Geriatric Syndromes

• Definition

  • Syndromes or changes that, though not unique to the geriatric, are increasingly common, concerning and present in variable ways
  • Think of these as general considerations -- not hard and fast rules
• Gait and Balance

  • Decrease in stride length
  • Slower gait
  • Decreased arm swing
  • Body sway when standing stationary
• Pulmonary

  • Decreased respiratory strength and vital capacity
  • Decreased chest wall compliance
  • Chest does NOT rise as much
  • Decreased maximal breathing capacity --> increased residual volume
  • Maximal breathing capacity = how much you can inhale and push out
  • Therefore increased residual volume
  • Ex: when they get winded, it takes them longer to recover [coughing]
• Cardiovascular Complications

  • Decreased baroreceptor activity --> increase orthostatic HTN
  • Baroreceptor -- balancer
  • Decreased cardiac output
  • Decreased coronary perfusion
  • Increased vascular resistance
  • Increased afterload
• Blood Pressure Increases with Age

  • Especially systolic
  • Tight control may improve dementia outcomes
  • Thiazides a reasonable approach --> targeting BP
  • NOT diuretic effects
  • Caution w/ hypokalemia, hyperglycemia, hyperuricemia
  • All increase incidence in elderly
  • CCB's -- great for those w/ atherosclerotic angina
  • Decrease ADRs
  • BB -- can become problematic (fatigue, falls risk, bradycardia)
  • Including in those w/ obstructive airway disease
• Heart Failure

  • Common in geriatrics
  • Digoxin usage more prominent
  • This population is more susceptible to arrhythmias
  • PK/PD changes increase risks of using Digoxin
  • Caution w/ toxic effects!
  • Caution w/ hypokalemia, hypomagnesemia, hypoxemia (from pulmonary disease), and coronary atherosclerosis
  • Increased risk of delirium, visual changes, endocrine abnormalities
• Arrhythmias

  • Increased risk of arrhythmias d/t:
  • Decreased hemodynamic reserve
  • Increased frequency of electrolyte abnormalities
  • Increased prevalence of coronary disease
  • PK/PD changes
  • Increased half-life of durgs
  • Altered clearance of drugs
  • Increased sensitivities to changes
  • Decreased compensatory functions
• Osteoarthritis (OA) and Rheumatoid Arthritis (RA)

  • OA is very common in geriatrics
  • Treatment includes anti-inflammatories as mainstay
  • NSAIDs
  • Geriatrics more susceptible to toxicities --> doesn't mean you can't use, just monitor more carefully if chosen
  • Caution w/ GI irritation and bleeding
  • Renal damage -- may be irreversible
  • Corticosteroid
  • Dose and duration-dependent risks during osteoporosis
• Glaucoma

  • More common in elderly
  • Treatment is generally the same as younger pts
• AMD

  • Age-related macular degeneration (AMD) most common cause of blindness

  --> damages macular causing it to lift and pull away from base

  --> rapid and severe loss of ventral vision 

  • Account for 10-15% of the AMD cases but causes 90% of all cases of severe vision loss
  • "Dry"
  • Most common
  • NOT vascular related, atrophy
  • Seen in 80-90% of the cases
  • Small white or yellowish deposits, called drusen, form on the retina, beneath the macula
  • Causes it to deteriorate or degenerate over time
  • Neovascular or "Wet"
  • Intrusion of new blood vessels which break/bleed/leak
• AMD (cont.)

  • HUGE risk factors
  • Oxidative stress is a key factor
  • Antioxidants may prevent/delay onset of AMD
  • Vit C, Vit E, beta-carotene, zinc oxide, cupric oxide, etc.
  • Carotenoids (lutein, zeaxanthin, omega-3-long-chain polyunsaturated fatty acids)
  • Neovascular causes treated w/ vascular endothelial growth factor (VEGF) antibodies
  • Some agents used to treat AMD -- injected intro vitreous for local effect
  • Bevacizumab (Avastin) -- off lablel
  • Ranibizumab (Lucentis) and (Susvimotm -- ocular implant)
  • Afibercept (Eylea)
  • Pegaptanib (Macugen)
  • Brolucizumab (Beovu®)
  • Faricimab-svoa (VABYSMO®)