Geriatric Service (Care of the Older Adults)

Geriatrics is the branch of medicine that deals with the problems and diseases of older adults and ageing. We work t
comprising Geriatricians, Geriatric nurse clinicians, medical social worker, physiotherapists, occupational therapists and
The geriatric team cares for the most complex and frail elderly populations. At the same time, with aging population, we d
changes in the delivery system to promote optimum care for all older adults in the hospital.

We provide various services including geriatric evaluation, ongoing care coordination, a physician-directed multidiscip
holistic approach to patient care that involves clinical, psychosocial and functional assessment. All the patients who a
service undergo full comprehensive geriatric assessment which includes their medical, function and psychosocial assessme

Our expertise includes:

Managing common conditions that affect older persons including dementia, falls, urinary incontinence, malnutrit
sensory impairment and depression.
Recognising effects of ageing and underlying illness on clinical health, physical and mental function.
To educate on the appropriate use of medications to avoid potential hazards and unintended consequences of multiple m
Coordinating care among other providers to help patients maintain functional independence and improve their overall q
Assisting families and other caregivers as they face decisions about declining capacity, independence and end-of-life d

The ACE (Acute Care of the Elderly) Model of Care

In recognition of the ageing population, the ACE model of care is implemented for the hospitalised patients who are ag
When the older adults are admitted, a protocol of care initiatives will be initiated by the nurses which include measur
orientation, adequate hydration and bowel management and early mobilisation with the intention to prevent delirium and fu

Patients admitted to the Geriatric wards are encouraged to ambulate at least three times daily. An individualised ADL (A
Living) Board will be updated by the rehabilitation therapists so that healthcare providers can engage the patient
recommended and assist them in ambulation with the appropriate assistive aids. Elderly patients, especially those with cog
will be engaged in cognitive therapy for mental stimulation. The goal of this model is to preserve their function and indepe

Advanced Internal Medicine/ Geriatric Home Transitional Care Programme

The Advanced Internal Medicine/Geriatrics home transitional care programme is targeted at our patients who require co
being discharged from the hospital, which includes rehabilitation and adjustment together with their family members and/o

For more information regarding the Advanced Internal Medicine/Geriatric Home Transitional Care Programme, please clic

Clinics

Geriatric Assessment Clinic

This clinic provides a full comprehensive assessment to address the complex care needs of an elderly person. The person
most will include those:
Above 65 years old
 Have complex health problems and atypical presentation e.g. functional decline, memory decline, weight loss, urinary
overall decline in personal well-being
During the first visit:
A Geriatric nurse will assess the older person through clinical, cognitive and vision assessments.
This will be followed by a full assessment and examination by a Geriatrician, including medication review and walking
If necessary, the Geriatrician will request investigations to be done and / or refer to the physiotherapist for formal asse
and caregiver training.
Subsequent visits will depend on the nature and the complexity of the problems.

Falls and Balance Clinic

This is a multidisciplinary clinic led by a Geriatrician with the aim of preventing elderly patients from subsequent falls and

The person who will benefit most will include those

Above 65 years old, and
Had fallen before and/ or gait balance problems
At the first visit, all patients will undergo a full comprehensive geriatric assessment and counselling if necessary.

For more info on the Falls and Balance Clinic, please click here.

Memory Clinic

The aim of this comprehensive multidisciplinary clinic is to provide an assessment facility for patients with complaints of m

After the initial assessment, we also provide patients and carers with information on memory management and services for

Outpatient Palliative Care

For patients who are facing incurable advanced progressive illnesses, this clinic serves to maximise the quality of life for
families by symptom control, management of the underlying disease condition and psychosocial support. The clinic
community support and home medical services in supporting seamless care for the patient and their families.

For all the clinics: It is preferred that the older person be accompanied by a close relative or caregiver, who is familiar
daily activities. They should also bring either the full medication list or medications along, especially at the first visit.

Geriatric Clinic

https://www.nuh.com.sg/umc/about-us/about-us/division-of-general-medicine-and-
therapeutics/geriatric-service-care-of-the-older-adults.html
 Geriatic Center
Geriatric Center is dedicated to Geriatric Medicine, a relatively
new field of medicine. At the Center, we deliver high quality,
comprehensive, and accessible healthcare by addressing the
genuine and unique needs of older adults. The problems,
diagnosis, and treatment of the physical and psychological
sickness of the elderly are handled by our team of experts in
Geriatric Medicine. The centerpiece of our services is the
Comprehensive Geriatric Assessment (CGA), a multi-
disciplinary diagnostic process used to determine medical,
functional, and psychosocial problems and capabilities in an
elderly patient to arrive at a comprehensive treatment plan
and long-term follow-up. It has guidelines for optimal medical
and nursing care in an inter-disciplinary environment.

We also reaches out to patients needing geriatric care

through its very own Home Care program. Specialists conduct
home visits to patients who are bedbound or have difficulty
into following up alambulatory out-patient clinics. Our patients
include:

People with dementia, behavioral problems,

neuromuscular disease, cancer, diabetes, heart diseases,
degenerative joint disease, infections, etc.
Terminally ill patients
Frail elderly
Recently discharged older patients from the hospital who
would have difficulty in succeeding follow-up visits with
their physicians
http://www.stluke.com.ph/geriatric-center-qc.html
Geriatric Multidisciplinary Clinic
Elderly Care Simplified

The Geriatric Multidisciplinary Clinic is an outpatient consultative service that

provides a comprehensive assessment of older persons with medical, psychological,
cognitive or social problems that impede function or threaten independent living.

A complete one-stop facility, the center is designed to cater to the specific requirements
of the elderly (60 years old and above) from evaluation to management and treatment
of geriatric disorders, including rehabilitation and other ancillary services.

Contact Information:

Trunkline: (02) 558-0888 Local 4603

Address: Ground Floor, Manila Doctors Hospital

Offered Services:

Comprehensive Geriatric Assessment

o Assessment of the Basic and Advance Activities of Daily Living Functional Test
o Assessment of the Nutrition Status
o Evaluation of the Mental Status
o Gait and Balance Assessment
Home Care/Home Visit
Inpatient Consultative Services

One needs to consult a geriatrician if he/she displays any of the following symptoms:

Frailty
Polypharmacy (5 or more drugs (+) side effects)
Incontinence
Problem on Mobility
Depression

Cognitive Problem (ie. Memory lapses/loss)

Behavioral Problem
Falls
Senso

http://www.maniladoctors.com.ph/geriatric-multidisciplinary-clinic/

PDF
http://www.ehealth.ph/media/kunena/attachments/196/1279-2440-2-PB1.pdf
http://www.map-
abcdf.com.ph/documents/presentations/Countryside%20Development/Health/g
eriatric%20syndromes-slmc.pdf
http://www.who.int/nmh/countries/phl_en.pdf

Geriatrics or geriatric medicine[1] is a specialty that focuses on health care

of elderly people.[2] It aims to promote health by preventing and
treating diseases and disabilities in older adults. There is no set age at which
patients may be under the care of a geriatrician or geriatric physician, a
physician who specializes in the care of elderly people. Rather, this decision is
determined by the individual patient's needs, and the availability of a specialist. It
is important to note the difference between geriatrics, the care of aged people,
and gerontology, which is the study of the aging process itself. The
term geriatrics comes from the Greek geron meaning "old man", and
iatros meaning "healer". However, geriatrics is sometimes called medical
gerontology.

https://en.wikipedia.org/wiki/Geriatrics

Hospital Elder Life Program[edit]

Perhaps the most pressing issue facing geriatrics is the treatment and prevention
of delirium.[citation needed] This is a condition in which hospitalized elderly patients
become confused and disoriented when confronted with the uncertainty and
confusion of a hospital stay. The health of the patient will decline as a result of
delirium and can increase the length of hospitalization and lead to other health
complications. The treatment of delirium involves keeping the patient mentally
stimulated and oriented to reality, as well as providing specialized care in order to
ensure that her/his needs are being met.
The Hospital Elder Life Program (HELP) is an model of hospital care developed
at the Yale University School of Medicine. It is designed to prevent delirium and
functional decline among elderly individuals in the hospital inpatient setting.
HELP uses a core team of interdisciplinary staff and targeted intervention
protocols to improve patients' outcomes and to provide cost-effective care.
Unique to the program is the use of specially trained volunteers who carry out the
majority of the non-clinical interventions.
In up to 40% of the cases, incident delirium can be prevented. To that end, HELP
promotes interventions designed to maintain cognitive and physical functioning of
older adults throughout the hospitalization, maximize patients' independence at
discharge, assist with the transition from hospital to home and prevent unplanned
hospital readmissions. Customized interventions include daily visitors;
therapeutic activities to provide mental stimulation; daily exercise and walking
 assistance; sleep enhancement; nutritional support and hearing and vision
protocols.
HELP has been replicated in over 63 hospitals across the world. Although the
majority of the sites are based in the United States located in 25 different states,
there is a growing international presence. International sites include: Australia,
Canada, the Netherlands, Taiwan and the United Kingdom.

https://en.wikipedia.org/wiki/Geriatrics#Subspecialties_and_related_services
http://www.doh.gov.ph/health-and-wellbeing-of-older-persons

https://www.merckmanuals.com/professional/geriatrics/prevention-of-disease-
and-disability-in-the-elderly/prevention-of-disease-in-the-elderly

PHILIPPINES TOP 50 CAUSES OF DEATH

AGE-STANDARDIZED DEATH RATE
PER 100,000 POPULATION
GOOD

POOR
TOP 50 CAUSES OF DEATH Rate World Rank TOP 50 CAUSES OF DEATH Rate World Rank
1. Coronary Heart Disease 161.43 29 26. Inflammatory/Heart 5.95 107
2. Stroke 119.21 54 27. Other Injuries 5.92 141
3. Influenza and Pneumonia 90.40 46 28. Cervical Cancer 5.84 109
4. Diabetes Mellitus 60.44 20 29. Meningitis 5.32 58
5. Tuberculosis 41.83 27 30. Drownings 4.88 71
6. Hypertension 38.20 11 31. Skin Disease 4.86 37
7. Lung Disease 33.05 28 32. Falls 4.75 99
8. Kidney Disease 25.71 13 33. Oral Cancer 4.55 52
9. Breast Cancer 22.01 30 34. Ovary Cancer 3.70 102
10. Asthma 21.20 9 35. Leukemia 3.53 100
11. Violence 18.56 25 36. Maternal Conditions 3.22 63
12. Lung Cancers 17.23 64 37. Suicide 2.94 153
13. Prostate Cancer 15.99 92 38. Stomach Cancer 2.73 148
14. Liver Disease 15.58 87 39. Other Neoplasms 2.61 87
15. Diarrhoeal diseases 13.41 62 40. Lymphomas 2.33 142
16. Road Traffic Accidents 11.56 123 41. Pancreas Cancer 2.15 111
17. Colon-Rectum Cancers 11.46 59 42. Pertussis 2.12 33
18. Endocrine Disorders 11.40 44 43. Epilepsy 2.09 81
19. Peptic Ulcer Disease 10.98 21 44. Rheumatoid Arthritis 1.79 40
20. Liver Cancer 9.97 34 45. Hepatitis B 1.71 50
21. Low Birth Weight 9.67 75 46. Dengue 1.41 6
22. Congenital Anomalies 7.96 100 47. Alzheimers/Dementia 1.20 145
23. Malnutrition 6.96 59 48. Fires 1.13 116
24. Rheumatic Heart Disease 6.78 56 49. Uterin Cancer 1.08 139
25. Birth Trauma 6.28 70 50. Oesophagus Cancer 1.06 140

http://www.worldlifeexpectancy.com/country-health-profile/philippines

PHILIPPINES TOTAL DEATHS BY CAUSE

PERCENT TOP 50 CAUSES

Deaths % Deaths %
Coronary Heart 26. Malnutrition 3,884 0.75
1. 87,881 16.86
Disease
27. Inflammatory/Heart 3,825 0.73
2. Stroke 63,261 12.14
28. Meningitis 3,817 0.73
Influenza and
3. 51,889 9.95 29. Falls 3,246 0.62
Pneumonia
4. Diabetes Mellitus 33,656 6.46 30. Prostate Cancer 3,124 0.60
31. Maternal Conditions 2,983 0.57
5. Tuberculosis 26,189 5.02
32. Leukemia 2,857 0.55
6. Hypertension 20,986 4.03
7. Lung Disease 16,407 3.15 33. Skin Disease 2,761 0.53
34. Oral Cancer 2,742 0.53
8. Kidney Disease 15,873 3.04
35. Pertussis 2,688 0.52
9. Violence 15,761 3.02
10. Asthma 12,342 2.37 36. Suicide 2,562 0.49
37. Cervical Cancer 2,106 0.40
11. Low Birth Weight 12,341 2.37
38. Epilepsy 1,885 0.36
12. Liver Disease 10,388 1.99
13. Diarrhoeal diseases 9,934 1.91 39. Other Neoplasms 1,645 0.32

Road Traffic 40. Stomach Cancer 1,521 0.29

14. 9,758 1.87
Accidents 41. Lymphomas 1,483 0.28
 Congenital 42. Dengue 1,331 0.26
15. 9,744 1.87
Anomalies
43. Ovary Cancer 1,301 0.25
16. Lung Cancers 9,722 1.87
44. Pancreas Cancer 1,219 0.23
17. Birth Trauma 8,019 1.54
45. Hepatitis B 1,062 0.20
18. Breast Cancer 7,730 1.48
46. Fires 1,002 0.19
Endocrine
19. 7,334 1.41 47. Rheumatoid Arthritis 949 0.18
Disorders
Colon-Rectum 48. Alcohol 680 0.13
20. 6,591 1.26
Cancers 49. War 642 0.12
Peptic Ulcer 50. Oesophagus Cancer
21. 6,234 1.20
Disease
22. Liver Cancer 6,144 1.18
23. Other Injuries 5,123 0.98
24. Drownings 5,061 0.97
Rheumatic Heart
25. 4,586 0.88
Disease
http://www.worldlifeexpectancy.com/country-health-profile/philippines

Geriatric care management

From Wikipedia, the free encyclopedia
Geriatric care management (also known as "elder care management", "senior health care
management" and "professional care management") is the process of planning and
coordinating care of the elderly and others with physical and/or mental impairments to meet
their long term care needs, improve their quality of life, and maintain their independence for as long
as possible. It entails working with persons of old age and their families in managing, rendering
and referring various types of health and social care services.[1] Geriatric care
managers accomplish this by combining a working knowledge of health and psychology, human
development, family dynamics, public and private resources and funding sources, while advocating
for their clients throughout the continuum of care. For example, they may assist families of older
adults and others with chronic needs such as those suffering from Alzheimer's disease or
other dementia.[2]

Contents
[hide]

1Overview
2Geriatric care managers
3See also
4References
5External links
Overview[edit]
Geriatric care management integrates health care and psychological care with other needed
services such as: housing, home care services, nutritional services, assistance with activities of daily
living, socialization programs, as well as financial and legal planning (e.g. banking, trusts). A care
plan tailored for specific circumstances is prepared after a comprehensive assessment has taken
place, and is continuously monitored and modified as needed.[3] A comprehensive geriatric care
assessment is thorough and can take anywhere from 2 to 5 hours in length, this of course is broken
down into 2 or 3 assessment visits with the patient/family members. The comprehensive assessment
is really a compilation of smaller individual assessments with the first one being a primary intake
assessment which includes demographic type data as well as a health history, social history, and
legal/financial history. From there, a medication profile assessment is included, as well as an
assessment of ADLs (Activities of Daily Living) and IADLs (Instrumental Activities of Daily Living). In
addition other assessments may include; Falls risk assessment, Home safety assessment,
Nutritional assessment, Depression assessment, Pain assessment, Mini Mental State
Exam (MMSE), MiniCog Clock Drawing Exam (Cognitive Assessment), Balance assessment, and
Gait assessment(ability to walk). If the comprehensive geriatric care management assessment is
being conducted by a Registered Nurse, then a physical assessment can be included such as vitals
signs recording temperature, pulse, respirations, blood pressure, oxygen saturation, and sometimes
FBS or RBS (Fasting or Random Blood Sugar) checks for diabetics. In addition, physical
assessments in areas such as cardiopulmonary, gastrointestinal, musculoskeletal, genitourinary,
eyes/ears/nose/throat, integumentary(skin), lower extremities inspection, as well as a modified neuro
assessment and medication compliance assessment.[4]

Geriatric care managers[edit]

Geriatric care managers typically have prior training in nursing, social work, gerontology or other
health service areas.[1] They are expected to have extensive knowledge about the costs, quality, and
availability of services in their communities. In some countries and jurisdictions, they may
obtain certification from various professional associations, such as the National Association of
Professional Geriatric Care Managers[2] in the United States.
Professional care managers help individuals, families and other caregivers adjust and cope with the
challenges of aging or disability by:

Conducting care-planning assessments to identify needs, problems and eligibility for assistance;
Screening, arranging, and monitoring in-home help and other services;
Reviewing financial, legal, or medical issues;
Offering referrals to specialists to avoid future problems and to conserve assets;
Providing crisis intervention;
Acting as a liaison to families at a distance;
Making sure things are going well and alerting families of problems;
Assisting with moving their clients to or from a retirement complex, assisted living
facility, rehabilitation facility or nursing home;
Providing client and family education and advocacy;
Offering counseling and support.
Depending on the country and health care organization, professional fees for the services of geriatric
care managers may be billed privately on a fee-for-service basis. In the United States, they are not
covered by Medicaid, Medicare nor by most private health insurance policies. However, clients may
be able to bill some services to long term care insurance, depending on the history of the individual
case.
https://en.wikipedia.org/wiki/Geriatric_care_management

Board-and-Care Facilities
By Barbara Resnick, PhD, CRNP, Professor, OSAH, Sonya Ziporkin Gershowitz Chair in
Gerontology, University of Maryland School of Nursing

CLICK HERE FOR

Patient Education

NOTE: This is the Professional Version. CONSUMERS: Click

here for the Consumer Version

Provision of Care to the Elderly

Overview of Geriatric Care
Home Health Care
Day Care for the Elderly
Respite Care
Hospital Care and the Elderly
Skilled Nursing Facilities
Board-and-Care Facilities
Assisted-Living Programs
Life-Care Communities
Program of All-Inclusive Care for the Elderly
Pharmacists and the Elderly

Board-and-care facilities provide care for elderly people who cannot live independently but who
do not need the constant supervision provided in nursing homes. Board-and-care facilities (also
called rest homes) typically provide the following:

A room
Meals in a communal dining room
Housekeeping services (eg, laundry, cleaning)
Minimal assistance with personal care
Sometimes supervision of drug administration

The number of board-and-care facilities is increasing because they offer an economic, federally
funded means of accommodating the increasing number of elderly people who would otherwise
require nursing home care paid for with state Medicaid funds.
Minimally regulated and sometimes unlicensed, these facilities principally serve 2 groups, often
cared for togetherthe elderly and the deinstitutionalized mentally ill. Although excellent homes
exist, some facilities tend to warehouse the disabled in substandard buildings and to employ few
skilled staff members.

Physicians should try to ensure that their patients in board-and-care facilities are safe and are
receiving appropriate care. Physicians may need to visit the facility or send a nurse or social
worker to evaluate it.

http://www.merckmanuals.com/professional/geriatrics/provision-of-care-to-the-
elderly/board-and-care-facilities

http://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2008.02150.x/full
http://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2011.03786.x/full