CM12.1-2 | CM12.1-2 | Geriatric Services and Health Problems — Summary & Reflection

KEY TAKEAWAYS

This module established the definitional and epidemiological foundation of geriatric medicine. Geriatrics is the medical specialty addressing disease, disability, and the social dimensions of old age; geriatric services are the organised, multidisciplinary care systems built around Comprehensive Geriatric Assessment (CGA) to maintain function and independence. India faces a major demographic shift — from ~140 million elderly now to 300 million by 2050 — with the old-age dependency ratio rising. The health problems of the aged are multidimensional: physical (NCDs especially HTN and diabetes, musculoskeletal disease including osteoarthritis and osteoporosis, sensory deficits, malnutrition), mental (depression — prevalence 25–41%, dementia — 8.8 million affected in India, delirium), and psychosocial (isolation, elder abuse). The determinants of vulnerability include biological ageing (homeostenosis, sarcopenia), social determinants (poverty, isolation, ageism), and environmental factors. Isaacs' four geriatric giants (instability, immobility, incontinence, intellectual impairment) and the concept of frailty are the unifying clinical frameworks. Functional status is assessed via ADL (Katz — 6 activities) and IADL (Lawton-Brody — 8 activities). Monitoring requires population-burden indicators (dependency ratio, elderly DALYs), coverage indicators (geriatric OPD access), and outcome indicators (fall rates, avoidable readmissions).

REFLECT

Consider the 72-year-old retired schoolteacher from the opening hook. Using the frameworks from this module — geriatric giants, CGA domains, determinants of vulnerability — map out: (1) which of the four geriatric giants he most likely has evidence of, (2) which social determinants are active in his case, and (3) what a structured CGA at the PHC level would need to assess. How would you argue to the PHC medical officer that this patient should not be referred to a specialist without first receiving a basic geriatric assessment?