The welfare and health care of older persons is a major issue in society today as society is ageing. The foundation of competent care of the older person is understanding both the biomedical and psychosocial aspects associated with being older, so the aim of this chapter is to cover the wider aspects of gerontology and geriatric medicine. A high proportion of podiatric patients are in this older age group and the podiatric care of the older patients takes place in a wide psychosocial context, so there is a need for podiatric education to reflect this. All health care providers need to respond to the demographic changes that are occurring, as this age group is the fastest growing in society. More and more of daily clinical practice in most disciplines will involve the care of older persons.
Health problems in the older person are often met with a passive and negative acceptance by many health professionals and the wider population. It is now clear that positive, organised and professional services can have significant and positive impact on the well being of the older persons. Podiatric care for this group can contribute to the prospects of improved quality of life.
Dorland’s Medical Dictionary defines ageing as the “gradual structural changes that occur with the passage of time, that are not due to disease or accident, and that eventually lead to death.” Spirduso (1995) defines ageing as “a process or group of processes occurring in living organisms that with the passage of time lead to a loss of adaptability, functional impairment, and eventually death”. All individuals age – physiologically, psychologically, sociology and spiritually, but each individual does it in different ways and at different rates.
Strehler’s (1962) definition of ageing has four components – ageing is:
1) Universal (we all age)
4) Intrinsic (innate to us and not a pathological process)
Geriatrics – the branch of healthcare that deals with the diseases of old age (has a medical and disease orientation)
Gerontology – the study of all aspects and process of aging and problems of older persons (has a biological, epidemiological, economic, cultural, sociological and psychological orientation) (‘geront’ is Greek for “old man”).
Podogeriatrics – branch of podiatric clinical practice that deals with the foot of the older patient, but the responsibility of the Podiatrist is the care of the older patient in a comprehensive way.
Sloane et al (2002) note that geriatric medicine differs from traditional internal medicine with three key features:
• Geriatric syndromes: Clinical features are commonly manifested as confusion, falls, dizziness and balance, immobility and dysmobility, incontinence, fatigue and weight loss.
• Management of disability: The focus should be on function rather than diagnosis; care rather than cure; and independence rather than freedom from disease.
• Low therapeutic ratios with high risk of harming the patient: Iatrogenic disease is the most common preventable problem in geriatrics.
• Ageing - more commonly used in the UK and Australia
• Aging – more commonly used in North America