ICD-10-CM Codes

Key Concepts

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  By 2030, approximately 20% of the U.S. population will be older than 65 years of age.

  
  
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  Geriatric medicine is medicine focused on patients older than 65 years.

  
  
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  Research has proven that regular exercise in the geriatric population provides many health benefits.

  
  
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  Appropriate exercise is safe in the geriatric population and provides numerous health benefits.

  
  
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  It is recommended that geriatric patients have 30 minutes of exercise at least 5 days each week.

  
  
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  Although physiologic changes occur with aging, the capacity for the geriatric patient to exercise and improve strength, endurance, flexibility, and performance is maintained.

  
  
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  Age-related changes in physiology affect metabolism of many medications, especially medications used to treat pain related to acute, chronic, or postoperative musculoskeletal conditions.

  
  
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  With the increasing geriatric population, every health care provider must be familiar with the physiologic changes with aging, as well as common musculoskeletal conditions and the impact of comorbidities on these conditions.

  
  
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  Physicians can support healthy lifestyles in the geriatric patient with an exercise prescription.

Physiologic Changes Associated With Aging

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  Elderly adults have a decline in coordination, balance, and reaction time, as well as impaired vision, hearing, and short-term memory.

  
  
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  Elderly adults have a decrease in bone mineral density, with losses as high as 3% per year in postmenopausal women and 0.5% per year in men older than 40 years.

  
  
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  Elderly adults can develop sarcopenia, with an average 30% reduction in strength from age 50 to age 70 secondary to atrophy of type II muscle fibers, with associated decrease in tensile strength and increased stiffness of tendons and ligaments.

  
  
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  Elderly adults also have weakening of articular cartilage and a decrease in elastic properties of intervertebral disks.

  
  
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  Geriatric patients do not have increases of antidiuretic hormone (ADH) with activity to signal thirst and need for hydration.

  
  
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  Body composition changes with age, leading to increased total body fat distribution that leads to increased retention of fat-soluble medication, such as those that cross the blood-brain barrier, as well as increased risk for dose stacking.

  
  
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  With normal aging, there is a decrease in renal function (both number of functioning nephrons and incoming blood flow) in the geriatric population. Hepatic metabolism is not affected by normal aging. This change in renal function affects the types and doses of safe medications.

  
  
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  Functional changes with aging can lead to impairment that can be assessed by determining a patient’s ability to perform their activities of daily living (ADLs) ( Box 5.1 ).

  
  
  
  

  Box 5.1

  
  

  Activities of Daily Living

  
  

  
  

  
  

  
  
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    Dressing

    
    
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    Eating

    
    
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    Ambulating

    
    
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    Toileting

    
    
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    Hygiene

  
  

  
  
  
  
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  As a person is less able to independently do their ADLs, their all-cause mortality risk increases with this functional decline.