Geriatric Syndromes Require Special Care

As we age, we become more likely to develop several co-occurring health problems that feed each other. These are called ‘geriatric syndromes’

By Deborah Jeanne Sergeant

Each individual’s health differs; however, “geriatric syndromes” describe a group of health concerns experienced by many older adults that often have multiple causes and involve different bodily parts and systems.

These can include continence, sleep issues, cognitive issues, falls, osteoporosis and weight loss/frailty.

For an older adult, incontinence could contribute to sleep issues and falls. Or weight loss and frailty from poor eating is often linked to osteoporosis, which would worsen the effect of a fall and lead to further frailty after a hip fracture.

Geriatrician Robert E. Stall, owner of Stall Senior Medical in Amherst, said that a general practitioner or internist may not connect the syndromes as causal or even relational, but view them as separate conditions.

“Geriatrician training is geared toward complex medical conditions, multiple medication use and multiple medical problems,” Stall said. “Geriatrics takes a holistic look at a patient. As far as a syndrome, it’s a constellation of symptoms that can often be caused by many different things. It’s important to tease out what the symptoms are and what the patient’s usual baseline is and go through what might be potential cases of that syndrome.”

Treating them as not related may reduce the overall effectiveness of the care provided to the patient. It can also contribute to secondary issues as more medications bring more side effects, according to Stall.

Unfortunately, not every senior can see a fellowship-trained geriatrician like Stall. He said that internists and family medicine doctors with added geriatric qualifications can be next in line.

With more providers looking for measurable symptoms like falls and osteoporosis, non-geriatricians can help patients prevent more complicated medical issues and, as needed, refer patients to geriatricians for more complex cases, where conservative measures seem less effective.

Stall offered the symptom of confusion as an example. He said he has treated numerous older patients who have experienced it along with anxiety or sudden significant decline in physical ability and energy level, all from a medication issue.

“Different people react differently to different medication,” Stall said. “I look at when did the symptoms start? Is there a correlation?”

Even over-the-counter pain medication with a sleep enhancer, such as Tylenol PM, can contribute to issues such as poor balance, constipation and urinary retention.

“If the change is in a short time frame, it’s almost certain something has happened,” Stall said. “Falls are multi-faceted issues as well.”

The factors can include cataracts, muscle weakness and slower reaction time. He added that the outcome of falls can also relate to many other health concerns, such as broken bones because of osteoporosis, bedsores and further frailty.

This can involve many aspects of care, too, such as reducing environmental hazards, balance improvement programs, eye exams, and bone density testing.

“Younger people have a much bigger buffer between being well and sick,” Stall said. “It’s rare that a 20-year-old with pneumonia will be confused. The older person takes less of an insult to cause cognitive changes and fatigue than a younger person.”

While some of these issues may be part of the normal aging process, geriatric syndromes aren’t, according physician Anjeet K. Saini, assistant professor of medicine at UBMD Internal Medicine, division of geriatrics and palliative medicine.

While doctors can’t manage and mitigate every aspect of a patient health — especially if the patient manifests complex, inter-related health issues — Saini wants more providers to improve quality of patient life in general.

“When we get older, we’re at greater risk for disability that interfere with activities of daily living,” she said. “In geriatrics, activities of daily living are the core principles we need to survive. Once ADLs are decreased, we have more disabilities.”

Someone with little ability to perform ADLs tends to have less independence. Saini said that maintaining core functions improve quality of life, but most general practitioners don’t receive enough geriatric training to recognize signs of reduced ADLs.   

“It’s always worth having a geriatrician evaluate people,” Saini said. “They treat the medical issues but also the big picture like economic, social, and the whole patient.”