Hand tremors in the elderly and how to treat them

Hand tremor is a very common complaint in the elderly, making it difficult for them to perform daily activities. However, hand tremor in the elderly has many causes and each type has its own unique characteristics. Accordingly, the treatment of hand tremor in the elderly should also be considered on many different factors.

Hand tremors are a common sign of old age. This is not a risk factor for the health of the elderly but remains challenging for geriatricians, neurologists and general practitioners alike.
Hand tremor is defined as a rhythmic movement, oscillating back and forth to a certain amplitude and beyond the control of the body. The degree of tremor can vary from a mild to severe condition. 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 tremors occur acutely, this is again indicative of a new-onset structural disease such as cerebellar stroke. Therefore, in the elderly, it is necessary to approach hand tremor in many different ways, with systematic evaluation for accurate diagnosis and appropriate treatment.

2.1 History Taken As with other clinical problems, a thorough history is always essential in the diagnosis of tremor. For example, people with essential tremor often present over many years, alcoholic tremors, hand tremors with palpitations...

However, the examination based on the medical history of the elderly is challenging for the doctor because at this age, the elderly often face diseases due to cognitive decline, hearing loss, language disorders. ... should be exploited more from caregivers or descendants in the family.
In addition, the effects of tremor on daily life should also be assessed. If older adults feel negatively about tremors, they should be treated more aggressively than those who are less or less significantly affected.
2.2 Physical Examination Physical examination can assess the extent to which a patient can perform normal activities and functions in the setting of tremor; For example, ask the patient to write a sentence, pour water, and raise the glass to drink.
Meanwhile, by observing tremor characteristics, evaluating other body parts as well as other neurolocating signs such as posture, posture, weakness... can contribute to finding Causes of hand tremor in the elderly.
Another important exam is to evaluate cognitive function. If the elderly have cognitive impairment, difficulty understanding medical orders or performing them, confusion and tremors, this should not be attributed to simple hand tremors.
2.3 Labs and imaging Blood tests such as thyroid function tests and X-ray images, computed tomography, or magnetic resonance brain imaging may be considered for adults. age with tremor, in order to rule out the possibility that a physical disease may play a role in the etiology. Accordingly, three common causes of tremor in the elderly are idiopathic Parkinson's disease, vascular Parkinson's disease and essential tremor.

Controlling hand tremor in the elderly is not always simple and easy to do while the elderly have many comorbidities and complex social situations. Accordingly, the elderly often take more than one drug and anti-tremor drugs will further increase the risk of drug interactions that are difficult to control.

Meanwhile, the causes of tremors in the elderly are often chronic conditions and can progress spontaneously over time. Therefore, long-term management plans require patient understanding and awareness plus support from the family.
Drugs used to treat need to be used according to the type of tremor. For elderly patients with resting tremor with the most important cause being idiopathic Parkinson's disease, the recommended therapeutics are levodopa, dopamine agonists such as ropinirole inhibitors, and monoamine-oxidase B (MAOIs) such as selegiline .

Modified-release levodopa, catechol-o-methlytransferase inhibitors such as entacapone, apomorphine (dopamine agonists acting on D1 and D2 receptors in intermittent subcutaneous injection or continuous subcutaneous infusion) ) is indicated as second-line treatment in idiopathic Parkinson's disease. In addition, anticholinergics such as benzhexol are effective in controlling tremors, but their use is uncommon in the elderly because of the confusing side effects.
In the management of resting tremor secondary to Parkinson's disease, the primary approach is to understand the underlying cause of the disease and optimize it. In particular, the most common cause in the elderly is stroke with multiple small infarcts and drug use with antipsychotic drugs such as chlorpromazine, haloperidol, risperidone and olanzapine. Although there is no specific immediate treatment for drug-induced resting tremor, if the suspected drug is discontinued, tremor may soon improve.

In addition, hand tremor in the elderly can also be treated by surgical intervention of deep brain stimulation with the indication to control the severity of essential tremor. At the same time, invasive treatment is only considered until conventional measures are ineffective or difficult to tolerate, and have side effects.
Besides, the application of exercise according to physical therapy can help improve tremor. There is much evidence that coordinated movements designed from common activities in life can help older adults be more flexible in their movements, as well as indirectly improve the problem of bone degeneration. joint.
In summary, the elderly can present with very different types of tremor. A systematic and comprehensive approach helps to find the cause and determine the appropriate course of treatment. However, the choice of intervention method to control hand tremor in the elderly needs to consider many different factors, in which, the patient's lifestyle and personal interests should be the top priorities in the treatment options. treatment plan, long-term follow-up.

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