ABFM Geriatric Medicine flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Aging kidney function

Glomerular filtration rate falls by about 8 mL/min per 1.73 m² each decade after age 30, while serum creatinine may remain normal because reduced muscle mass lowers creatinine production.

Immune senescence

Aging reduces naive T-cell production and cell-mediated immunity, blunts vaccine responses, and increases susceptibility to infections such as influenza and herpes zoster.

Aging thermoregulation

Older adults have reduced sweating and cutaneous vasodilation, impaired shivering, and blunted thirst, increasing risk of heat illness and dehydration during exertion or hot weather.

Katz ADL index

A six-item scale rating independence in bathing, dressing, toileting, transferring, continence, and feeding; lower scores indicate greater need for assistance with basic self-care.

Mini-Cog test

A brief cognitive screen combining three-word recall with a clock-drawing task; a positive result suggests cognitive impairment and warrants further evaluation, including medication and delirium review.

Timed Up and Go

The patient rises from a chair, walks three meters, turns, and returns; a time of 12 seconds or longer suggests increased fall risk and impaired mobility.

Falls screening question

Ask whether the patient has fallen in the past year; a yes answer or reported gait or balance problem triggers multifactorial fall-risk assessment and intervention.

Gait speed frailty cutoff

A usual gait speed below 0.8 meters per second is associated with frailty, disability, falls, and mortality and can be measured with a timed four-meter walk.

Normal pressure hydrocephalus

Triad of magnetic gait, urinary incontinence, and cognitive impairment with ventriculomegaly; large-volume lumbar puncture or shunt response supports the diagnosis.

Dementia diagnostic criterion

Acquired cognitive decline in one or more domains that interferes with independence in daily activities and is not explained by delirium or another reversible condition.

Lewy body dementia

Dementia with fluctuating attention, recurrent visual hallucinations, parkinsonism, and REM sleep behavior disorder; affected patients often have severe sensitivity to typical antipsychotics.

Delirium versus dementia

Delirium has acute onset, fluctuating course, and impaired attention; dementia is chronic and progressive, though delirium can occur in patients with underlying dementia.

Cholinesterase inhibitor side effects

Donepezil, rivastigmine, and galantamine can cause nausea, diarrhea, bradycardia, syncope, and vivid dreams; monitor heart rate and gastrointestinal tolerance after starting or increasing dose.

Late-life depression

Depression in older adults often presents with somatic complaints, pain, insomnia, or cognitive slowing rather than sadness; suicide risk is elevated, especially in older men.

Confusion Assessment Method

A structured delirium screen requiring acute onset or fluctuation, inattention, and either disorganized thinking or altered consciousness; it is brief and can be used at the bedside.

Antipsychotics in dementia

Use only for severe agitation or psychosis after non-drug measures fail; choose the lowest dose for the shortest time and monitor for falls, sedation, and metabolic effects.

Beers Criteria

A consensus list of potentially inappropriate medications for older adults, including benzodiazepines, anticholinergics, chronic NSAIDs, and long-acting sulfonylureas, used to guide safer prescribing.

Polypharmacy

Commonly defined as use of five or more medications; hyperpolypharmacy is ten or more. It increases risk of adverse drug events and warrants regular medication review.

Prescribing cascade

A drug side effect is misinterpreted as a new condition, leading to another medication; an example is anticholinergic-induced confusion treated with an antipsychotic.

Deprescribing

The systematic process of reducing or stopping medications when harms outweigh benefits, using tapering when needed and monitoring for withdrawal or symptom recurrence.

Urge incontinence

Involuntary urine loss preceded by sudden urgency, often from detrusor overactivity; behavioral therapy and bladder training are first-line, with antimuscarinics or beta-3 agonists considered later.

Pressure injury staging

Stage 1 is intact skin with nonblanchable redness; stage 2 is partial-thickness skin loss; stage 3 extends to subcutaneous tissue; stage 4 involves muscle, bone, or supporting structures.

Braden Scale

A pressure-injury risk tool scoring sensory perception, moisture, activity, mobility, nutrition, and friction or shear; lower scores indicate higher risk and need for preventive measures.

Individualized HbA1c targets

Healthier older adults may target about 7.0 to 7.5 percent, those with complex illness about 8 percent, and very complex patients avoid symptomatic hyperglycemia while minimizing hypoglycemia risk.

Multimorbidity

The coexistence of two or more chronic conditions; management should prioritize patient goals, function, and treatment burden rather than applying single-disease guidelines rigidly.

Frailty phenotype

Defined by unintentional weight loss, exhaustion, weakness, slow gait, and low physical activity; three or more criteria indicate frailty and predict falls, disability, and mortality.

Hospice eligibility

Hospice is appropriate when prognosis is six months or less if the illness follows its expected course, with focus on comfort; it does not require forgoing all treatment.

Decision-making capacity

Capacity requires understanding relevant information, appreciating consequences, reasoning about options, and communicating a choice; it is decision-specific and assessed clinically, not by diagnosis alone.

PAINAD scale

A behavioral pain scale for advanced dementia scoring breathing, negative vocalization, facial expression, body language, and consolability; higher scores suggest pain and guide treatment trials.

PACE program

Program of All-Inclusive Care for the Elderly provides comprehensive medical and social services to nursing-home-eligible adults, usually permitting them to remain at home.

Care transitions

Moves between hospital, skilled nursing facility, home, and community care; medication reconciliation, clear discharge summaries, and timely follow-up reduce readmissions and errors.

Elder mistreatment screening

Ask about physical, emotional, sexual, and financial abuse, neglect, and self-neglect; report suspected abuse according to state law and assess safety and decisional capacity.