Why elderly patients need different care

Ageing changes how the body responds to illness and medication. A drug dose appropriate for a 45-year-old may cause serious side effects in a 75-year-old whose kidneys and liver process it more slowly. Blood pressure targets that reduce cardiac events in middle-aged adults can cause dangerous falls in the elderly if lowered too aggressively. A chest infection that a younger person shakes off in a week can precipitate acute confusion (delirium) in an elderly patient, which is not a brain problem — it is how systemic illness presents in an aged brain.

These are not exceptions; they are consistent enough patterns to constitute a medical speciality. The World Health Organization’s Decade of Healthy Ageing programme documents this clearly, as does the Ministry of Health and Family Welfare’s National Programme for Health Care of the Elderly.

Conditions commonly managed in geriatric care

Multiple chronic diseases

Hypertension, Type 2 diabetes, chronic kidney disease, COPD and ischaemic heart disease frequently co-exist in the same patient. Managing them in combination — rather than in isolation in four separate outpatient clinics — reduces conflicting advice, drug interactions and over-investigation.

Polypharmacy review

The average elderly patient in India who has been seen by multiple specialists is often taking eight or more medications. Some of these will be duplicates, some will interact with each other, and some — particularly sleeping pills, high-dose diuretics, anticholinergics and certain pain medications — carry significant risks in elderly patients that are not always flagged. A structured medication review, comparing all current prescriptions against the patient’s current conditions and kidney function, frequently eliminates two or three medications without any loss of disease control.

Falls and fracture risk

Falls are the leading cause of injury-related hospitalisation in people over 65. The causes are usually multiple: blood-pressure medication causing dizziness on standing (postural hypotension), muscle weakness, impaired vision, sleeping tablets impairing balance at night, and environmental factors. A falls assessment identifies which of these are contributing and what can be changed. The orthopaedic team manages fractures when they occur; the geriatric review aims to reduce the next fall.

Cognitive decline and dementia

Gradual memory loss and slowed thinking that goes beyond normal ageing may indicate mild cognitive impairment or early dementia. A formal cognitive assessment, alongside thyroid, B12 and metabolic testing to exclude treatable causes, establishes the baseline. The psychiatry team provides specialist input for psychiatric manifestations of dementia, including agitation, depression and sleep disturbance.

Depression and social isolation

Depression is significantly under-diagnosed in older adults, partly because it often presents with physical complaints — fatigue, pain, poor appetite — rather than low mood. It is also understandably common in people living with chronic pain, disability, loss of independence, and bereavement. Treatment is as effective in elderly patients as in younger ones.

Delirium (acute confusion)

Sudden or rapidly worsening confusion in an elderly person is a medical emergency until proven otherwise. Common causes include urinary tract infection, pneumonia, heart failure, electrolyte disturbance and medication change. Come to the emergency department immediately.

Post-hospitalisation recovery

Older patients who have been admitted for surgery, a cardiac event or a serious infection often need structured support after discharge — nutrition, physiotherapy, medication reconciliation and wound care. Apex’s inpatient care team coordinates this before discharge.

What a geriatric assessment at Apex involves

• Full medication review against kidney function and current conditions
• Cognitive screening with validated tools (Mini Mental State Examination or similar)
• Falls risk assessment — postural blood pressure, gait and balance observation, medication contributors
• Nutritional assessment
• Depression screening
• Blood tests: full metabolic panel, thyroid, B12, D3, bone markers where relevant
• Echocardiogram and ECG if cardiac symptoms or new onset of breathlessness
• Specialist referral coordination — cardiology, nephrology, neurology, psychiatry — within the same hospital

For family members and caregivers

Caring for an elderly family member with multiple conditions is exhausting and often confusing. You are frequently managing conflicting advice from different specialists, a complex medication regime, and the distress of watching someone you care about lose capacity.

A comprehensive geriatric review gives you one coherent picture of what is happening and what the priorities are. Bring all the medications (in their packaging), all previous reports and discharge summaries, and a list of the symptoms you are most concerned about. One family member should be the primary contact for the team.

If there is an urgent concern — acute confusion, a fall with injury, inability to eat, new breathlessness — come to the emergency department at any hour. The emergency team is trained to assess geriatric presentations and can mobilise the required specialist input.

Frequently asked questions

At what age does geriatric care become relevant?

Most geriatric care guidelines define “elderly” as 65 and older, but the practical answer is: when a person has multiple chronic conditions that interact with each other, or when ageing-specific issues like falls, cognitive change or polypharmacy become relevant — regardless of age.

How is a geriatric consultation different from seeing a general physician?

A geriatric assessment specifically addresses multiple co-existing conditions in combination, medication safety in ageing physiology, function and independence, cognitive screening, and falls risk — areas that a standard single-complaint OPD consultation does not routinely cover.

My father has diabetes, kidney disease and heart failure. Which doctor should he see?

This is exactly the situation geriatric care is designed for. Rather than having three separate specialist clinics generate potentially conflicting advice, a geriatric review coordinates all three alongside a medication safety check. At Apex, the cardiology, nephrology and diabetology teams are all in the same building.

Can I bring my elderly mother in a wheelchair to Apex?

Yes. Elderly patients can be brought to Apex Multispeciality Hospital in a wheelchair. Although the hospital entrance includes stairs, a stair lift is available to help patients access the hospital safely, including during emergencies. Our staff can assist elderly and mobility-impaired patients as needed.

What should I do if my elderly relative suddenly becomes confused?

Acute confusion (delirium) in an elderly person is a medical emergency until a cause is found. Come directly to the emergency department — do not wait until the next morning.

Is dementia treatable?

The common forms of dementia (Alzheimer’s, vascular) are not currently curable, but treatable causes of cognitive decline (thyroid, B12 deficiency, depression, medication side effects) must be excluded first. Symptomatic medications can slow progression in Alzheimer’s. The psychiatry and neurology teams at Apex manage this jointly.

Is insurance accepted for elderly care?

Inpatient admissions are generally covered by health insurance for elderly patients. Senior citizen health insurance plans vary in their OPD benefits. See the insurance and TPA page.

Book a geriatric assessment

Call +91 85912 35064 or book an appointment online. Bring all current medications, all recent reports, and if possible, a family member who can provide the medical history. Apex Multispeciality Hospital, Sector 19, near MSEB, Kopar Khairane, Navi Mumbai 400709.