GERIATRIC SYNDROME

Assoc. Prof. Dr Rosediani Muhamad

MD, MMED (Family Med, USM) PhD (Public Heath, Aust)
 INTRODUCTION

• According to data from World

Population Prospects: the 2019
Revision, by 2050, one in six people
in the world will be over age 65
(16%), up from one in 11 in 2019
(9%). Source-https://www.un.org/en/sections/issues-
depth/ageing/
 AGING POPULATION

• The number of people aged 65 and over is growing larger in

both developed and developing countries worldwide.
• The care of older people will continue to make up an
increasingly higher proportion of the workload of HCP
AGING PROCESS

Thus, it is important not just

to consider approaches
that ameliorate the losses
associated with older age
but also those that may
reinforce recovery,
adaptation and
psychosocial growth.
• Aging means the risk for chronic diseases rises
• Burden of disability and death from aging related
losses increases
WHAT IS GERIATRIC SYNDROME?
 GERIATRIC SYNDROME
• GS are common clinical conditions that don't fit into specific disease
categories but have substantial implications for functionality and life
satisfaction in older adults. (Inouye et al., 2007)
• The word syndrome was first used in an English translation of Galen in
1541.
• Derived from the Greek roots “syn” (meaning “together”) and
“dromos” (meaning “a running”), this term generally refers to “a
concurrence or running together of constant patterns of abnormal
signs or symptoms.”
• The term syndrome “has as its philosophic basis not specific disease
factors, but a chain of physiologic processes, the interruption of which
at any point produces the same ultimate impairment of body function.
(Flacker, 2003)
GERIATRIC SYNDROME

Sharon K. Inouye, Stephanie Studenski, Mary E. Tinetti, George A. Kuchel. J. Geriatric Syndromes: Clinical, Research and Policy
Implications of a Core Geriatric Concept. Am Geriatr Soc. 2007 May; 55(5): 780–791. doi: 10.1111/j.1532-5415.2007.01156.x
(Flacker, 2003)
HEALTH PROBLEMS RELATED TO GS
• 5 common GS are:
• Fall
• Incontinence
• Pressure sore
• Delirium
• Functional decline

• Others includes: malnutrition- eating/ feeding problems;

sleep problems; hearing problems; self-neglect

• The definition and “list” of geriatric syndrome has remained

a task marked with controversies.

• Frailty is the common end product of these geriatric

syndrome
(Wu et al, 2012)
 CONCEPTUAL MODEL & SHARED RISK
FACTORS

• Frailty intensifies these shared risk factors and geriatric syndromes.

• Without proper and effective intervention, frailty can lead to unwanted
results, such as disability, dependence, reliance on long-term care, and even
death. (Inouye et al., 2007)
HOW TO REVERSE IT?
 HEALTHY AGING
Is the process of developing and maintaining the functional ability that enables
well-being in older age (WHO)

(home to broader
society)

(Physical and mentally)

 RESILIENCE
• At any point in time, an individual may have reserves of functional ability
that they are not drawing on. These reserves contribute to an older person’s
resilience.
• Resilience means the ability to maintain or improve a level of functional
ability in the face of adversity (either through resistance, recovery or
adaptation).
• This ability comprises both components intrinsic to each individual (for
example, psychological traits that help an individual frame problems in a way
that can lead to a positive outcome, or physiological reserves that allow an
older person to recover quickly after a fall) and environmental components
that can mitigate deficits (for example, strong social networks that can be
called on in times of need, or good access to health and social care).
 COMPREHENSIVE
GERIATRIC ASSESSMENT (CGA)

Multidiciplinary
care
 Problem List

• It should be
developed in
collaboration with a
patient and/or
caregiver
• Individualised,
reflecting patients’
and families’
concerns. Personalised Care Plan
 Personalised Care

• Identify the best clinical

treatments and/ or social and
psychological supports for them
• Agreeing the actions individuals
themselves will take to help
them achieve their jointly agreed
goals and the support they may
need to do that.
• Come out with a planned and
continuous process, not a one-
off event.
A Way Forward In Managing
Geriatric Syndrome
 Tips for Goal Setting
• Specific: both the goal and the action plan (which must be explicit -
who will do what and when?).
• Measurable: consider how we can help people to track whether they
are achieving their goals (Diary? Checklist?)
• Achievable: Patients and clinicians (nurses) must ensure that goals
remain within the realms of achievability given the patient’s clinical
situation. To assess this, it is worth asking patients to grade their
confidence in achieving their aim using a scale of 1-10.
• Relevant: to the patient and their situation.
• Timely: is it possible to make a difference in a relevant time frame
and when should things be reviewed?
*Involve carer and family (when relevant) with these discussions
Example: Elderly With Higher
Risk Of Fall
Advantage of CGA