The Geriatrics (from ancient Greek γέρων Geron , German , old ' and ἰατρεία , medicine' ), and geriatric medicine or Old Medicine and Geriatrics , is the study of the diseases of aging people, the branch of medicine or gerontology , which deals with the deals with psychological, social, preventive, clinical and therapeutic concerns of the elderly. This applies above all to problems in the areas of general medicine and internal medicine , orthopedics , neurology and psychiatry ( geriatric psychiatry ).
As gerontology or age (s) sforschung science is called, which deals with aging processes in all its aspects, including psychological, social, economic, political and social. The word geriatrics was first used by Ignatz Leo Nascher , a doctor born in Vienna who later worked in the USA and published his textbook Geriatrics: The diseases of old age and their treatment as early as 1914 .
Geriatrics comes into play (and has come) to help the old, but above all the very old, to a better life. Either as gerotherapy (treatment of the elderly) or as geroprophylaxis (prevention of age-related diseases ). The geriatrician is mainly challenged when there are multiple illnesses ( multimorbidity ) that overwhelm the individual doctor of the respective medical discipline due to various interrelationships, but there must be the potential to achieve an improvement. Geriatrics is therefore to be understood as an interdisciplinary discipline ( interdisciplinarity ).
After completing their specialist training (for example, specialists in internal medicine, general medicine, psychiatry, neurology) in Germany, doctors can acquire the additional qualification "geriatrics" by working at a clinic authorized for further training for one and a half years. In other European countries there are higher-quality specializations up to specialist doctors.
The attempts to define the term "geriatrics" in German-speaking countries include different approaches:
A detailed conceptualization of what is geriatrics was undertaken in 1991 by an expert commission of the German Society for Gerontology and Geriatrics and the German Society for Geriatrics , which includes "17 dimensions of geriatric medicine". These dimensions of medical activity for elderly patients can be assigned to three groups:
- Special knowledge content
- Characteristic forms of perception and understanding
- Identity and experience of working with older people
The "17 dimensions of geriatric medicine" include: knowledge modification by generally trained doctors, multimorbidity , risk recognition , senile dementia , ability to consent and protection of rights , psychosomatic relationships , hierarchization , rehabilitation , irreversibility (irreversibility of the life process), proximity to death, associated polarity , guarantee of Further care , focus on the environment , work with relatives , consultation effects , interdisciplinarity , structural and organizational upheaval.
A European definition of "Geriatric Medicine" and "Geriatric Patients" was formulated by the "Geriatric Medicine" section of the European Union Geriatric Medicine Society on May 3, 2008 in Malta and agreed on September 6, 2008 in Copenhagen:
“Geriatric medicine is a special medical discipline that deals with the physical, mental, functional and social conditions of acute, chronic, rehabilitative, preventive treatment and care - including at the end of life. The group of patients is associated with a high degree of frailty and active multiple illnesses that require a holistic approach to treatment.
The diseases in old age can present themselves in different ways; are often very difficult to diagnose; response to treatment is delayed and there is a regular need for social support.
Geriatric medicine therefore transcends medicine oriented towards organ medicine and offers additional therapy offers in a multidisciplinary team environment (milieu; setting). The main goal is to optimize the functional status of an elderly person as well as improve quality of life and autonomy.
Geriatric medicine is not specifically age-defined, but it does address the typical morbidity of elderly patients. Most patients are over 65 years of age. Those health problems that can best be addressed by geriatrics as a specialty are much more common in the over 80 age group. "
- Age depression
- Diabetes mellitus
- Parkinson's Disease
- Chronic senile rhinitis
- Atrial fibrillation
In geriatrics this means:
- Deterioration in intelligence due to the various types of dementia
- Brain dysfunction with increasing limitation of the senses (sight, hearing, touch, balance, taste, feeling of thirst )
- Instability, e.g. B. as a result of a stroke or as a result of various forms of dizziness with the increasing risk of falls
- Incontinence of the bladder or bowel
- the gradual loss / breakdown of tissue fluid ( desiccosis )
A syndrome is the simultaneous, common occurrence of different symptoms or characteristics. Age syndrome means the accumulation of several individual symptoms, which in this combination are typical for the age group, but can have their cause in very different diseases (at the same time). Typical is the creeping progression, which on the one hand helps to get used to the condition, on the other hand brings about different coping strategies (coping) for partial problems. So there is no early therapy, but a small aggravation can trigger complete decompensation in an end phase. These age syndromes are also called the "Big i's" in geriatrics in English-speaking countries after Brocklehurst.
Other age-specific technical terms in geriatrics: multimorbidity , low symptoms.
Drug therapy in geriatrics
Due to age-specific risks and adverse drug effects, it is important to pay attention to the spectrum of side effects of a large number of drugs, especially in geriatric patients who are often subject to multimedia , or to recommend their use as potentially unsuitable for older patients only if there is an urgent need.
The geriatric assessment
The geriatric assessment should lead the doctor to clarify unclear symptoms step by step so that interactions between the damage to individual organ systems are not overlooked if a single damaging factor is known. The procedure can be carried out in a structured manner and its quality is assured. There are different assessment sets that can be used in different treatment settings (at home, in the day clinic, in a clinic, in the nursing home, among others).
Definition of the term assessment (derived from “to assess”: to weigh up): Comprehensive geriatric assessment is defined as a multidisciplinary evaluation through which the multiple problems of older people are revealed, described and - if possible - explained; catalogs a person's resources and strengths, weighs the need for assistance, and creates a coordinated care plan for targeted intervention in a person's multidimensional problems.
The following recommendations / steps were developed:
- Screening : A standardized questionnaire is used to search for impaired performance or complaints in the areas of vision and hearing, mobility of arms and legs, urinary or fecal incontinence , nutrition , cognitive performance, emotional well-being, social support and various activities. If there are problem areas, a more comprehensive basic assessment should follow.
- Basic assessment : The actual basic assessment consists of determining the Barthel index , a memory test according to Folstein ( mini-mental status test ), the depression test according to Yesavage (also GDS), a social questionnaire, the mobility test according to Tinetti , the Timed up and go test , watch sign test and measurement of hand strength .
- Implementation : The time required to carry out the screening is around 5–10 minutes; the basic assessment should take a good half an hour. The depression questionnaire can be filled out by the patient himself, the other questionnaires and the performance of the performance tasks can also be carried out by non-medical staff after appropriate instructions. The therapeutic consequences that result from the results of the basic assessment are decisive.
The geriatric early rehabilitation complex treatment
As part of the introduction of the case flat rate system (DRG system) in the hospital sector, a - billing-oriented - treatment procedure (OPS 8-550.X) has been named "geriatric early rehabilitation complex treatment" (GFK). The procedure makes use of essential elements of the geriatric assessment - but is in no way to be regarded as congruent with this, but only a billing specific in the DRG system. This complex treatment is indicated for patients who are not yet suitable for another rehabilitation facility ( e.g. geriatric rehabilitation ) because there are other acute medical diseases (e.g. pneumonia , kidney failure , insufficient cooperation).
The geriatric early rehabilitation complex treatment is particularly often carried out in patients with:
- Heart failure (for example after decompensation)
- Condition after fractures
- Condition after apoplexy (ischemia and cerebral haemorrhage)
- Chronic obstructive pulmonary disease (COPD)
A GRP is of course not suitable for every patient, but immobile patients in particular often benefit from the treatment as a prophylaxis for contractures or pneumonia.
The GFK treatment is carried out by a team (usually a doctor, physical and occupational therapist, specially trained nursing staff, clinical psychologist, speech therapist and social service) according to requirements and according to precise regulations.
Geriatrics in everyday life
An increasingly pressing problem in the future will be the care of geriatric patients not only in hospitals and old people's homes, but also outside these established institutions. Individual, organized approaches to solutions can usually only be found in private areas, e.g. B. in the form of the establishment of cross-generational residential complexes. Particularly in view of the steadily growing number of single households and childless couples with no family ties, there will have to be new care solutions for people who have come of age in the coming decades.
A pilot project initiated by the Ministry of Labor, Integration and Social Affairs of the State of North Rhine-Westphalia began in 2010 in East Westphalia-Lippe. The “Regional Geriatrics Care Management ” model, which is planned for three years, is intended to show in the Lippe district how new management structures contribute to efficient health care in the future. In doing so, existing supply structures should be systematically recorded from the perspective of the health needs of older people on site and the weak points addressed. Goals are
- Guarantee of a comprehensive offer of geriatric services and development of region-specific offers with the participation of the health insurance companies
- Development of cooperation models between service providers such as nursing services, resident doctors, hospitals, physiotherapists, etc. a.
- Coordination of treatment in the form of integrated care concepts, e.g. B. Establishment of case management to improve the transition between acute care, rehabilitation and outpatient and inpatient care.
Geriatrics in veterinary medicine
Also in the veterinary medicine ( Veterinary ) geriatrics won due to increased life expectancy of pets in importance and is becoming a science, matched to the respective animal species, as well as treatment includes preventative measures.
- Federal Association of Geriatrics V. (Ed.): White Paper Geriatrics: The Care of Geriatric Patients: Structures and Requirements - Status Quo and Further Development. Kohlhammer, Stuttgart 2010, ISBN 978-3-17-021588-7 , 324 pages, abstract of the publisher (PDF; 79 kB)
- JB Halter et al. (Ed.): Hazzard's Geriatric Medicine & Gerontology. 6th Revised Edition. McGraw-Hill, 2009, ISBN 0-07-148872-3
- Mark H. Beers (Ed.): The Merck Manual of Geriatrics . Merck & Co., Inc. (English)
On the history of geriatrics:
- Dietrich von Engelhardt : Geriatrics. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. Walter de Gruyter, Berlin and New York 2005, ISBN 3-11-015714-4 , pp. 478-481.
- Paul Lüth : History of Geriatrics. 3000 years of physiology, pathology and therapy of the elderly. Enke, Stuttgart 1965.
- Gerhard Pfohl : Paracelsus geriatrics and contemporary gerontology. In: Medical World. Volume 29, 1978, pp. 1862-1866.
- Johannes Steudel : On the history of the theory of diseases of the elderly. In: Sudhoffs Archiv 35, 1942, pp. 1–27.
For geriatric assessment:
- M. Bach et al. a. (Red.): Basic geriatric assessment . 2nd, updated edition. Working Group Geriatric Assessment AGAST. MMV, Munich 1997, ISBN 3-8208-1309-8 (Geriatric Practice series).
- Henning Freund: Geriatric assessment and test procedure. Basic concepts - instructions - treatment pathways . 2nd, revised and expanded edition Kohlhammer, Stuttgart 2014, ISBN 978-3-17-023088-0 , 254 pages.
- Roman Kleindienst (2002): Geriatric Assessment Wizard . Interactive Scientific Toolkit. A-6170 Zirl
- LZ Rubinstein (1990): Assessment Instruments . In: Merck Manual of Geriatrics , 2007. 7th edition ISBN 978-3-437-21761-6 , 3,648 pages.
- R. Thiesemann: An investigation into the suitability of standardized procedures of comprehensive geriatric assessment to describe the process quality in inpatient geriatric treatment. Medical dissertation, University of Hamburg, 1996.
- Consensus Development Panel, National Institutes of Health Consensus Conference (1988) Statement: Geriatric Assessment methods for clinical decision making . In: J Am Geriatr Soc , 1996, 36, pp. 342-347.
- WHH Kruse, R. Schulz, HP Meier-Baumgartner: Geriatric assessment - case finding through screening in hospitalized patients . In: Z Gerontol Geriat , 1995, 28, pp. 293-298.
- T. Nikolaus, N. Specht-Leible: The geriatric assessment . Series of publications Geriatrie Praxis, MMV Verlag, Vieweg, 1992.
- LZ Rubenstein: Geriatric Assessment: An overview of its impact . In: LZ Rubenstein, LJ Campbell, RL Kane (eds.): Clinics in Geriatric Medicine , Vol. 3, No. 1, 1987, Saunders, Philadelphia, pp. 1-16.
To the age syndromes:
- JC Brocklehurst: Geriatric medicine in Britain - the growth of a specialty. Age aging . 1997 Dec; 26 Suppl 4, pp. 5-8, PMID 9506426 .
- JC Brocklehurst: The evolution of geriatric medicine . In: J Am Geriatr Soc. , 1978 Oct; 26 (10), pp. 433-439, PMID 701692 .
- Edward J. Masoro (Ed.): CRC Handbook of Physiology in Aging . CRC Press, Boca Raton FA 1981, ISBN 0-8493-3143-9 .
- MS Kanungo: Biochemistry of Aging . Academic Press, London / New York / Toronto / Sydney / San Francisco 1980, ISBN 0-12-396450-4 .
- JM Bauer, R. Wirth, D. Volker, C. Sieber: Malnutrition, sarcopenia and cachexia around old age - from pathophysiology to therapy. In: German Medical Weekly. Volume 133, 2008, pp. 305-310.
- Dieter Platt (ed.): Pharmacotherapy and Age - A Guide for Practice. Springer-Verlag, Berlin / Heidelberg / New York / London / Paris / Tokyo 1988, ISBN 3-540-18491-0 .
- WE Müller: Sedatives as an example for the peculiarities of psychopharmacotherapy in old age. In: Hans Förstl (Ed.): Textbook Gerontopsychiatrie. Thieme, Stuttgart 2002, pp. 220-226.
- Torsten Kratz, Albert Diefenbacher: Psychopharmacotherapy in old age. Avoidance of drug interactions and polypharmacy. In: Deutsches Ärzteblatt. Volume 116, Issue 29 f. (July 22) 2019, pp. 508-517.
- Federal Association of Geriatrics (accessed December 12, 2012)
- German Society for Geriatrics (Retrieved December 12, 2012)
- Competence Center Geriatrics: Information service of the GKV and MDK with guidelines and assessment instruments (accessed on December 12, 2012)
- DRG Geriatrics Competence Team : Geriatric Assessment according to AGAST (Geriatric Assessment Working Group) 1995 (accessed on December 12, 2012)
- Hans Franke: Very old and very old. Causes and Problems of Old Age. Springer-Verlag, Berlin / Heidelberg etc. 1987 (= Understandable Science. Volume 118), ISBN 3-540-18260-8 , p. 2.
- Hermann Orth: Diaita ΓEPONTΩN - geriatrics of Greek antiquity. In: Centaurus 8, 1963, pp. 19-47.
- Hans Franke (Ed.): Gerotherapy. Fischer, Stuttgart 1983.
- Hans Franke: Very old and very old. Causes and Problems of Old Age. Springer-Verlag, Berlin / Heidelberg etc. 1987 (= Understandable Science. Volume 118), ISBN 3-540-18260-8 , pp. 1-2.
- J. Brother, C. Lucke, A. Schramm, HP Tews, H. Werner: Was ist Geriatrie . Expert commission of the German Society for Gerontology and Geriatrics and the German Society for Geriatrics. Rügheim 1991
- Translation by: R. Thiesemann: adoption of preventive and rehabilitation requirement of very old requiring care as expert task , focus seminar for medical assessor of the PKV association, Berlin, May 9th 2009
- K. Müller: Gerio-Implantatprothetik - Safe and economical Dental Magazin 4/2007 pp. 38–41
- N. Siegmund-Schultze: Polypharmacotherapy in old age: Less medication is often more. In: Deutsches Ärzteblatt. Volume 109, 2012, pp. 418-420.
- Torsten Kratz, Albert Diefenbacher: Psychopharmacotherapy in old age. Avoidance of drug interactions and polypharmacy. 2019, p. 515.
- US Consensus Development Panel 1988