Biomedical Engineering Reference
In-Depth Information
Straus and Tinetti (2009) identified five factors that distinguish clinical approaches
toward elderly people from the traditional medicine proposed for young adult patients:
1. The difficulty in differentiating age-related physiological changes in organ sys-
tems from disease and the coexistence of chronic diseases;
2. The fact that distressing symptoms or impairments frequently depend on several
factors (physical, psychological, social, environmental, etc.);
3. The difficulty for the physician in selecting and interpreting diagnostic tests that
may be affected by age and comorbidity;
4. The variability observed in the importance that older patients assign to potential
health outcomes; and
5. The involvement of caregivers who support the patients, provide information, and
facilitate in terms of treatment, but who could also be a source of conflict when
their goals do not coincide with those of the patient.
Unlike the traditional disease-oriented form of medical evaluation, the geriatric
approach to the patient includes the assessment of cognitive, affective, functional, social,
economic, environmental, and spiritual factors as well as a discussion about the patient's
preferences regarding advance directives (Reuben and Rosen 2009), as illustrated in
Figure 13.1.
In addition to medical history, a physical examination, and laboratory and ancillary
tests, the geriatrician considers visual and hearing impairments, malnutrition/weight loss,
urinary incontinence, balance and gait impairments, falling, and polypharmacy.
The assessment could be implemented by a single geriatrician or by a team of health pro-
fessionals; in the latter case, the term “comprehensive geriatric assessment” (CGA) is used.
This term was defined by a National Institute of Health (NIH) Consensus Development
Conference in 1987 as a
multidisciplinary evaluation in which the multiple problems of older persons are uncov-
ered, described, and explained, if possible, and in which the resources and strengths of
Cognitive
Medical
Affective
FUNCTIONAL
STATUS
Environmental
Social support
Economic
Spirituality
FIgUre 13.1
Interaction dimensions of the Geriatric Assessment. Modified from Reuben and Rosen (2009).
