Occam's Razor Revisited: Geriatric Syndromes
Transcript of Occam's Razor Revisited: Geriatric Syndromes
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Falls: A Geriatric Syndrome
Jacqueline Jordan Lloyd, MD
Florida State University College of Medicine
Copyright 2007, Florida State University College of Medicine. This work was supported by a grant from the Donald W. Reynolds
Foundation. All rights reserved.
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Definition: “Syndrome”
a group of symptoms that together are characteristic of a specific disorder, disease, or the like
the pattern of symptoms that characterize or indicate a particular condition
Ex.: Parkinson’s Syndrome, Cushing’s Syndrome, Congestive Heart Failure
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Definition: “Geriatric”
Diminished homeostatic reserve capacity of all organ systems called homeostenosis
In the absence of significant stressors, homeostenosis causes no symptoms and very few restrictions on routine activities
Progressive risk of homeostatic failure with increasing age
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Definition: “Geriatric”
Muravchick S. Atlas of Anesthesia: Subspecialty Care. Edited by Ronald Miller (series editor), Stanley Muravchick. ©1998 Current Medicine, Inc.
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Definition: “Syndrome”
syn, together, + dromos, a running
a predictable, characteristic pattern of symptoms or signs that tends to occur under certain circumstances
aggregate of symptoms and signs associated with any morbid process, together constituting the picture of the disease Stedman’s
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Geriatric Syndrome?
“Geriatric Syndromes are multifactorial health conditions that occur when the accumulated effects of impairments in
multiple systems renders a person vulnerable to situational challenges.”
Tinetti, Williams and Gill; Dizziness among Older Adults: A Possible Geriatric Syndrome; Ann Intern Med. 2000;132:337 - 344
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Geri-Syndrome Characteristics
Multifactorial etiologies
Common risk factors among the syndromes
Intimate association with functional impairment /decline
Association with increased morbidity and mortality
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Geriatric Syndromes AGS_GRS
Dementia
Delirium
Urinary Incontinence*
Falls*
Gait Disturbances
Dizziness*
Syncope*
Hearing Impairment
Visual Impairment
Osteopenia
Malnutrition*
Eating and Feeding
Problems
Pressure Ulcers
Sleep Problems*
* Classic geriatric syndromes
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‘Other’ Geriatric Syndromes
Polypharmacy
Self-Neglect
Elder Abuse
Frailty
Hypo and Hyperthermia
Dehydration and Electrolyte Imbalance
Iatrogenesis
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Medications Digoxin
Poor Vision
Can’t read labels
or recipes
Economics Low income
No glasses
No dentures
Social Isolation Eating Alone
Poor mealtime
ambience
Depression Anhedonia
Sarcopenia Muscle Protein
Muscle Strength
Congestive Heart
Failure Na restriction
Anorexia
Fatigability
Arthritis
Impaired Dexterity
Immobility
Poor Oral Health
Periodontal
Disease
Malnutrition
Geriatric Syndrome
Characteristic: Multifactorial Etiology
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Geriatric Syndromes
Malnutrition
Incontinence Falls
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Standard Medical Approach
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OCCAM’S RAZOR
“Plurality must not be posited without necessity”
Law of Parsimony of Diagnosis
Productive cough
Fever
Tachypnea
Shaking Chills
Pneumonia
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Let’s Reconsider…….
Why did Mrs. D fall?
What is the definition of “FALL” (as a
geriatric syndrome)
How does one treat a ‘geriatric
syndrome’ of FALL ?
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Geriatric Syndrome
FALL
Hyper/Hypoglycemia
ORTHOSTATIC HYPOTENSION
Acute Illness
Neuropathy
Medications
Arthritis