Steps to Take for a Healthy and Active Old Age

Geriatric medicine can be defined as the health and diseases of the elderly. It addresses problems that emerge as individuals age, including internal, physical, mental, psychological and social issues, from a holistic perspective, and focuses on improving overall health status. It manages the diagnosis, treatment and follow-up of diseases that occur in the elderly through a single channel. But why is there a need for a specialty dedicated solely to the elderly? Which symptoms or reasons require a visit to a geriatrician? Doç. Dr. Birkan İlhan, Internal Medicine and Geriatrics Specialist at Liv Hospital, answers.

What is the geriatric age definition?
Geriatric age is defined as 65 years and above. On the other hand, defining aging solely by chronological age is not correct; the individual's biological, psychological and social status matters for aging.

Why is there a need for a specialty dedicated solely to the elderly?
With aging, the number of chronic diseases and consequently the number of medications used increases. For example, when a person has internal diseases such as hypertension, heart disease and diabetes, and these are combined with dementia, depression, balance and gait problems, rather than visiting separate specialties, the person's issues are treated and followed up in a single specialty—geriatrics. Additionally, changes in the body make elderly individuals more susceptible to certain conditions. These situations, which are not commonly seen in young and middle-aged adults and, even if they occur, do not affect daily life, have a very negative impact on an elderly person's quality of life and overall health. These are "geriatric syndromes"—elderly diseases such as falls, urinary incontinence, forgetfulness, loss of appetite, nutritional deficiency and sleep problems. Because a geriatrician is aware of these elderly diseases and all adverse conditions an elderly person may encounter, they evaluate and undertake the follow-up and treatment of the elderly patient from a holistic perspective that encompasses these issues.

Which symptoms or reasons require a visit to a geriatrician?
Individuals with certain age-related diseases, namely "geriatric syndromes," elderly people with numerous chronic diseases and those taking numerous medications can consult a geriatrician for evaluation and follow-up by a single specialty. Likewise, at the end of life, bed-bound patients can be followed by a geriatrician. It is very important to guide the patient and caregivers through the final stage of life in comfort.

What are geriatric syndromes?
Malnutrition (inadequate nutrition, weight loss and loss of appetite), swallowing difficulty (dysphagia), reduction in muscle strength and mass; accompanied by slowing in gait (sarcopenia), balance disorders, falls, fractures, polypharmacy (use of numerous or inappropriate medications), urinary incontinence, constipation, sleep problems, forgetfulness, depression, vision and hearing problems.

What are the chronic diseases commonly seen in elderly individuals?
Hypertension, diabetes, cardiovascular diseases, cerebrovascular diseases, Alzheimer's disease and other types of dementia, Parkinson's disease, cancers, osteoporosis and infections (urinary tract infections, pneumonia, etc.) are diseases commonly seen in elderly individuals. Individuals with these and similar diseases can consult a geriatrician for follow-up and treatment.

Should they visit even if they have no disease?
Yes, healthy elderly individuals can also consult a geriatrician "to age healthily." Early detection and treatment of diseases is important for a vigorous and active elderly period. Bone density screening, muscle mass screening (though not widely known), cognitive tests, balance tests, cancer screening (breast, colon, etc.), eye and hearing examinations can be performed to detect problems early and provide treatment before they progress. Furthermore, there are important interventions including age and elderly-specific healthy eating recommendations that protect the patient's cardiovascular health, strengthen muscles, ensure proper functioning of the digestive system and maintain bone health. Geriatric nurses, physiotherapists, psychologists and nutritionists who work with the geriatrician are also important members of this team.

Are there diseases in the elderly that are overlooked and missed?
Every new symptom in an elderly individual should be taken into account and should not be seen as a natural consequence of aging. New symptoms are often not signs of aging but rather signs of disease or side effects of medications being used. For example, infections in the elderly often do not present symptoms as they do in young people. An elderly person experiencing new onset confusion may be thought to have a brain problem, but the cause may actually be a urinary tract infection or pneumonia. When the infection is treated, the confusion completely resolves and the patient regains their former mental health. Infections can only cause subtle symptoms such as loss of appetite, reduced mobility and lethargy in daily life, which may be overlooked as being "due to old age." In elderly individuals, symptoms such as difficulty urinating, constipation and dry mouth can sometimes be a side effect of a medication, and these complaints can completely resolve when that medication is discontinued. With every new or suddenly worsening symptom, elderly individuals' relatives should be vigilant and not forget that it could be a sign of disease or medication side effect.

What steps can be taken to facilitate the lives of elderly individuals and improve their health status?
First, awareness is very important. If we learn about and become aware of elderly problems that await our elders beforehand, we can recognize them early and take precautions. In this age group, screenings, health checks and vaccinations should not be neglected. Since elderly individuals cannot express themselves well, undetected and progressive diseases may occur. For example, elderly individuals have a high pain threshold and an elderly person may even have a heart attack with no symptoms or signs. An elderly person with mild loss of appetite, weight loss and thinned arms and legs may view this as normal, but these are actually signs of sarcopenia and malnutrition that require treatment. For these reasons, examinations and tests in geriatrics are conducted more comprehensively to assess, detect and treat the complex and interacting problems of the elderly. There are certain vaccines that must be administered at regular intervals in individuals 65 years of age and older, just as in infants. These include pneumonia, flu, shingles, tetanus and, in certain special cases, meningitis vaccines.

In addition to health checks, there are situations that require care in the general living environment. For example, preventing falls in this age group is very important. One in three elderly individuals falls once a year. As a result, significant fractures such as hip fractures and life-threatening situations can occur. An elderly person who has fallen, even if they experience no health problems, may become fearful of falling again and consequently hesitate to move, leading to a more sedentary life—a situation we geriatricians never want to see. Therefore, fall prevention measures should be taken at home; among these are non-slip mats in bathrooms, grab bars when rising from toilets, well-lit pathways to the toilet at night, absence of slipping carpets and rugs, absence of items such as cables and toys that could trip feet, and colored strips at the edges of stair steps.