Manual de geriatría

Handbook of

GERIATRICS

AB Dey MD
Professor
Department of medicine
All India Institute of Medical Sciences
New Delhi

Paras Medical Publisher
Hyderabad, India

Preface

Human beings are living longer than ever before. It is thus natural that clinicians working in all levels of
health care are treating frail and older patients more frequently than ever before. The impact ofsocioeconomic determinants of health care, the cost of advancing technology and unusual health
problems hitherto considered rare in younger age group are some of the issues which make clinical
medicine challenging but interesting. Currently, geriatric medicine does not exist in the undergraduate
curriculum in India. Physicians in primary and secondary health care do not have enough exposure totheory and practice of geriatric medicine.
The Handbook of Geriatrics is meant for those physicians working in the frontline of medicine in India
and providing health care to millions of older patients in their everyday practice. This handbook is not a
textbook of geriatrics but deals with basic concepts of old age care and common problems encountered
in day-to-day practice. This publication isthe revised version of “Health Care of the Elderly: A Manual for
Physicians in Primary & Secondary Health Care Facilities”, which was produced and edited by the author
and published in 1999 with funding support from Directorate General of Health Services and South East
Asia Regional Office of World health Organization under the country budget program for the biennium
1998-1999.This manual wasdistributed all over the country to medical officers working in government
hospitals and dispensaries. Responding to popular demand for greater availability, Handbook of
Geriatrics is being published after updating the contents with present state of knowledge in geriatric
medicine.
The author hopes this publication will provide the information necessary to provide quality health care to
olderpatients and empower physicians in primary and secondary health care to change their practice to
the benefit of millions of older Indians in coming years.

AB Dey
Professor
Department of Medicine
AIIMS, New Delhi.

Acknowledgements

The author acknowledges the contributions of Dr. Ashish Goel, MD, in updating and revising the
manuscript.

Contents……………………………………………………………………………………………………………………………………………………………..

1. Introduction
2. Principles of Geriatric Medicine
3. Healthy Ageing
4. Cardiovascular System
5. Respiratory System
6. Gastrointestinal system
7. Endocrine System
8. Musculoskeletal System
9. Urinary system
10. Brain Ageing and Cognitive Impairment
11. Neurological Disorders and Stroke
12. Mental Health
13. Sensory System
14. Cancers
15. Burden of Care-Giving and Elder Abuse

CHAPTER 1

Introduction____________________________________________________________________________________

DEFINATION OF AGEING
 Ageing is the progressive and generalized impairment of functions resulting in the loss of
adaptive response to stress and in increasing the risk of age-related diseases. The overall
effect of these alterations is an increase in the probability dying, which is evident from the
rise in age-specificdeath rates in the population.

AGEING SCENARIO IN INDIA
 In the beginning of this century about 12 million Indians were aged 60 years or more. The
number of the aged doubled in the next sixty years to 24 million. Since then there has been a
great increase in the number of the elderly to 76 million in 2001. The projected figures for
the years 2021 and 2051 are 140 million and 350 millionrespectively.
 The decadal growth rates in the 60+ age group since 1951-1961 have remained above 26%
and are about 5% to 8% higher than those for the total population.
 There has been a tremendous increase in the life expectancy at birth and at 60 years of age.
 More than half of the elderly have one or more chronic...