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Databook on Geriatrics by G. S. Rai MD, MSc, MRCP, V. Pearce MB, BSc, MRCP (auth.)

By G. S. Rai MD, MSc, MRCP, V. Pearce MB, BSc, MRCP (auth.)

The objective of those brief notes is to supply the newcomer to the speciality of geriatrics with a large although now not exhaustive differential analysis of many of the more often than not encountered signs within the aged, and to attract specific realization tothe universal and significant problems. the typical explanations of indicators and the typical dis­ eases in addition to definite gains that have specified value to the medication of the aged are emphasised. a last part on investigations (with brief notes) which one could hire within the perform of geriatric drugs is integrated in addition to an appendix of standard values for the aged. In our view this publication doesn't convey how geriatric drugs is practised however it does supply an summary of scientific points of medication (geriatrics), wisdom of that is necessary to the perform of ger­ iatrics. G.S.R. V.P. Foreword I take the view that if energy is diminished to the level that it interferes with existence because the previous individual would want to stay it, then a formal clinical review might be made as a part of the final appraisal of that person's difficulties. the supply of a house aid or the nutrition on wheels provider can't be anticipated to revitalize the individual struggling with hypothroidism or pernicious anaemia! within the occasion either scientific remedy and social help will be wanted and to supply one with out the opposite will be part measures.

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Flapping or 'wing beating' - characteristic of liver failure but it can be present in respiratory or renal failure hysteria - can be fine or coarse 41 Visual Failure Lens cataract Cornea keratitis keratomalacia Iris uveitis Aqueous glaucoma Vitreous haemorrhage Optic nerve compression demyelinating disease Retina detachment optic neuritis retinal artery thrombosis retinal vein thrombosis papilloedema optic nerve atrophy macular degeneration temporal arteritis choroid retinitis Intracerebral pituitary tumours damage to chiasma at pituitary surgery intracranial tumours cerebrovascular accident intracerebral abscess raised intracranial pressure from any cause aneurysm Cranial trauma Paget's disease Orbital lesions Drugs chloroquine practolol 42 Common disorders Anaemia WHO definition: Hb < 13g/dl in men and < 12g/dl in women Occurs in 5-20% of elderly Iron deficiency anaemia aetiology poor nutrition poverty, immobility etc.

Testosterone Haematological causes Hodgkin's disease lymphomas iron deficiency anaemia polycythaemia Metabolic diabetes mellitus hyperthyroidism hypothyroidism Obstructive jaundice stone tumour at head of pancreas cholestatic jaundice primary biliary cirrhosis drugs see p. 100 Chronic renal failure Malignancy particularly abdominal carcinomas 37 Speech Disturbance Dysarthria brain stem lesions cerebellar lesions motor neurone disease myasthenia gravis Parkinson's disease oro-facial dyskinesia alcohol badly fitting dentures Steele-R ichardson syndrome Dysphasia cerebrovascular accident malignancy - primary or secondary temporal lobe abscess neurosyphylis Alzheimer's disease Hoarseness laryngitis laryngeal polyp or carcinoma myxoedema rheumatoid arthritis affecting the cricoarytenoid joint systemic diseases affecting the larynx amyloid diabetes mellitus collagen disease psychogenic 38 Swelling of Glands (Lymphadenopathy) Malignancy lymphomas leukaemias secondaries from other malignancies Infection any infection may cause swelling specific tuberculosis toxoplasmosis infectious mononucleosis granulomatous conditions rheumatoid arthritis SLE amyloid Drugs barbiturates salicylates nalidixic acid phenytoin PAS 39 Tinnitus Ear wax otitis media otosclerosis acoustic neuroma Meniere's syndrome labyrinthiti$ drugs streptomycin quinine salicylates Cerebral cerebral tumour epilepsy Brainstem vertebrobasilar insufficiency psychogenic tinnitus may be part of hallucinations pulsating tinnitus A/V malformation 40 Tremor Resting or static Parkinson's disease - 'pill rolling' Action anxiety - coarse tremor thyrotoxicosis - fine tremor of outstretched hands drug intoxication alcohol barbiturate withdrawal, etc.

S. s. v. 5 mg iron-dextran/kg body weight/g Hb deficient) . test dose given before the infusion to avoid serious allergic reaction Megaloblastic Anaemias B 12 deficiency anaemia aetiology poor diet pernicious anaemia - incidence 1% after age of 60 partial or total gastrectomy atrophic gastritis carcinoma of stomach jejunal diverticular disease (stagnant loop syndrome) ileal resection malabsorption see p. 1g initially followed by 250 Jig of cyanocobalamin at monthly intervals Folate deficiency anaemia aetiology poor diet } malabsorption account for majority of folate deficiency in elderly increased demand lymphoma neoplasm infection liver disease drugs phenytoin etc.

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