Guidelines for Treatment of Elderly Diseases

Hello. I’m Dr Rajiva Gupta. I’m a senior consultant in internal medicine at Ashok Vihar and Fortis Hospital, Shalimar Park. My special areas of interest are diabetes and care of the elderly.

Now talking about care for the elderly, the branch of medicine that deals with the care of the elders is called Geriatrics anthology. The elderly patients present peculiar problems. They present not just discreet conditions, but with discreet syndromes. A syndrome is a constellation of symptoms and signs. In common, they are called the geriatric syndromes. The common geriatric syndromes are false, impaired cognition, deficiencies in a hearing, difficulty in vision, delirium. These syndromes are important because we have to investigate several different causes. For example, if the patient falls, it is not necessary that he may be having weakness in his legs. It is highly possible that the patient will be suffering from an acute infection or from some electrolyte imbalance or from CVA or cardiovascular problem. The patient is having disorientation, he is not oriented, he may have necessarily, he may be having, that he is having infection of the brain, he could as well be having electrolyte imbalance or any infection or a cardio-vascular problem. It means that the syndromes present, similar syndromes present with different types of illness in the elderly. The reason is that the physiological reserves of the elderly are just on the borderline and any acute insult that results in these syndromes. The approach to geriatric patients is slightly different from the way we approach people of other age.

So there are two components, one is the Curative component and another is comfort, or the palliative. That depends much on the functional ability of the patient. So if you have got an elderly person, above 80 years, he does regular exercise, enjoys his life, goes out for walks, the treatment of any condition in such a patient would be on the lines the management is done for a younger or a middle aged patient. Whereas, on the other end, if the patient is 70 years or 75 years, and he suffers from a problem, he is immobile, confined to bed, he is not able to take care of his own daily needs. For such patient, the aim would be to have a comfort care. So, the treatment of the elderly has to be individualized and surprisingly, there are not many guidelines which are available for treatment of elderly in different, for different medical conditions. SO the treatment for each individual has to be individualized, considering his individual circumstances. For example, if we take a very common problem like sugar, and we call that, there is a parameter called the Glycosylated hemoglobin, so we say that glycosylated hemoglobin for a normal should be less than 7% or less than 6.5 %. Bit for the elderly, because they may be having other illnesses, they may be having kidney disease or may be living alone in the house, they may not be able to take care, so in such patients, we will not go in for a very strict control, we’ll go in for a modest control, where the range may be say, around 8 or 8.5.

As physicians, we need to be aware that the number of elderly people is increasing, we need to be aware about their special needs, we have to give time once they come to our clinic and we have to define their problems and treat them accordingly.

I will be most willing and happy to answer to any questions, which can be approached through the lybrate website or they can seek consultation by telephone or physical consultation.