With over 16% of the U.S. population now over the age of 65—a number that's projected to reach nearly one in four Americans by 2060—the need for specialized geriatric care is on the rise. But what does "specialized" mean when it comes to the aging population? To answer this question, let's turn our focus to the field of integrative geriatric medicine.
Integrative geriatric medicine offers a holistic approach, blending traditional and complementary therapies to address the unique needs of aging individuals. A key component in this specialized care is the use of biomarkers, which are measurable indicators of physiological states or conditions. These biomarkers help in diagnosing, monitoring, and even predicting a wide range of health issues commonly faced by the elderly. In this article, we'll explore the various critical biomarkers used in geriatric medicine and their role in achieving optimal health outcomes.
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Comprehensive Geriatric Assessment
The Comprehensive Geriatric Assessment (CGA) serves as the cornerstone of integrative geriatric medicine, offering a multidimensional, multidisciplinary approach that evaluates an elderly patient's overall well-being. This holistic strategy involves a team of healthcare providers—physicians, nurses, nutritionists, and sometimes social workers or physical therapists—to identify a variety of medical, psychosocial, and functional limitations that an older adult may have. The aim is to develop an individualized, coordinated plan to manage these issues comprehensively.
The CGA is divided into several key components to ensure a thorough evaluation:
- The physical health assessment looks at the patient's chronic illnesses, nutritional status, and other bodily systems that could decline.
- A cognitive and psychological assessment provides insight into any mental health or cognitive issues, such as depression or early signs of dementia.
- The functional status evaluation addresses the patient's ability to perform daily activities, assessing both mobility and independence.
- The social and environmental assessment reviews the patient's living conditions and social support networks.
Together, these components enable healthcare providers to develop a tailored treatment plan that accounts for the multi-faceted challenges often faced by older adults (2-4).
Key Biomarkers in Geriatric Medicine
Geriatric medicine focuses on the health and well-being of older adults. Biomarkers play an important role in understanding the aging process and managing age-related diseases.
Blood Pressure and Hypertension
Blood pressure monitoring is an essential aspect of geriatric care, as elevated levels can significantly increase the risk of heart disease, stroke, and other cardiovascular issues in older adults. Consistent monitoring can identify trends and help clinicians adjust medications or recommend lifestyle modifications before the condition worsens. Ideal blood pressure ranges for the geriatric population may differ from the general adult population; typically, a reading below 130/80 mm Hg is considered within the normal range for most older adults. However, personalized targets may be set based on the individual's overall health, co-existing medical conditions, and medication regimen.
Cholesterol Levels
Cholesterol plays a pivotal role in cardiovascular health, especially in the aging population, where the risk of heart disease is elevated. The levels of LDL ("bad" cholesterol), HDL ("good" cholesterol), and triglycerides each have specific implications for cardiovascular health in older adults. For seniors, maintaining LDL levels below 100 mg/dL, HDL levels above 60 mg/dL, and triglycerides below 150 mg/dL is often generally recommended.
Blood Sugar and Diabetes
Blood sugar levels are a vital component to monitor in geriatric medicine, as elevated levels can speed up the aging process and exacerbate other age-related conditions. Poorly managed blood sugar is linked to complications such as neuropathy, cardiovascular disease, and impaired wound healing. Diabetes screening for older adults usually involves tests such as hemoglobin A1C tests or fasting insulin, among others. One great comprehensive choice is the Diabetes Panel, which contains several different biomarkers to get a comprehensive picture of metabolic health.
Bone Density
In older adults, declining bone density is a major concern as it significantly increases the risk of fractures and osteoporosis. Osteoporosis can be particularly debilitating for seniors, as even minor falls may result in severe fractures. Dual-energy X-ray absorptiometry (DEXA) scans are the gold standard for diagnosing osteoporosis, measuring bone mineral density, and helping to predict fracture risk. Early detection through DEXA allows for proactive management strategies, such as lifestyle modifications and medications, aimed at reducing the risk of fractures.
Cognitive Function
Cognitive decline is a common concern as people age, with conditions like dementia and Alzheimer's disease becoming increasingly prevalent in the older population. Such decline not only impacts the individual but also places a burden on caregivers and healthcare systems. To assess cognitive function, healthcare providers often employ various cognitive assessments and may also look at specific brain health biomarkers.
Inflammation Markers
Chronic inflammation is a significant concern in aging, as it's linked to many age-related diseases, including cardiovascular issues, diabetes, and even cognitive decline. Monitoring inflammation markers can offer insights into an individual's overall health and potential risk factors. One common biomarker for inflammation is C-reactive protein (CRP). Elevated levels of CRP and other inflammatory markers such as ESR or hs-CRP can indicate underlying chronic inflammation and may necessitate further evaluation and management to mitigate long-term health risks.
Specialized Biomarkers and Tests Used For The Geriatric Population
In aging adults, specialized tests and biomarkers are key for tailored healthcare. Functional medicine labs offer these essential tools to diagnose and manage age-related conditions effectively.
Hormone Levels
Hormonal imbalances often occur as people age, affecting everything from metabolism and bone density to cognitive function. Testing for hormone levels is a routine part of geriatric care, offering insights into a wide range of physiological processes. One such test is the DUTCH Complete. This test is a comprehensive hormone panel that checks several biomarkers that may be abnormal in geriatric patients, such as sex hormones, thyroid levels, or cortisol levels.
Nutritional Status
Malnutrition is a pervasive issue among older adults, affecting not just weight but also immune function, muscle strength, and even cognitive ability. Various functional medicine labs offer nutritional assessments that go beyond basic metabolic panels. Some choices include micronutrient testing and food allergy testing. These tests can guide dietary changes, supplementation, or further diagnostic procedures.
Genetic Markers
The role of genetics in aging and disease susceptibility is an expanding field of study, making personalized medicine more attainable than ever. Genetic tests in geriatric care can help to shed light on a patient's predisposition to various diseases like Alzheimer's. For more general wellness concerns, genetic testing such as the Wellness Panel or the 3X4 Genetics Test + Blueprint Report can help guide personalized treatment decisions.
Additional Labs To Test
As it is not uncommon for geriatric patients to have impaired renal function, tests such as a renal panel may help to assess and guide optimal health outcomes.
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Summary
In summary, the increasing number of older adults underscores the need for specialized medical attention that addresses the unique challenges of aging. Integrative geriatric medicine, with its holistic approach, offers a comprehensive evaluation that goes beyond traditional metrics. Utilizing a range of biomarkers and specialized tests aids in the accurate diagnosis and management of age-related conditions. These diagnostic tools empower healthcare providers to formulate personalized treatment plans, ultimately enhancing the well-being and quality of life for the elderly.
Lab Tests in This Article
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References
- 9 Common Causes Of Dementia. (2022, April 22). Rupa Health. https://www.rupahealth.com/post/a-functional-medicine-approach-to-dementia
- A Root Cause Medicine Protocol For Patients With Osteoporosis: Testing, Therapeutic Diet, and Supportive Supplements. (2023, September 6). Rupa Health. https://www.rupahealth.com/post/a-root-cause-medicine-protocol-for-patients-with-osteoporosis-testing-therapeutic-diet-and-supportive-supplements
- American Heart Association. (2017a). Monitoring Your Blood Pressure at Home. Www.heart.org. https://www.heart.org/en/health-topics/high-blood-pressure/understanding-blood-pressure-readings/monitoring-your-blood-pressure-at-home
- American Heart Association. (2017b). What Your Cholesterol Levels Mean. Www.heart.org. https://www.heart.org/en/health-topics/cholesterol/about-cholesterol/what-your-cholesterol-levels-mean
- An Integrative Medicine Approach to Alzheimer’s Disease: Testing, Nutrition, and Supplements. (2023, May 23). Rupa Health. https://www.rupahealth.com/post/to-functional-medicine-labs-that-help-individualize-treatment-for-alzheimers-disease
- Centers for Disease Control and Prevention. (2022). Promoting Health for Older Adults. CDC. https://www.cdc.gov/chronicdisease/resources/publications/factsheets/promoting-health-for-older-adults.htm
- Cleveland Clinic. (2020, December 15). DEXA Scan (DXA): Bone Density Test, What Is It & How It’s Done. Cleveland Clinic. https://my.clevelandclinic.org/health/diagnostics/10683-dexa-dxa-scan-bone-density-test
- Comprehensive Geriatric Assessment - Geriatrics. (n.d.). Merck Manuals Professional Edition. https://www.merckmanuals.com/professional/geriatrics/approach-to-the-geriatric-patient/comprehensive-geriatric-assessment
- High Blood Pressure and Older Adults. (n.d.). National Institute on Aging. https://www.nia.nih.gov/health/high-blood-pressure-and-older-adults#do
- Integrative Primary Care for Geriatrics. (2023, March 30). Rupa Health. https://www.rupahealth.com/post/integrative-primary-care-for-geriatrics
- Maholy, N. (2023, May 26). Integrative Nutrition Approaches to Managing Blood Sugar Levels. Rupa Health. https://www.rupahealth.com/post/integrative-nutrition-approaches-to-managing-blood-sugar-levels
- MedlinePlus. (2017). Aging changes in hormone production: MedlinePlus Medical Encyclopedia. Medlineplus.gov. https://medlineplus.gov/ency/article/004000.htm
- Norman, K., Haß, U., & Pirlich, M. (2021). Malnutrition in Older Adults—Recent Advances and Remaining Challenges. Nutrients, 13(8), 2764. https://doi.org/10.3390/nu13082764
- Sanada, F., Taniyama, Y., Muratsu, J., Otsu, R., Shimizu, H., Rakugi, H., & Morishita, R. (2018). Source of Chronic Inflammation in Aging. Frontiers in Cardiovascular Medicine, 5. https://doi.org/10.3389/fcvm.2018.00012
- Sartori, A. C., Vance, D. E., Slater, L. Z., & Crowe, M. (2012). The Impact of Inflammation on Cognitive Function in Older Adults: Implications for Health Care Practice and Research. The Journal of Neuroscience Nursing, 44(4), 206–217. https://doi.org/10.1097/JNN.0b013e3182527690
- UpToDate. (2019). Uptodate.com. https://www.uptodate.com/contents/comprehensive-geriatric-assessment
- Weinstein, J. R., & Anderson, S. (2010). The Aging Kidney: Physiological Changes. Advances in Chronic Kidney Disease, 17(4), 302–307. https://doi.org/10.1053/j.ackd.2010.05.002
- Welsh, T. J., Gordon, A. L., & Gladman, J. R. (2013). Comprehensive geriatric assessment - a guide for the non-specialist. International Journal of Clinical Practice, 68(3), 290–293. https://doi.org/10.1111/ijcp.12313
- What is Integrative Geriatric Medicine? (2023, March 27). Rupa Health. https://www.rupahealth.com/post/what-is-integrative-geriatric-medicine#:~:text=Malnutrition%20is%20common%20in%20the
