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Certain changes generally occur in the human body in conjunction with the aging process. These changes include:
- Gradual decline in glomerular filtration rate
- Gradual decline in hepatic oxidative metabolism (phase I)
- Increase in proportion of body fat
- Reduction in muscle mass
Because of these changes, the older adult is subject to the development of what are termed “geriatric syndromes” or “geriatric conditions.” Examples of these geriatric syndromes include falls, delirium, urinary incontinence, and pressure injury.
Some medications can increase the risk of geriatric syndromes through a variety of mechanisms. A medication that causes blurred vision or dizziness can increase the risk of falls, for example. A pharmacist who works with older adults should be aware of geriatric syndromes and how medications may affect these syndromes.
Reducing the risk of falls, and reducing injury from falls, are important public health goals because of the impact on the elderly and the cost of falls. A variety of resources are available on this topic.
STEADI – The Centers for Disease Control and Prevention has this website on Stopping Elderly Accidents, Deaths, and Injuries. Included are tools and educational materials for health professionals and patients.
Delirium, an acute decline in attention and cognition, is a common, life-threatening and potentially preventable clinical syndrome among persons who are 65 years of age or older. The development of delirium often initiates a cascade of events culminating in the loss of independence, an increased risk of morbidity and mortality, and increased health care costs. (1)
(1) Inouye SK. Delirium in older persons. N Engl J Med 2006;354;1157-65.
The Hospital Elder Life Program has a variety of tools and resources to help clinicians identify and manage delirium in hospitalized older adults.
National Institute for Health and Care Excellence. Clinical Guideline 103. July 2010. Delirium: Prevention, Diagnosis and Management.
NHS Education for Scotland. Think delirium. 2014.
The most common definition of frailty is an age-associated, biological syndrome characterised by decreased biological reserves, due to dysregulation of several physiological systems, which puts an individual at risk when facing minor stressors, and is associated with poor outcomes (ie, disability, death, and hospitalisation). The prevalence of frailty in people older than 65 years is high, ranging from 7 to 16.3%. The prevalence increases with age, and is greater in women than in men. (2)
(2) Rodriguez-Manas L, Fried LP. Frailty in the clinical scenario. Lancet 2015;385:e7-e9. (open access article - free registration required).
The frailty.net website has a variety of resources on frailty.
The older term “pressure ulcer” was replaced in April 2016 with the newer term “pressure injury.”
A pressure injury is localized damage to the skin and/or underlying soft tissue usually over a bony prominence or related to a medical or other device. The injury can present as intact skin or an open ulcer and may be painful. The injury occurs as a result of intense and/or prolonged pressure or pressure in combination with shear.
Pressure injuries are more common in persons who have impaired mobility and spend time in a wheelchair or in bed. Additional risk factors, such as frailty or impaired nutrition, may also contribute.
The National Pressure Ulcer Advisory Panel has a variety of useful resources on this topic.
Another list of useful resources on pressure injuries is available from the Partnership for Patients.