Geriatric Syndromes and Care of the Older Adult
What the exam tests
Geriatric questions test recognition of syndromes that cross organ systems: falls, delirium, dementia, incontinence, polypharmacy, frailty, and elder mistreatment. Older adults often present atypically-delirium, falls, or poor intake instead of fever or pain.
Concepts
Delirium is acute, fluctuating inattention; dementia is chronic progressive cognitive decline; depression can mimic both. Any acute mental status change is delirium until proven otherwise, and it is a medical emergency. Falls: assess gait and balance, vision, medications, orthostasis, feet, and home hazards; recommend exercise and deprescribing. Incontinence: classify as stress, urge, overflow, or functional; check for UTI, constipation, and medications. Polypharmacy: use Beers criteria and STOPP/START; avoid anticholinergics, benzodiazepines, and sedative-hypnotics. Functional assessment: distinguish ADLs from IADLs. Advance care planning and goals of care belong in every chronic visit.
Traps
Labeling delirium as dementia or UTI without evaluation; treating asymptomatic bacteriuria; using physical restraints; missing abuse or neglect; and continuing medications that increase fall risk. Do not screen for dementia without a plan for evaluation and support.
Worked example
An 82-year-old becomes acutely confused after starting oxybutynin and diphenhydramine. The diagnosis is delirium with likely anticholinergic burden. Management: stop the offending agents, treat pain, constipation, or infection if present, reorient, mobilize, and review all medications-not just add an antipsychotic.
Rule of thumb
For any acute functional or cognitive decline, think DIMES: Drugs, Infection, Metabolic, Environmental, Structural. Fix reversible causes first.