Geriatrics & Healthy Ageing
Geriatricians are those specifically trained in the care of older adults, they understand the complexity and the needs of older adults / the older population. The geriatric care setting ranges from the community to the hospital and geriatricians have roles in managing the older adults within this spectrum of geriatrics care settings. Examples of the geriatric services are in-patients acute and general geriatrics wards, out-patients general geriatrics clinics, specialized geriatric clinics such as memory clinic, falls clinic, continence clinic, and elderly pain service. A general practitioner manages the general medical aspects of patients that also include the older populations and therefore, they are expected to be able to care and manage for the usual diseases or illnesses in the elderly and at the same time, be aware of the complex medical issues in the older population and able to work together with the geriatricians to attain a similar aim of treatment and management. Some of the objectives of geriatrics medicine are :
- To enable older persons to lead full and active lives
- To prevent disease or to detect and treat it early
- To reduce suffering due to disability and disease and minimize dependency by proper rehabilitation
- To provide holistic medical care and arrange for adequate social support when needed
- To manage “Geriatric Giants”
Geriatric Giants is a term coined by a well-known Geriatrician, Dr. Bernard Isaacs, and this expression refers to the principal chronic disabilities of old age that impact on the physical, mental and social domains of older adults. They are conditions, not diseases, therefore they cannot be classified into specific diseases. They are also multifactorial and have shared risk factors (older age, functional & mobility impairment). The geriatric giants are associated with functional decline, increasing frailty, and poor health outcomes.
Geriatrics giants are also known as the Big 5 I – Impaired cognition, Immobility, Instability, Incontinence, and Iatrogenesis.
Geriatricians received referrals from the GPs and other fellow doctors. Our patients are commonly those aged 60 and above, have complex medical problems (including social issues), and have any one of the components of the geriatric giants.
Apart from the geriatric giants, (also known as geriatrics syndrome) other conditions that are usually seen in older populations are frailty, sarcopenia ( loss of muscle mass, function and strength), malnutrition or undernutrition, cancers, and complications of medical diseases such as stroke, heart failure, and kidney failure.
Geriatric services can be divided into acute, sub-acute as well as chronic problems. In other words, we can be inward settings, clinic settings, and long-term settings such as nursing homes. Geriatrician manages the older patients from primary care to long-term care.
Malaysian Society of Geriatric Medicine or MSGM was founded in 2012, aiming to address the issues of the healthcare needs of the older population in Malaysia.
Among our missions are :
- To increase awareness of the health care needs of older people in Malaysia
- To advise appropriate regulatory bodies over matters pertaining to the training and credentialing of geriatricians
- To represent the medical profession in matters related to geriatric medicine in Malaysia
- To promote, conduct, and coordinate publications, surveys, and research in the field of geriatric medicine
- To collaborate with the government and its agencies, particularly in the implementation of national policies relevant to the field
Article by Dr Ungku Ameen Bin Ungku Mohd Zam – Consultant Geriatrician