Hand tremor is a commonly popular complaint in the elderly, limiting them in their daily activities. However, hand tremor in the elderly is caused by many causes and each type has its characteristics. Accordingly, the treatment of hand tremors in the elderly also needs to be considered based on many different factors.
1. What is hand tremor in the elderly?
Hand tremor is a common sign of old age. This is not a dangerous factor for the health of the elderly but is always a challenge for geriatricians, neurologists, and general practitioners in general.
Hand tremor is defined as a rhythmic, oscillating movement with a certain amplitude and beyond the body's control. The level of tremor can vary from mild to severe. Any form of severe hand tremor can have a negative impact on activities of daily living as well as quality of life in the elderly.
On the other hand, if hand tremor occurs acutely, this is a manifestation of a newly developed physical pathology such as cerebellar stroke. Therefore, in the elderly, it is necessary to approach hand tremor from many different aspects, systematically evaluate for accurate diagnosis and appropriate treatment.
2. How to approach the diagnosis of hand tremor in the elderly?
2.1 Exploit medical history
As other clinical problems, exploiting a thorough medical history is always necessary in diagnosing tremor. For example, people with tremor often have appeared over many years, tremor in alcoholics, hand tremor with palpitations...
However, examining the medical history of the elderly is a challenge for the doctor because at this age, the elderly often encounter diseases due to cognitive decline, hearing loss, language disorders, etc., so it is necessary to exploit more from caregivers or relationship in the family.
In addition, the effects of tremors on daily life also need to be assessed. If the elderly feel negative because of tremors, they should be treated more actively than those who are less or not significantly affected.
2.2 Physical examination
Physical examination can assess the level of the patient's ability to perform normal activities and functions in the context of hand tremor; for example, asking the patient to write a sentence, pour water, and raise a cup to drink.
Meanwhile, by observing the characteristics of the tremor, assessing other parts of the body as well as other localizing neurological signs such as posture, gait, weakness, etc. can contribute to finding the cause of hand tremor in the elderly.
Another important examination is to evaluate cognitive function. If the elderly have cognitive impairment, difficulty in understanding or carrying out instructions, they are confused and shaky, they should not be attributed to simple hand tremor.
2.3 Tests and imaging
Blood tests such as thyroid function tests and X-ray images, computed tomography or magnetic resonance imaging of the brain can be considered for the elderly with hand tremor, to rule out the possibility of organic diseases playing a role as the cause. Accordingly, the three common causes of tremor in the elderly are idiopathic Parkinson's disease, vascular Parkinson's disease and essential tremor.
3. Treatments for hand tremor in the elderly?
Controlling hand tremors in older adults is not always simple and easy, as older adults have multiple comorbidities and complex social circumstances. Accordingly, older adults often take more than one medication, and anti-tremor medications will increase the risk of difficult-to-control drug interactions.
Meanwhile, the causes of tremors in the elderly are often chronic and can progress naturally over time. Therefore, long-term management plans require understanding and awareness of the patient parallel with supports from family.
The type of medication used for treatment should be based on the type of tremor. For the elderly with resting tremor with the most important cause being idiopathic Parkinson's disease, the recommended treatments are levodopa, dopamine agonists such as ropinirole and monoamine-oxidase B inhibitors (MAOIs) such as selegiline.
Modified-release levodopa, catechol-o-methlytransferase inhibitors such as entacapone, apomorphine (dopamine agonist acting on D1 and D2 receptors in intermittent subcutaneous injection or continuous subcutaneous infusion) are indicated as second-line treatment in idiopathic Parkinson's disease. In addition, anticholinergic drugs such as benzhexol are effective in controlling tremor, but it is not common in the elderly because of confusing side effects.
In the management of resting tremor in secondary Parkinson's disease, the main treatment is to identify the underlying cause and optimize. The most common causes in the elderly are stroke with multiple small infarcts and medication-induced antipsychotics such as chlorpromazine, haloperidol, risperidone, and olanzapine. Although there is no specific immediate treatment for drug-induced resting tremor, the tremor may decrease early if the suspected drug is discontinued.
In addition, hand tremor in the elderly can also be treated by surgical intervention with deep brain stimulation, with the indication of controlling severe essential tremor. At the same time, invasive treatment is only considered when conventional measures are ineffective or difficult to tolerate, and side effects occur.
In addition, the application of physical therapy exercises can help improve tremors. There is several evidence that coordinated movements designed from common activities in life can help the elderly to be more flexible in their movements, as well as indirectly improve the problem of osteoarthritis.
In summary, the elderly can manifest with very different types of hand tremors. A systematic and comprehensive approach will help find the cause and determine the appropriate treatment direction. However, the choice of intervention method to control hand tremors in the elderly needs to consider many different factors, in which the lifestyle and personal interests of the patient should be the top priority in treatment plans and long-term monitoring.
