Common Medical Disorders in Older Adults Across Organ Systems
Atypical presentations are the rule
Older adults often present with nonspecific symptoms: confusion, falls, functional decline, weakness, or anorexia rather than classic pain or fever. Myocardial infarction may present with dyspnea or delirium; pneumonia may lack fever or cough; urinary tract infection may cause confusion without dysuria; hypothyroidism and depression may mimic dementia.
Common conditions to know: heart failure with preserved ejection fraction (diastolic dysfunction, hypertension, atrial fibrillation), aortic stenosis (syncope, angina, dyspnea), atrial fibrillation (stroke risk, rate control, anticoagulation), COPD, aspiration pneumonia, constipation, GERD, dysphagia, CKD, diabetes with hypoglycemia risk, osteoporosis, osteoarthritis, Parkinson disease, and stroke.
Traps: treating asymptomatic bacteriuria; attributing dyspnea only to COPD when heart failure is present; pursuing tight glycemic control in frail elders; and missing drug-induced syndromes.
Worked example: an 86-year-old with new confusion and falls has a urinalysis showing pyuria and bacteriuria but no fever, dysuria, or urinary symptoms. Asymptomatic bacteriuria should not be treated; look for another cause-dehydration, medication, constipation, or delirium.
Rule of thumb: treat the patient, not the laboratory value; atypical presentation is the default in geriatrics.