Geriatric Medicine in Bangalore

It is common to fall and get injured, but older adults are very vulnerable to this. The risk of falling increases as we age, and the elderly suffering from debilitating, chronic, and long-term health conditions are prone to collapsing. It is estimated that the risk of a fall increases significantly after 65, and more than 50% of adults above 80 years of age encounter this incidence at least once a year.

Not all falls are dangerous, but they can cause bone fractures, restrict movement, and impact their confidence and sense of freedom.

Many factors can trigger a sudden fall. If you have an aged person at home, making specific arrangements like making ample space to walk with support, removing obstacles in the middle of the house, and adjusting the beds’ height is crucial. It is also advised to arrange for grab bars near toilets and in the bathroom to avoid slipping and falling.

These following physiological factors trigger a sudden incidence of falls in the elderly.

Electrolyte Issues:

An electrolyte imbalance happens when the body stores too much or insufficient of certain minerals. Also known as electrolytes, these minerals dissolve in blood, urine, and other body fluids and power the body in many functions, including maintaining fluid balance, regulating heart rhythm, and supporting muscle and nerve function.

What Are the Types of Electrolytes?

Many electrolytes support multiple functions in the body. For example, sodium, potassium, calcium, chloride, magnesium, phosphate, and bicarbonate are responsible for the following:

• Calcium helps in the contraction and expansion of blood vessels and stabilizes blood pressure.
• Chloride maintains blood pressure and body fluids.
• Sodium maintains fluid levels besides regulating nerve and muscle functions.
• Magnesium plays a pivotal role in keeping bones and teeth healthy.
• Potassium is responsible for heart, nerve, and muscle functions. In addition, it aids in transporting nutrients into cells and supports metabolism.
• Phosphate supports skeletal, nerve, and muscle functions.
• In addition, bicarbonate is responsible for regulating essential alkaline compounds and blood pH balance.

What Causes An Electrolyte Imbalance?

More than half of the human body’s weight is contributed by water. It is held mainly by the blood and fluid in and around cells, known as fluid compartments, while kidneys, liver, tissues, and other organs keep adjusting the fluid levels by moving electrolytes in and out of cells. Health conditions like cardiovascular conditions, severe dehydration, eating disorders, cirrhosis, kidney disease, and prolonged use of medications can affect the electrolyte balance can cause electrolyte imbalance.

What Are The Symptoms of Electrolyte Imbalance?

Symptoms of electrolyte imbalance vary broadly. However, the common signs include:

• Confusion
• Constipation or diarrhea
• Severe fatigue
• Nausea and vomiting
• Numbness in feet, toes, and fingers

How Is Electrolyte Imbalance Diagnosed and Treated?

Electrolyte imbalance is diagnosed by blood and urine tests that check for the presence of various electrolytes.

This condition is treated by providing fluids and medicines via an intravenous route to restore electrolyte balance and rehydrate the body. In case of kidney failure, the patient would need dialysis.

If not treated promptly, electrolyte imbalance can lead to coma, seizures, and cardiac arrest.

Muscle Weakness:

Muscle weakness, also known as Sarcopenia, is a common, progressive age-related disorder that affects muscle mass and strength in the elderly. Sarcopenia presents with muscle weakness, loss of strength, and weight. Sarcopenia, if not addressed on time, can compromise the quality of life, making it tougher to perform even daily tasks. Patients suffering from Sarcopenia would require lifelong help and assistance, as they are prone to falls, fractures, and frailty.

What Are The Symptoms of Sarcopenia?

The most common sign of Sarcopenia is muscle weakness and loss of stamina. This further causes issues related to agility, climbing stairs, and walking and can also lead to difficulty in maintaining balance while standing. As the condition progresses, it shrinks muscle size.

What Causes Sarcopenia?

The common reason behind Sarcopenia is the aging process. It is normal to start losing muscle mass and strength in the 40s, but the muscles degenerate faster after 65 years of age. Besides aging, the other factors that trigger Sarcopenia include:

• Inactive lifestyle
• Obesity
• Diabetes
• COPD
• Kidney disease
• Diabetes
• Inadequate intake of protein

How Is Sarcopenia Diagnosed and Treated?

Sarcopenia is done after doing a detailed, thorough physical examination. The doctor would test for agility while walking, sitting, rising from the chair, the strength of the grip, etc., to understand the muscle strength.

Imaging tests, including Dual X-ray absorptiometry and Bioelectrical Impedance Analysis, are done to measure muscle and fat mass and density.

There is no specific treatment for Sarcopenia. Patients are advised strongly to lead a physically active lifestyle and follow a protein-rich healthy diet.

Dizziness or Vertigo:

Dizziness is a common occurrence in the elderly, which causes faintness, nausea, and unsteadiness while standing up. If it is severe and you feel that the room around is spinning, making you believe that you might lose consciousness, that condition is known as Vertigo.

What Are The Symptoms of Vertigo?

Vertigo can cause severe uneasy symptoms that can be quite scary to experience. Common among people above 60, it can interfere with their confidence levels and increase their dependence on others. If you notice the following symptoms, consult your doctor immediately:

• A sudden spinning feeling, even while standing still.
• A feeling of light-headedness
• Losing balance in a jiffy
• Feeling like you are floating in the air.

What Causes Vertigo In The Elderly?

Vertigo is often an inner ear problem that causes balance problems. However, in the elderly other factors include disturbances in the vision, severe inner ear infections, anxiety, poor circulation of oxygen, low levels of iron, sudden drops in blood sugar, and certain medications used for treating seizures, depression, and other psychological disorders.

How Is Vertigo Diagnosed and Treated?

Diagnosis of Vertigo includes a thorough physical examination and coordinating it with the results of various imaging tests. Your doctor would ask various questions to understand the frequency of Vertigo episodes, the length of each episode, medical history, etc.

Physical and imaging tests include Fukuda-Unterberger’s test, Romberg’s test, Head impulse test, Vestibular test battery, CT-Scan, and MRI.

The treatment for Vertigo depends on the severity of the condition. Medicines, including antibiotics, help in treating inner ear infections. Vestibular rehabilitation and physical therapy are recommended for strengthening the senses.

Surgery is performed if Vertigo is caused due to underlying conditions like a brain tumour or severe injury to the neck.

How To Prevent Vertigo Attacks?

• Always take some extra time to stand up and turn your head slowly
• Sleep with your Head in the elevated position
• Sit immediately as soon as you start feeling dizzy
• Squat instead of bending over completely while picking something up

Postural Hypotension:

Orthostatic hypotension, also known as postural hypotension, is a sudden drop in blood pressure while standing up. This occurs after getting up from the chair or bed and can cause immediate dizziness, lightheadedness, and fainting.

Occasional hypotension is expected in the elderly, but it’s time to diagnose and treat the underlying cause if it occurs frequently.

What Causes Postural Hypotension?

Postural hypertension is a common occurrence in the elderly aged 65 and above.

Orthostatic hypotension can occasionally be caused due to severe dehydration or prolonged bed rest after surgery. It can be treated. But, if you notice an older adult suffering from chronic postural hypotension, diagnosing the underlying health condition is essential.

The other reasons that can cause a sudden dip in blood pressure include cardiovascular conditions, neurodegenerative conditions like Parkinson’s disease, multiple system atrophy, Dementia, Lewy body syndrome, and amyloidosis, as these conditions can interfere with the blood pressure.

What Are The Symptoms Of Postural Hypotension?

The classical symptom of orthostatic hypotension is dizziness, which can last for a few minutes. Other signs include blurry vision, fatigue, fainting, lack of focus, and confusion.

How Is Postural Hypotension Diagnosed and Treated?

Postural hypotension is diagnosed by regular blood pressure monitoring. In addition, your doctor may ask for blood tests to evaluate blood sugars, hemoglobin, and other factors to diagnose underlying reasons.

Other tests include ECG, EKG, Stress test, and Tilt table test to evaluate the total functioning of the cardiovascular system and blood pressure regulation.

Lifestyle changes can treat postural hypotension, like eating healthy, drinking more water, and staying active. In addition, doctors may prescribe medication that can increase blood pressure to treat the condition.

Syncope:

Syncope or fainting is a medical condition where there is a sudden, temporary disruption in the amount of blood that flows to the brain. In most cases, this is a harmless, short-lived occurrence that can cause fainting. The most common reasons behind Syncope are sudden dip in blood pressure, drop in the heart rate, and also changes in the supply of blood in the body.

What Are The Types of Syncope?

Sudden and frequent fainting in the elderly is a sign of a serious health condition that would need immediate medical intervention. There are various types of Syncope, including:

• Vasovagal or Neurocardiogenic Syncope
• Situational Syncope
• Orthostatic Syncope or postural hypotension
• Cardiac Syncope
• Neurologic Syncope
• Postural Orthostatic Tachycardia Syndrome

What Are The Symptoms of Syncope?

The most common symptoms of Syncope include:

• Blacking out
• Feeling lightheaded and dizzy
• Drowsiness
• Sudden falls for no reason
• Fainting while walking, working out, and eating
• Feeling unstable and weak to stand up
• Blurred vision and tunnel vision
• Frequent headaches

What Causes Syncope?

Syncope can be caused due to multiple reasons. The most common reason is a sudden drop in blood pressure, which in turn reduces the blood flow to the brain. Dehydration, stress, fear, pain, and anxiety can also make one lose consciousness briefly.

In cardiac patients, Syncope is triggered due to abnormal heartbeat, hypertrophic cardiomyopathy, myocardial ischemia, valve disease, stenosis, and heart failure. Neurologic Syncope is caused by a seizure, stroke, or Transient Ischemic Attack (TIA).

How Is Syncope Diagnosed and Treated?

If you are suffering from Syncope, see your doctor immediately. The condition is diagnosed by running various tests to evaluate the complete functioning of the heart. The tests include a blood test, ECG, EKG, Tilt table test, autonomic reflex testing, and ambulatory monitor.

The treatment protocol includes medication to improve blood flow to the brain. Lifestyle changes include eating a healthy diet, staying away from smoking and alcohol, and maintaining caution while standing up.

In patients suffering from severe cardiac disorders, surgical intervention and placement of a pacemaker will bring down the frequency of Syncope.

How To Attend a Patient With Syncope?

Make sure the patient is breathing normally.

Make the patient sit quietly for 10 to 15 minutes.

Let the patient sip on cold water before seeing the doctor.

Anorexia in the elderly subjecting to weight loss

Anorexia of Aging is a common condition in the elderly where they find it difficult to eat and digest adequate food to meet their nutritional requirements. If you have a loving, older adult in the family suffering from anorexia of aging, presenting symptoms like a significant decrease in appetite, talk to the geriatric specialist immediately.

What Causes Anorexia of Aging?

Many factors can contribute to loss of appetite in old age. One of the critical components is a decrease in the ability to smell and taste, which can adversely affect the food ingested. The functioning of the taste buds decreases with age, and if the individual is on medications and fighting chronic conditions, there is a high chance of losing interest in food.

Another significant contributor is poor gastrointestinal function. It is often noticed that elderly individuals suffer from decreased digestive ability in the stomach, which causes severe gastritis. Certain drugs, too, play a crucial role in delaying gastric emptying.

Physical and psychological factors like battling chronic conditions, depression, anxiety, and social isolation can also directly influence a lack of interest in consuming food.

What Are The Effects of Anorexia of Aging?

Anorexia of aging poses a significant threat to the overall well-being of an older adult. It increases the chances of frailty, sarcopenia, and syncope and can aggravate other health conditions.

How Is Anorexia of Aging Diagnosed and Treated?

If your loved one refuses to ingest food regularly or has significantly reduced the intake, talk to your doctor immediately. Blood tests and physical examination will help in finding out the cause.

Anorexia of aging is treated by making significant dietary modifications. Encourage your elderly parent or family member to try homemade, authentic, or even new dishes, like you would with your child. Spend quality time at the dining table and remind them of their accomplishments that would boost their confidence and eat.

Ask your doctor for medications that trigger appetite and supplements to meet their nutritional needs.

Advanced Care Planning

Advanced Care Planning is a niche area in geriatrics that will lay down a custom-made treatment template for each individual elderly patient, depending on their health condition. While few patients witness the faster deterioration of their health, others might battle it for months to years with the help of medications and medical and family support.

Whichever is the case, advanced care planning lays emphasis on providing optimum health care and all needed support that will make them lead comfortable and pain-free life. If you have an elderly parent or family member requiring round-the-clock assistance and medical support, talk to your doctor about the available options.

• Seek professional help in planning the type of care, support, and assistance the elderly individual might require.
• Stick to nutritional diet charts
• Spend quality time and ensure emotional support
• Keep up with doctor’s consultations
• Follow modifications in the medications and monitor vitals regularly

 For more information on Geriatric Care, talk to your experts.