ABFM Geriatric Medicine key terms

The age-related narrowing of physiologic reserve, so that older adults tolerate stressors such as illness, surgery, or dehydration poorly. Multiple organ systems decline simultaneously, reducing the margin between baseline function and failure.

Progressive loss of skeletal muscle mass and strength with aging, contributing to weakness, slow gait, falls, and functional decline. Diagnosis uses low muscle mass plus low strength or performance on measures such as grip strength.

Illness in older adults manifesting as confusion, falls, weakness, or poor appetite rather than classic symptoms such as fever or pain. This pattern reflects blunted physiologic responses and complicates diagnosis.

A multidimensional, interdisciplinary evaluation of an older patient's medical, functional, cognitive, psychological, and social status, producing a coordinated care plan. It improves outcomes in hospitalized and frail older adults.

Basic self-care tasks such as bathing, dressing, toileting, transferring, continence, and feeding. Loss of these functions marks significant disability and predicts need for long-term care and increased mortality.

Higher-order tasks needed to live independently, including managing finances, medications, transportation, shopping, cooking, housekeeping, and using the telephone. Impairment in these often precedes decline in basic self-care.

A quick mobility screen in which the patient rises from a chair, walks ten feet, turns, returns, and sits. A time of twelve or more seconds suggests increased fall risk.

A fourteen-item performance measure rating static and dynamic balance tasks, scored zero to fifty-six; scores below forty-five indicate increased fall risk. It is used to track balance and guide rehabilitation.

A drop in blood pressure on standing, defined as a fall of at least 20 mm Hg systolic or 10 mm Hg diastolic within three minutes. It causes dizziness, falls, and syncope, and is often medication-related.

Persistent concern about falling that leads older adults to restrict activity, with resulting deconditioning, loss of independence, and paradoxically increased fall risk. It is distinct from the number of actual falls.

Progressive cognitive decline in one or more domains severe enough to impair independence in daily activities, not due to delirium or another reversible cause. Alzheimer disease is the most common etiology.

Cognitive decline beyond normal aging that does not yet impair functional independence. It is a risk state for dementia, with conversion rates of roughly ten to fifteen percent per year.

A brief screening instrument for cognitive impairment that tests memory, executive function, attention, language, and visuospatial skills. It is more sensitive than the Mini-Mental State Examination for mild impairment and vascular dementia.

Dementia with fluctuating cognition, visual hallucinations, parkinsonism, and sensitivity to neuroleptics, caused by Lewy body pathology. Autonomic dysfunction and rapid eye movement sleep behavior disorder are common supportive features.

A treatable cause of dementia characterized by the triad of gait apraxia, urinary incontinence, and cognitive impairment, with ventriculomegaly on imaging but normal opening pressure. Shunt surgery may improve symptoms.

An acute, fluctuating disturbance of attention and awareness, often caused by infection, medications, pain, or metabolic derangement. It is common in hospitalized older adults and associated with longer stays, functional decline, and mortality.

Depression in later life, often presenting with somatic complaints, apathy, or cognitive changes rather than classic sadness. It increases disability, suicide risk, and mortality and is often undertreated.

Depression presenting with apparent cognitive impairment, including poor concentration, slowed responses, and memory complaints, that improves with treatment of the mood disorder. Recognizing it prevents mislabeling patients as having dementia.

Use of multiple medications, commonly defined as five or more, which raises risks of adverse drug events, drug interactions, and nonadherence in older adults. It is a common and often modifiable contributor to geriatric syndromes.

A published list of medications considered potentially inappropriate for older adults because of high risk of adverse effects, drug interactions, or limited benefit, with alternatives suggested. It guides prescribing and deprescribing but does not replace clinical judgment.

The cumulative effect of taking one or more medications with anticholinergic activity, which can precipitate confusion, falls, constipation, urinary retention, and dry mouth. Risk scales help clinicians quantify and reduce this load.

The systematic, supervised process of stopping or reducing medications that no longer provide benefit, have become inappropriate, or are causing harm, performed with the patient and caregivers.

Involuntary loss of urine, categorized as stress, urgency, overflow, or functional types. It is common in older adults yet underreported; evaluation distinguishes reversible causes, such as infection or medications, from chronic bladder dysfunction.

Localized damage to skin and underlying tissue, usually over a bony prominence, resulting from sustained pressure with or without shear. Staging describes depth from nonblanchable erythema through full-thickness tissue loss.

Age-related bilateral, symmetric sensorineural hearing loss, greatest at high frequencies, that impairs speech discrimination in background noise. It contributes to social isolation, depression, and cognitive decline and is often underrecognized.

Loss of accommodative ability of the lens with age, producing difficulty focusing on near objects and typically requiring reading glasses by the mid-forties. It results from lens stiffening and weakening of the ciliary muscle.

A state of increased vulnerability to stressors due to declining physical and cognitive reserve. The Fried phenotype uses unintentional weight loss, exhaustion, weakness, slow walking, and low activity; three or more criteria define frailty.

The coexistence of two or more chronic conditions in one person, which complicates guideline-based care because single-disease recommendations may conflict and produce burdensome regimens and polypharmacy.

Reversible loss of muscle strength, endurance, and functional capacity caused by prolonged bed rest or inactivity. Early mobilization and physical therapy in older adults reduce complications, including pressure injuries, delirium, and pneumonia.

Unexplained weight loss, declining function, and withdrawal in an older adult without a clear single disease cause. It warrants broad evaluation for depression, malignancy, malabsorption, medication effects, and social factors.

A written statement made while a patient has capacity that specifies future health care wishes, often including a living will and appointment of a health care proxy or durable power of attorney.

A portable medical order document, signed by clinician and patient or surrogate, that translates goals of care into specific directives about resuscitation, hospitalization, antibiotics, and artificial nutrition for seriously ill patients.

The ability to make a specific health care decision, judged by understanding relevant information, appreciating consequences, reasoning about options, and communicating a consistent choice. It is decision-specific and distinct from legal competence.

Criteria determining coverage of hospice benefits, generally a prognosis of six months or less if the disease follows its expected course, with documented functional decline and disease-specific markers.

Shared understanding between patient, family, and clinicians about desired outcomes and priorities, guiding treatment intensity. Discussions should occur early and be revisited as illness and preferences evolve.

The physical, emotional, financial, and social strain experienced by family or friends caring for an older adult, which can lead to depression, illness, and institutionalization of the care recipient.

An inpatient facility providing around-the-clock nursing care and rehabilitation, typically for short post-acute recovery or longer custodial care. Medicare covers limited post-acute stays with specific eligibility requirements.

Program of All-Inclusive Care for the Elderly, a capitated Medicare and Medicaid model that provides comprehensive community-based services, including adult day health care, to nursing-home-eligible older adults so they can remain at home.

Coordinated actions to ensure continuity and safe movement of patients between care settings, including medication reconciliation, discharge planning, and timely follow-up. Poor transitions cause readmissions and adverse drug events.

Intentional acts or omissions by a trusted person that harm an older adult, including physical, sexual, psychological, and financial abuse, neglect, and abandonment. Screening requires awareness because victims often do not report.