Management of Common

Geriatric Problems
Lourenz S. Bontia
BSN IV
Aging

Aging is a normal progressive process, beginning at conception

and ending in death.
Aging is not synonymous with diseases but diseases become more
common as age progresses.
Increasing age in the elderly is associated with the higher morbidity
and frequent use of health services.
Their illness tends to be chronic with no simple cure. This makes
them more dependent on the family, society and health services.
Geriatric Syndromes

Geriatric syndrome refers to a symptom presentation that is

common in older adults.
Most are multifactorial in origin.
Geriatric Giants

4 Geriatric giants : 4 Is
Immobility - pressure ulcers
Instability - falls
Incontinence urinary incontinence
Intellectual impairment dementia and delirium
Dementia and Delirium

Dementia is a syndrome of progressive decline in which multiple

intellectual abilities deteriorate, causing both cognitive and
functional impairment.
Dementia is a state of chronic confusion.
Delirium is an acute state of confusion. It is important to
differentiate delirium from dementia.
Dementia and Delirium

Both dementia and delirium are characterized by :

Disorientation,
Memory impairment,
Paranoia,
Hallucinations,
Emotional lability,
Sleep-wake cycle reversal.
Management

Spend time with the patient

Use touch to convey concern
Provide frequent reiteration of orienting data (e.g. time, place)
Have clocks or calendars in the environment
Explain all actions, procedures and routines to the patient
Address the patient by his/her name
Keep a routine activities
Falls

Excludes falls occurring from seizure, stroke, syncope.

Fall rates and risk of injury from falls increase with age.
Annually ~30% of community dwelling adults >65 years fall.
While 50% of individuals >80 years fall.
Management

Clear patients room of any hazardous materials, and accompany

patient who wanders to prevent injury.
Provide adequate lighting.
Raise side rails of the bed, if available.
Place personal items within the clients reach.
Make necessary changes in clients environment (i.e., remove
throw rugs)
Urinary Incontinence

UI is a major problem for older adults

Up to age 80 years, UI affects women twice as commonly as men
After age 80, both sexes are equally affected.
Urinary Incontinence

Leaking of urine or urinary Incontinence occurs in four ways.

Stress incontinence,

Urge incontinence,

Mixed stress and urge incontinence,

Overflow incontinence.
Stress Incontinence Management

Stress test - can be performed by patient stand with a full bladder

and cough. The test is positive if urine leakage coincides with the
cough.
Surgical interventions are the most effective treatments
pelvic muscle exercises can be helpful
Treatment failure is higher in patients who have two or more
leakages per day.
Urge Incontinence Management

Bladder retraining by encouraging the patient to void every 2 h or

based on the patient's symptom frequency.
The patient can also try urgency control. If no incontinence for 2
days, the voiding interval can be increased by 3060 minutes until
the patient is only voiding every 34 h.
Give anticholinergic drugs such oxybutinin and tolterodine
Patients using tolterodine have a reduced risk of dry mouth and
fewer withdrawals due to side effects.
Mixed Incontinence

Mixed incontinence refers to UI where symptoms of both

stress and urge incontinence are present.
Management is same with stress and urge incontinence
Overflow Incontinence Management

Adrenergic blockers :
Terazosin
Doxazosin
Tamulosin
5-reductase inhibitor Finasteride
Pressure Ulcers

Pressure ulcers, also known as pressure sores, bedsores, or

decubitus ulcers, occur in older patients with reduced
mobility.
Pressure Ulcers

Repositioning patients at risk for developing pressure

ulcers every 2 hrs.
Providing bedbound patients mattresses with pressure-
relieving capabilities are standard interventions to prevent
pressure ulcers.
Other Problems
Constipation

Increase Fluid Intake

Daily Exercise
Increase fiber intake (e.g. fruits and vegetables)
Osteoporosis

Have adequate calcium in diet

Get regular exercise
Avoid alcohol, quit smoking. Alcohol and smoking reduce bone
mass.
Avoid large amounts of protein rich or salty and caffeine foods.
They can cause loss of calcium from the body.
Make the home safe to avoid accidents.
Practice good posture.
Osteoporosis

Use good body mechanics when lifting objects (e.g. bend the knees
instead of the back).
Do back exercises to improve posture.
Wear rubber-soled, low-heeled shoes that grip well.
Dont lift heavy objects.
Avoid using a stool or bending over.
Put items frequently used within easy reach.
Use handrails when going up and down stairs.
Hormonal Replacement Therapy (HRT) for menopausal women as
prescribed.
Postural Hypotension (PH)

Get out of bed slowly and in stages.

Sleep with head of bed elevated several inches.
Have a daily fluid intake of 2 to 3 liters.
Avoid hot showers or baths, may cause venous dilatation thereby,
venous pooling.
Avoid straining at stool. This may cause fall of BP
Avoid bending down and suddenly standing up again.
Rest for 60 minutes after meals.
Postural Hypotension (PH)

Avoid hyperventilation. This lowers the BP.

Exercise regimen must be recommended.
Use thigh-length elastic stockings to reduce venous pooling.
Avoid prolonged standing.
Heed warning signs of PH (e.g., dizziness, faintness, visual
disturbances)
Pharmacotherapy: Fludrocortisone (a mineralocorticoid that
promotes retention of water and sodium)
Hypertension

Encourage stress reduction and relaxation.

Encourage exercise such as swimming and walking.
Encourage healthy diet (fresh fruits, rice, vegetable).
No weightlifting.
Quit smoking, no alcohol,
Reduce intake of saturated fats.
Reduce salt intake to 1 to 6 gm per day.
Take prescribed medications at regular basis.
Elder Abuse

There are many types of abuse used against the elderly. They
include:
Psychologic abuse such as instilling fear, threatening or making the
elderly perform demeaning tasks,
Physical abuse such as hitting, slapping, or burning.
Financial abuse such as taking their money or forcing them to sign
over their assets.
Neglect such as withholding food, medications or basic care.
Elder Abuse

Infringement of personal rights such as restraining for long periods of

time against their will or isolating them from normal social
interactions.
Sexual abuse
The perpetrator of abuse is usually the spouse or the children of the
victim. Caregivers who abuse their elderly family members are often
middle-aged or older or have emotional problems such as
alcoholism or substance abuse.