ABIM Geriatric Medicine cheat sheet

GFR declines by roughly 8 mL/min/1.73 m² per decade after age 30; serum creatinine may stay normal because muscle mass is lower, so creatinine-based eGFR can overestimate renal function.

Maximal heart rate falls about 1 beat/min per year; arterial stiffening raises systolic pressure and pulse pressure while diastolic pressure may fall.

FEV1 declines about 20–30 mL/year after age 30; chest wall stiffness and reduced elastic recoil increase residual volume and dyspnea risk.

Total body water and lean mass decrease while body fat increases; hydrophilic drugs have smaller distribution volumes and lipophilic drugs have larger, longer-lasting volumes.

Thermoregulation is impaired by reduced sweating, skin blood flow, and thirst; older adults are prone to hyperthermia and hypothermia.

Hepatic blood flow and first-pass metabolism decline; gastric acid output and colonic transit often decrease.

Immunosenescence reduces cell-mediated immunity and blunts fever; vaccine responses are lower but vaccination still reduces severe disease.

Bone mineral density and vitamin D synthesis decline, while sarcopenia reduces strength by about 1–2% per year after age 50.

Comprehensive geriatric assessment covers medical, cognitive, affective, functional, social, nutritional, medication, and advance care domains.

Basic ADLs are bathing, dressing, toileting, transferring, continence, and feeding; dependence signals need for caregiver support and higher mortality risk.

IADLs are more complex community skills: finances, medication management, telephone use, shopping, transportation, housekeeping, and cooking.

Gait speed below 0.8 m/s or Timed Up and Go above 12 seconds identifies elevated fall, hospitalization, and mortality risk.

Mini-Cog is positive when three-word recall is zero or when recall is one to two words with an abnormal clock draw.

SPICES screen covers Sleep, Problems eating, Incontinence, Confusion, Evidence of falls, and Skin breakdown.

Katz ADL measures basic self-care; Lawton IADL measures community living skills such as finances, medications, shopping, and transportation.

Advance care planning documents health care proxy, code status, preferred setting, and goals; POLST/MOLST converts preferences into portable orders.

A fall is an unintentional event in which a person comes to rest on the ground or lower level; recurrent falls are two or more in 12 months.

Fall risk rises with prior fall, gait or balance impairment, orthostasis, sedating or antihypertensive drugs, vision loss, cognitive impairment, and home hazards.

STEADI framework: screen for fall risk annually, assess modifiable factors after a fall or positive screen, and intervene with multifactorial treatment.

Timed Up and Go above 12 seconds, 30-second chair stand below age norms, or inability to hold tandem stance indicates impaired mobility and higher fall risk.

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

Operable hip fracture is generally repaired within 48 hours; early surgery reduces delirium, pressure injury, and mortality in medically stable patients.

Immobility complications include pressure injury, venous thromboembolism, pneumonia, constipation, contracture, deconditioning, and delirium.

Physical restraints do not prevent falls and increase injury, delirium, and functional decline; they are not a fall-prevention intervention.

Dementia is acquired progressive cognitive decline severe enough to impair function; delirium, depression, medication effects, and sensory deprivation are common mimics.

Alzheimer disease is the most common cause; early short-term memory loss reflects medial temporal and hippocampal involvement.

Vascular cognitive impairment shows stepwise decline, executive dysfunction, and gait disturbance; vascular risk factor control reduces further injury.

Lewy body dementia: fluctuating attention, visual hallucinations, parkinsonism, REM sleep behavior disorder, and neuroleptic sensitivity.

Frontotemporal dementia presents with personality, behavior, or language change and often begins before age 65; cholinesterase inhibitors are not effective.

Initial dementia workup includes CBC, comprehensive metabolic panel, TSH, vitamin B12, and neuroimaging when onset is atypical, rapid, or focal.

Cholinesterase inhibitors are used for mild to moderate Alzheimer disease; memantine is added in moderate to severe disease; neither reverses decline.

Behavioral symptoms are managed first by identifying pain, constipation, infection, sleep loss, and environmental triggers; antipsychotics carry increased stroke and mortality risk.

Delirium is acute fluctuating disturbance of attention and awareness; hypoactive delirium is common and often mistaken for depression.

Predisposing factors include dementia, advanced age, sensory impairment, frailty, and polypharmacy; precipitating factors include infection, pain, constipation, urinary retention, and sleep deprivation.

CAM-ICU or 4AT can screen for delirium; the Confusion Assessment Method requires acute fluctuation, inattention, and disorganized thinking or altered consciousness.

Antipsychotics are reserved for severe agitation or psychosis that threatens safety; use the lowest dose briefly and avoid in Lewy body dementia and Parkinson disease.

Late-life depression is associated with high suicide risk, especially in older men; PHQ-2 or PHQ-9 screens and treatment reduces suffering.

Benzodiazepines worsen cognition, falls, and delirium; they are not first-line for insomnia, anxiety, or agitation in older adults.

SSRIs can cause hyponatremia, falls, and serotonin syndrome; monitor sodium after starting or increasing dose.

Beers criteria and STOPP/START identify potentially inappropriate medications and prescribing omissions; they guide review but do not replace individualized risk-benefit assessment.

Anticholinergic burden causes confusion, constipation, urinary retention, dry mouth, and falls; cumulative scales help identify combinations to reduce.

Cockcroft-Gault creatinine clearance is used for renal drug dosing; normal serum creatinine can mask reduced clearance in older adults with low muscle mass.

High-risk medication classes include anticoagulants, insulin, opioids, sedative-hypnotics, antihypertensives, and anticholinergics; these cause many adverse drug events.

A prescribing cascade occurs when a drug effect is treated with another drug instead of stopping the first; example: edema from amlodipine treated with a diuretic.

Deprescribing uses gradual tapering, monitoring for withdrawal, and documented rationale; benzodiazepines, proton pump inhibitors, and antipsychotics are common targets.

Medication reconciliation at every transition reduces duplication, omission, and dosing errors; pill burden and cost affect adherence.

Urinary incontinence subtypes: stress (leak with cough), urge (sudden urgency), overflow (retention), and functional (access or cognition); postvoid residual helps distinguish overflow.

Reversible incontinence causes include urinary tract infection, constipation, medications, delirium, and restricted mobility; treat these before bladder drugs.

Pressure injury risk is scored with the Braden scale; prevention uses offloading, repositioning, moisture control, nutrition, and skin inspection.

Pressure injuries are staged by tissue depth; routine systemic antibiotics are not indicated for clean wounds without infection.

Presbycusis is bilateral high-frequency hearing loss; hearing aids and communication strategies reduce isolation, depression, and delirium risk.

Age-related vision loss from cataract, glaucoma, macular degeneration, and diabetic retinopathy increases fall and driving risk.

Insomnia in older adults is treated first with cognitive behavioral therapy for insomnia; sedative-hypnotics increase falls and confusion.

Elder mistreatment includes physical, emotional, sexual, financial abuse, and neglect; private screening and mandatory reporting are required when suspected.

Heart failure with preserved ejection fraction is common; diuretics relieve congestion, and NSAIDs worsen fluid retention and renal function.

Hypertension treatment reduces stroke and heart failure; orthostatic blood pressure should be checked because overtreatment causes falls and syncope.

Diabetes glycemic targets are individualized: A1c about 7–7.5% for healthy older adults and 8–8.5% for frail or multimorbid patients; hypoglycemia risk drives relaxation.

Atrial fibrillation anticoagulation uses CHA2DS2-VASc; fall risk alone is not a contraindication, and DOAC doses require renal adjustment.

CKD management avoids NSAIDs, adjusts renally cleared drugs, and treats anemia and metabolic bone disease.

Pneumonia and urinary tract infection may present with confusion, falls, or weakness rather than fever; asymptomatic bacteriuria is not treated.

Osteoporosis treatment includes calcium, vitamin D, bisphosphonates or other antiresorptives, and fall prevention; DXA guides therapy.

Acute ischemic stroke: thrombolysis within 4.5 hours and thrombectomy for selected large-vessel occlusions; secondary prevention targets blood pressure, lipids, and anticoagulation when indicated.

USPSTF colorectal cancer screening starts at age 45 for average risk and continues through 75; after 75, screening is individualized by health and life expectancy.

Breast cancer screening is individualized after 75; cervical screening generally stops at 65 if prior screening was adequate and low risk.

Adult vaccines include annual influenza, COVID-19, pneumococcal, recombinant zoster, Tdap, and RSV for eligible older adults.

Physical activity goal is 150 minutes/week of moderate activity plus strength, balance, and flexibility training.

Hospital prevention targets delirium, catheter-associated infection, pressure injury, venous thromboembolism, and functional decline through early mobility.

Long-term care quality focuses on infection control, falls, pressure injuries, antipsychotic reduction, and advance care planning.

Care transitions require medication reconciliation, discharge summary, follow-up appointment, and patient/caregiver teach-back.

Home safety assessment addresses lighting, stairs, grab bars, loose rugs, bathroom safety, and emergency communication.

Hospice eligibility generally requires prognosis of six months or less if disease follows usual course, plus comfort-focused goals; recertification is possible with continued decline.

Pain management follows analgesic principles: scheduled opioid for severe pain, bowel prophylaxis, and adjuvants for neuropathic pain; meperidine is avoided.

Dyspnea treatment includes opioids, a fan, positioning, and oxygen only for hypoxemia; anxious patients may need anxiolytics.

Terminal delirium and agitation are treated with low-dose antipsychotics when nonpharmacologic measures fail; benzodiazepines may worsen delirium.

Decision-making capacity requires understanding, appreciation, reasoning, and communication of choice; it is decision-specific and not equivalent to competence.

Advance directives include living will and durable power of attorney for health care; POLST/MOLST translates goals into portable medical orders.

Withdrawing or withholding life-sustaining treatment is ethically permissible when burdens outweigh benefits and aligns with patient goals; intention and causation matter.

Palliative sedation for refractory symptoms is distinct from euthanasia; the intent is symptom relief, and ethics consultation helps with conflict.