According to 2010 data, the number of elderly individuals (65 years and above) worldwide constitutes approximately 8% of the population. While the rate is higher in developed countries, it is very low in underdeveloped countries (16% vs 3%) (2010 World Population Data Sheet). Thanks to the developing health facilities in our country, the number of elderly people is increasing day by day. While individuals aged 65 and over constituted 4.2% (2.2 million) of the entire society in 1985, today this rate is around 8.1% (6 million) (T.R. Başkabanlık Turkish Statistical Institute, 2015). This number will increase further in the future (Figure 1).
With increasing age in society, the number of chronic diseases increases, resulting in fatigue, weakness, depression, physical disability, addiction, It causes many problems such as drug use, decrease in quality of life, economic and social problems, etc. In fact, when it comes to geriatric care and follow-up, it is aimed to combat all these problems, as well as to increase the quality of life and to enable the individual to live his life independently as long as he lives.
Problems seen in older ages (geriatric syndromes):
- Neurological diseases (Stroke, dementia, movement disorders)
- Depression
- Cardiovascular diseases
- Cancer
- Multiple chronic diseases
- Polypharmacy (using multiple medications and related side effects)
- Infections
- Rapidly developing medical problems and the resulting delirium (sudden cognitive and behavioral impairment)
- Eating disorders and difficulty swallowing
- Immobility, dependency and fragility due to decrease in muscle mass and strength
- Osteoporosis
- Balance disorders, falls and fractures
- Gastrointestinal problems (constipation, etc.)
- Pressure sores
- Sleep disorders
- Vision and hearing problems
- Urinary incontinence
- Oral and dental problems
Then all these possible problems should be reviewed during an effective geriatric evaluation. Detailed tests are needed for this. In this article, Comprehensive Geriatric Evaluation, which is performed during the detailed geriatric examination, clinical evaluation of existing problems and geriatric The approach to syndromes will be explained.
Comprehensive Geriatric Evaluation
Geriatric evaluation; It combines detailed interrogation, physical examination and numerous test results. During this time, physical, functional, social, environmental, cognitive and psychological evaluation is performed. During questioning, older individuals may not be able to express many problems due to age or cognitive impairment. On the other hand, many individuals do not wish to express their problems due to social reasons. In this case, physicians have more work to do, and it is necessary to be more meticulous during geriatric evaluation.
With comprehensive geriatric evaluation, life expectancy and even quality of life are prolonged, functional capacity increases and dependency decreases, the frequency of hospitalization decreases and the individual's health improves. expenses are decreasing.
During Comprehensive Geriatric Evaluation;
·Questioning current medical problems and physical examination (Approach to medical problems)
· Cognitive evaluation (Are there signs of dementia?)
·Questioning depression
·Evaluation of daily living activities (How self-sufficient is he/she?)
·Feeding and swallowing Evaluation
·Evaluation of vision and hearing
·Evaluation of muscle strength and muscle mass
·Questioning physical activity/exercise status, balance problems and falls
·Questioning urinary incontinence and its subtypes
·Evaluation of the presence and risk of pressure sores
·Evaluation of sleep patterns
·Using drugs and their possible side effects and interactions questioning
·Questioning the vaccination of the elderly
Medical questioning and physical examination
Detailed questioning of the individual's current complaint After the medical history, medications used and habits are learned, family history and detailed physical examination, the social environment in which the patient lives is questioned. As mentioned at the beginning, the questioning and physical examination of many people over the age of 65 is more difficult and takes more time than the evaluation of a normal individual. Physics mua Detailed neurological evaluation, as well as internal examination, is important during recuperation.
Cognitive evaluation
The purpose of the cognitive examination is to measure the individual's awareness of the place and time he is in, what his reasoning, attention, memory, perception and application abilities are. To evaluate how much it protects. As cognitive impairment occurs, people begin to lose these abilities. The most frequently used examination in this regard is the Mini Mental Assessment Test. In addition, some auxiliary tests are used and, when necessary, a detailed Neuropsychological evaluation test is performed. When further examinations are required, we always work together with the Department of Neurology.
Depression
Depression occurs frequently in older ages and can seriously impair the quality of life. On the other hand, it is one of the important causes of dementia. It is very important to question depression in individuals over the age of 65 and treat it once diagnosed. For this purpose, the Geriatric Depression Scale is included in the Comprehensive Geriatric Evaluation. During the treatment phase, we work together with the Department of Psychiatry, especially in chronic patients.
Daily life activity
The most important indicator of quality of life is that a person is self-sufficient and does not depend on others at any stage of his life. For this reason, the individual's daily life activities (eating, hygiene, bathing, going to bed and getting up, toilet and bath activities) are questioned during the Comprehensive Geriatric Evaluation. Instrumental daily living activities are also questioned (using the phone, taking medications, money accounting, travel, cooking, room cleaning, etc.).
Evaluation of nutritional status
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Eating disorders are a common problem in older ages. In particular, skipping meals (going to bed late and waking up late, and the belief that it is okay to eat less) causes medical problems to increase even more. The most up-to-date data for today is to consume 30-34 kcal per kilo per day and 1.2 grams of protein per kilo in advanced age. However, there are misconceptions that consuming fewer calories and protein is necessary for a healthy life and longevity. Medical stress increases with advancing age, muscle breakdown accelerates, and the medical problems the individual struggles with increase. �r. For this reason, nutrition, which is a very dynamic process, should not be interrupted, and it is important to consume 3 meals, each containing as much protein as needed. A comprehensive geriatric evaluation includes a test that evaluates nutritional status in detail. Meanwhile, swallowing disorders, which can accompany many neurological diseases, are also questioned. Swallowing disorders can cause food to get into the respiratory tract, causing serious lung infections, hospitalization and even death. Like the main nutrients (carbohydrates, protein and fat), minerals and vitamins, called micronutrients, are also important. Their deficiencies are also questioned through laboratory examinations. When B vitamins (especially B6, B12), which are effective in neurological functions, vitamin D in bone and muscle metabolism, iron, which is one of the most important causes of anemia, and other elements in the blood (sodium, potassium, calcium, phosphorus, magnesium, etc.) are low, the causes should be investigated and treated. In this regard, the consumption of foods rich in minerals and vitamins by the individual may also be questioned. For individuals who cannot meet their daily nutritional needs due to their current medical condition, support can be provided with medical nutrition products when diet lists fail to achieve success. For those with swallowing disorders, this treatment is performed with tubes extended into the stomach or intestine. In temporary applications, tubes extended from the nose to the stomach are used, and in longer-term applications, nutrition is provided through tubes extended from the abdominal skin to the stomach or intestine.
Evaluation of muscle mass, muscle strength and physical activity
After the age of 40, muscle mass decreases in our body. In addition, muscle strength also decreases. There are many reasons for this. This process accelerates as medical problems increase with age, and factors such as joint problems, obesity, sedentary lifestyle and depression further increase muscle loss. Loss of muscle mass and strength and the resulting decrease in physical activity are called sarcopenia. We have previously stated that the factor that most impairs the quality of life in older ages is addiction. Sarcopenia is the leading cause of addiction. Comprehensive geriatric evaluation includes measurement of walking speed and muscle strength. During physical examination Measurement of l and leg circumferences also gives an idea about muscle mass. Effective nutrition (especially replacing daily protein needs), measuring vitamin D levels in the blood and treating them when they are low, and a daily exercise plan are included in the fight against individuals with low muscle mass and muscle strength. Among the treatment methods, amino acids (leucine and hydroxymethyl butyrate), which have been shown by some studies to increase muscle mass, are also used.
Comprehensive Geriatric Evaluation also includes physical activity questioning, walking speed measurement, balance tests and determination of fall risk. In this way, taking some precautions comes to the fore, and aerobic and stretching exercises can be planned during the day. We are working together with the Department of Physical Medicine and Rehabilitation on this issue.
Urinary incontinence
Urinary incontinence is quite common in individuals over the age of 65. It is a common medical problem. There are many reasons. Often there are multiple reasons together. When the causes are considered separately, urge incontinence (hyperactive bladder), which causes sudden urgency and subsequent urinary incontinence, incontinence after laughing and sneezing (stress incontinence, is common in women), accumulation of large amounts of urine in the bladder and overflow incontinence as a result of the bladder muscles not working in the course of some neurological diseases, Reasons such as prostate enlargement in men and secondary urine accumulation in the bladder, inability to empty easily and subsequent incontinence, etc. can be listed. In such cases, the history is first questioned thoroughly (for differential diagnosis), the treatment of internal problems and medications are reviewed (diabetes, diuretic treatments), and urinary tract infections must be investigated. When all these problems are excluded, a urological evaluation is performed. The Department of Urology performs some imaging and urodynamic examinations in this regard.
Assessment of the risk of pressure sores
Those who spend a significant part of the day in bed or In individuals who cannot get up at all, reducing the pressure on the surfaces in contact with the bed during care (with air mattresses or special medical beds), reducing moisture on the skin, frequent positioning and in-bed movement.
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