ABFM Geriatric Medicine cheat sheet

Glomerular filtration declines by roughly 8 mL/min/1.73 m² per decade after age 30; serum creatinine may remain normal because muscle mass and creatinine production fall.

Total body water decreases and body fat increases, raising peak serum levels of water-soluble drugs and prolonging the half-life of lipophilic drugs.

Arterial stiffness increases and beta-adrenergic responsiveness decreases, producing isolated systolic hypertension and a reduced maximum heart rate (approximately 220 minus age).

Bone mineral density decreases, intestinal calcium absorption falls, and renal production of 1,25-dihydroxyvitamin D declines, increasing fracture risk.

Immune senescence reduces naive T cells and cell-mediated immunity, blunts vaccine response, and increases risk of influenza and herpes zoster.

Thermoregulation is impaired by reduced sweating, cutaneous vasodilation, and shivering, increasing risk of hyperthermia and hypothermia.

Pulmonary elastic recoil and FEV1 decline while residual volume increases; PaO2 decreases with age, and cough clearance is less effective.

Hepatic drug metabolism and gastric acid secretion may decline; constipation is common from slower colonic transit.

ADLs are bathing, dressing, toileting, transferring, continence, and feeding; IADLs include finances, medication management, transportation, shopping, telephone use, and housekeeping.

Katz ADL and Lawton IADL scales quantify functional dependence; a new ADL deficit warrants evaluation for acute illness, delirium, depression, and environmental barriers.

Mini-Cog combines three-item recall and clock drawing; it is a brief cognitive screen, not a diagnostic test.

Timed Up and Go ≥12 seconds or gait speed <0.8 m/s indicates increased fall and frailty risk.

Comprehensive geriatric assessment is multidisciplinary and addresses medical, functional, cognitive, psychological, social, and advance-care-planning domains.

SPICES screening flags Sleep problems, Problems eating, Incontinence, Confusion, Evidence of falls, and Skin breakdown.

The 4Ms framework: What Matters, Medication, Mentation, and Mobility.

Unintentional weight loss >5% in 6 months or low BMI triggers nutrition assessment, including Mini Nutritional Assessment.

Ask all older adults about falls in the past year; a positive response or gait/balance complaint triggers multifactorial assessment.

Fall risk factors include sedative, antipsychotic, anticholinergic, antihypertensive, and hypoglycemic medications; orthostasis; vision loss; neuropathy; vestibular disease; weakness; and home hazards.

Timed Up and Go ≥12 seconds, 30-second chair stand below age norms, and gait speed <0.8 m/s indicate impaired mobility and fall risk.

Exercise programs combining balance, strength, and gait training, such as Tai Chi, reduce falls; vitamin D is indicated only for deficiency.

Unexplained falls require evaluation for syncope, arrhythmia, carotid sinus hypersensitivity, and orthostatic hypotension.

Normal pressure hydrocephalus triad: magnetic gait, urinary incontinence, and cognitive impairment; ventriculomegaly with improvement after large-volume lumbar puncture supports shunt referral.

Gait disorder patterns include antalgic, hemiplegic, parkinsonian, ataxic, sensory ataxic, and cautious gait.

Osteoporosis treatment and fall prevention both reduce hip fracture risk; FRAX estimates 10-year fracture probability.

Dementia requires acquired cognitive decline in at least one domain that interferes with independence, without delirium or another explanatory condition.

Initial evaluation includes medication review, TSH, vitamin B12, CBC, comprehensive metabolic panel, depression screen, and neuroimaging when focal signs or rapid decline are present.

Alzheimer disease is the most common cause; cholinesterase inhibitors are used for mild to moderate disease and memantine for moderate to severe disease.

Lewy body dementia features fluctuating cognition, visual hallucinations, parkinsonism, and REM sleep behavior disorder; severe neuroleptic sensitivity is common.

Frontotemporal dementia presents with early personality, behavior, or language changes; cholinesterase inhibitors are not effective.

Vascular dementia shows stepwise decline and cerebrovascular disease; risk-factor control is central.

Delirium is acute, fluctuating, and attention-impaired; dementia is chronic and progressive, and delirium commonly superimposes on dementia.

Driving, financial capacity, medication adherence, caregiver burden, and advance care planning are assessed longitudinally.

Late-life depression often presents with somatic complaints, pain, insomnia, appetite change, or cognitive slowing; suicide risk is highest in older men.

PHQ-2 and PHQ-9 are screening tools; SSRIs are first-line pharmacotherapy, while tricyclics are avoided because of anticholinergic and orthostatic effects.

Psychotic depression and severe treatment-resistant depression may require electroconvulsive therapy.

Delirium is an acute neuropsychiatric emergency; common causes include infection, medications, pain, urinary retention, constipation, hypoxia, and metabolic derangement.

The Confusion Assessment Method requires acute onset or fluctuation, inattention, and disorganized thinking or altered consciousness.

Behavioral and psychological symptoms of dementia are managed first with nonpharmacologic approaches; antipsychotics are reserved for severe agitation or psychosis.

Benzodiazepines increase falls, confusion, and dependence and are not first-line for anxiety or insomnia in older adults.

Alcohol screening with AUDIT-C; withdrawal can cause seizures and delirium tremens.

Polypharmacy is commonly ≥5 medications; hyperpolypharmacy is ≥10; each additional medication increases adverse drug event and interaction risk.

Beers Criteria identify potentially inappropriate medications, including benzodiazepines, anticholinergics, chronic NSAIDs, long-acting sulfonylureas, and proton pump inhibitors beyond 8 weeks without indication.

Prescribing cascades occur when a drug side effect is treated as a new disease, such as anticholinergic confusion treated with an antipsychotic.

Anticholinergic burden scales predict confusion, constipation, urinary retention, falls, and dry mouth.

Renal dosing commonly uses Cockcroft-Gault creatinine clearance, especially for renally cleared drugs.

Deprescribing reviews indication, benefit, harm, and patient goals; benzodiazepines, antipsychotics, and proton pump inhibitors often require tapering.

Medication reconciliation at every transition reduces duplication, omission, and dosing errors.

Acetaminophen is preferred first-line for many older adults with pain; NSAIDs increase GI bleeding, renal injury, and heart failure risk.

Urinary incontinence types: stress (leak with cough/sneeze), urge (urgency), overflow (retention), and functional (access or cognitive barriers).

Postvoid residual helps distinguish retention/overflow from detrusor overactivity; behavioral therapy and pelvic floor training are first-line.

Antimuscarinics for urge incontinence can worsen cognition and constipation; beta-3 agonists are alternatives.

Fecal incontinence evaluation includes impaction, diarrhea, sphincter injury, and neurologic disease; disimpaction and bowel regimen are initial steps.

Pressure injuries are staged 1 through 4, plus unstageable and deep-tissue injury; staging is based on deepest visible tissue.

Braden Scale scores sensory perception, moisture, activity, mobility, nutrition, and friction/shear; lower scores indicate higher risk.

Presbycusis is age-related high-frequency hearing loss; hearing aids reduce communication difficulty and may reduce fall and cognitive risk.

Vision impairment from cataract, glaucoma, and macular degeneration increases fall risk and limits medication and driving safety.

Multimorbidity management prioritizes patient goals, function, and treatment burden; single-disease guidelines can cause harmful polypharmacy.

Diabetes targets are individualized: about 7.0-7.5% for healthy older adults, about 8% for complex illness, and avoidance of symptomatic hyperglycemia or hypoglycemia in very complex patients.

Hypoglycemia risk is higher with insulin and sulfonylureas; both require caution and simplified regimens in older adults.

Hypertension treatment should include standing blood pressure checks to detect orthostatic hypotension.

Cardiac and pulmonary rehabilitation improve exercise capacity and quality of life; early mobilization reduces hospital-associated functional decline.

Frailty phenotype: unintentional weight loss, exhaustion, weakness, slow gait, low activity; ≥3 criteria indicates frailty.

Stroke rehabilitation is most effective when started early and is intensive, task-specific, and multidisciplinary.

Advance care planning and goals-of-care discussions should be integrated into chronic illness management.

Palliative care addresses symptoms and goals at any disease stage; hospice requires a prognosis of ≤6 months if disease follows its expected course.

Pain in advanced dementia is assessed with behavioral scales such as PAINAD; treatment includes scheduled acetaminophen, opioids, and bowel prophylaxis.

Dyspnea treatment includes opioids, fan-directed airflow, and oxygen only for hypoxemia.

Decision-making capacity requires understanding, appreciation, reasoning, and communication of choice; it is decision-specific.

Surrogate decision-makers use substituted judgment when prior wishes are known and best interests when they are not.

POLST/MOLST documents portable treatment preferences for seriously ill patients; advance directives guide future care.

Withholding and withdrawing life-sustaining treatment are ethically equivalent when consistent with patient goals.

Terminal secretions are managed with repositioning and anticholinergics; routine suctioning is not recommended.

Long-term care includes home and community-based services, assisted living, skilled nursing facilities, and PACE.

PACE provides comprehensive medical and social care to nursing-home-eligible adults, usually allowing them to remain at home.

Care transitions require medication reconciliation, discharge summary, follow-up appointment, and patient/caregiver education to reduce readmissions.

Medicare Part A covers hospital and skilled nursing facility care; Part B covers outpatient and physician services; Part D covers prescription drugs.

Dual-eligible beneficiaries qualify for both Medicare and Medicaid; Medicaid covers long-term custodial care.

Nursing home care is regulated by OBRA, with MDS assessments and individualized care plans.

Elder mistreatment includes physical, emotional, sexual, financial abuse, neglect, and self-neglect; suspected abuse is reported under state law.

Interdisciplinary team care and geriatric care managers improve coordination for multimorbid older adults.