Geriatric care

A three-article symposium

Symposium coordinator

T. S. Dharmarajan, MD
Associate Professor of Medicine
New York Medical College, Valhalla
Chief, Division of Geriatrics
Director, Geriatric Medicine Fellowship Program
Acting Director, Department of Medicine
Our Lady of Mercy Medical Center
Bronx, New York

VOL 113 / NO 5 / MAY 2003 / POSTGRADUATE MEDICINE

• INTRODUCTION TO THE SYMPOSIUM. By T. S. Dharmarajan, MD
• MANAGING THYROID DYSFUNCTION IN THE ELDERLY: Answers to seven common questions. By Rajesh Mohandas, MD, Krishan Lal Gupta, MD
• DEFINING DIFFUSE LEWY BODY DISEASE: Tetrad of symptoms distinguishes illness from other dementias. By Jonathan T. Stewart, MD
• THE GROWING PROBLEM OF PRESSURE ULCERS: Evaluation and management for an aging population. By T. S. Dharmarajan, MD, Shamim Ahmed, MD

Trends in aging show that the fastest growing segment of the US population is older than 65 years and that a significant number of the elderly are older than 85 years (1). In this context, caring for even centenarians is no longer a rarity; my oldest patient came to me for care at age 103 and lived to be 108. For this population, health status appears to be the major determinant of quality of life, although economic security, housing, and transportation also are important (1).

Are we prepared for the task of caring for geriatric patients? Unfortunately, we are not. Despite the "maturing" of the field of geriatrics and the dissemination of knowledge through training, books, journals, and courses, we will not be adequately prepared for years to come. The dearth of practicing and academic geriatricians (2) will place the responsibility for geriatric care largely on primary care physicians.

To prepare primary care physicians for this task, we offer a symposium that focuses on a sample of complex but common geriatric problems. Broadly, manifestations in older adults may be related to age (physiologic) or to disease (pathologic) (3). This symposium focuses primarily on pathologic processes.

In the first article, Drs Rajesh Mohandas and Krishan Lal Gupta address and provide solutions to dilemmas associated with diagnosis and management of subclinical and overt hypothyroid and hyperthyroid states in the geriatric population.

In the second article, Dr Jonathan T. Stewart conveys insights on diffuse Lewy body disease, an underrecognized cause of dementia. Lewy body disease shares some characteristics with Alzheimer's and Parkinson's diseases, which are more common, but it has its own unique features that affect prognosis and management. Lewy body disease cannot be cured, but measures can be taken to maximize the quality of life for patients and their families.

In the third article, Dr Shamim Ahmed and I discuss prevention and management of pressure ulcers, which are commonly encountered in elderly persons with impaired mobility. The prevalence of pressure ulcers in a healthcare facility is a measure of the quality of care and is sometimes a basis for litigation.

In these scenarios and others, it is worth remembering that geriatric patients can always be provided care if not a cure. We hope these articles offer valuable suggestions to optimize the quality of care for your geriatric patients.

References

1. Schneider EL. Aging in the third millennium. Science 1999;283(5403):796-7
2. Mitka M. As Americans age, geriatricians go missing. JAMA 2002;287(14):1792-3
3. Dharmarajan TS, Ugalino JT. The physiology of aging. In: Dharmarajan TS, Norman RA, eds. Clinical geriatrics. Boca Raton, Fla: Parthenon, 2003:9-22

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