- https://www.uclahealth.org/medical-services/geriatrics – Geriatric Medicine & Care
- https://therapybrands.com/blog/optimizing-medication-management-for-geriatric-patients/ – Optimizing Medication Management for Geriatric Patients
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10092911/ – Optimizing Medications with the Geriatrics 5Ms: An Age-Friendly Approach
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5741014/ – Optimizing pharmacotherapy in elderly patients: the role of pharmacists
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4736713/ – Aging and liver disease
- https://medlineplus.gov/ency/article/004010.htm – Aging changes in the kidneys and bladder: MedlinePlus Medical Encyclopedia
- https://www.uofmhealth.org/conditions-treatments/kidney/older-adults-kidney-disease – Older Adults with Kidney Disease
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8054920/ – Applying Geriatric Principles to Transitions of Care in the Emergency Department
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4026496/ – Regardless of Age: Incorporating Principles from Geriatric Medicine to Improve Care Transitions for Patients with Complex Needs
- https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-023-04482-0 – Transitions of care for older adults discharged home from the emergency department: an inductive thematic content analysis of patient comments – BMC Geriatrics
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3854807/ – Preventing Falls in the Geriatric Population
- https://www.mayoclinic.org/healthy-lifestyle/healthy-aging/in-depth/fall-prevention/art-20047358 – Fall prevention: Simple tips to prevent falls
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9523684/ – World guidelines for falls prevention and management for older adults: a global initiative
- https://medicine.smhs.gwu.edu/geriatrics-palliative-medicine – Geriatrics & Palliative Medicine
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7961659/ – The Overlap Between Geriatric Medicine and Palliative Care: A Scoping Literature Review
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10544005/ – Uncovering Methods and Outcomes of Palliative Care for Geriatric Patients: A Scoping Review
- https://www.uhc.com/health-and-wellness/caregiver-resources – Caregiver resources
- https://www.nia.nih.gov/health/caregiving/services-older-adults-living-home – Services for Older Adults Living at Home
- https://www.aarp.org/caregiving/ – AARP Resources for Caregivers and their Families
- https://www.atrainceu.com/content/13-conclusion – 13. Conclusion | ATrain Education
- https://www.montesmedical.com/the-importance-of-geriatric-care-for-seniors-and-their-families/ – The Importance of Geriatric Care for Seniors and Their Families – Montes Medical Group
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9260589/ – Changing Hospital Care For Older Adults: The Case for Geriatric Hospitals in the United States