Geriatric Health and Aging
Core concepts
Geriatrics is about function and goals, not just disease. Master the geriatric syndromes: falls, delirium, incontinence, frailty, polypharmacy, and failure to thrive. Screen for falls annually (ask about falls, gait/balance, orthostatics), and use the Timed Up and Go or gait speed. Falls workup includes vision, footwear, home hazards, medications (sedatives, anticholinergics, antihypertensives), and vitamin D.
Polypharmacy and the Beers criteria are frequent test targets: avoid benzodiazepines, anticholinergics, and long-acting sulfonylureas in older adults when possible. Deprescribing is a skill - taper rather than stop abruptly for drugs with withdrawal risk.
Dementia: distinguish delirium (acute, fluctuating, inattention) from dementia (chronic, progressive) and depression (pseudodementia). Alzheimer's is the most common dementia; vascular dementia follows strokes; Lewy body dementia has visual hallucinations, parkinsonism, and fluctuating cognition. Workup includes B12, TSH, and imaging when atypical.
Advance care planning and capacity assessment are core. Capacity requires understanding, appreciation, reasoning, and expressing a choice; it is decision-specific. Elder mistreatment screening is mandatory in many states.
Traps
- Assuming cognitive decline is normal aging - screen and work up.
- Missing delirium superimposed on dementia.
- Tight glycemic or BP control in frail elders causing harm.
- Forgetting driving, home safety, and caregiver burden in the plan.
Rule of thumb
In an older adult with any new functional decline, think "D" first: Delirium, Drugs, Depression, Dementia, Deconditioning. Address reversible causes before labeling it aging.