ABPS Geriatric Medicine cheat sheet

Normal aging decreases renal clearance, lean body mass, and maximal heart rate; it does not cause confusion, incontinence, or falls (these require evaluation).

Cockcroft-Gault creatinine clearance = [(140 − age) × weight kg × (0.85 if female)] / (72 × serum creatinine).

Comprehensive geriatric assessment evaluates function (ADLs/IADLs), cognition, mood, mobility, nutrition, continence, and social support.

Katz ADL items: bathing, dressing, toileting, transferring, continence, feeding; Lawton IADL items include finances, medications, shopping, transport.

Gait speed <0.8 m/s and timed up-and-go >12 seconds indicate elevated fall and frailty risk.

Aging reduces total body water and increases fat proportion, raising the volume of distribution for lipid-soluble drugs and prolonging half-life.

Mini-Cog combines a 3-item recall with a clock-drawing test; a positive screen prompts formal cognitive testing.

Sarcopenia is defined by low muscle mass plus low strength or performance; prevalence rises with each decade after 60.

Delirium features acute onset, fluctuating course, inattention, and altered consciousness; it is the most common presentation of acute illness in older adults.

Confusion Assessment Method (CAM) requires acute onset/fluctuation plus inattention, plus either disorganized thinking or altered consciousness.

Predisposing delirium factors include dementia, advanced age, sensory impairment, and polypharmacy; precipitating factors include infection, pain, medications, and immobility.

Nonpharmacologic delirium prevention (orientation, sleep hygiene, mobilization, hydration, glasses/hearing aids) reduces incidence more than any drug.

Anticholinergic burden, sedative-hypnotics, and urinary retention are reversible contributors to incontinence and confusion.

Urinary incontinence subtypes: stress (leak with cough/sneeze), urge (sudden urgency), overflow (retention), and functional (mobility/access barriers).

Frailty phenotype (Fried) criteria: unintentional weight loss, exhaustion, low grip strength, slow gait, low activity; ≥3 criteria = frail.

Falls evaluation includes orthostatic vitals, vision, gait/balance, footwear, home hazards, and medication review; vitamin D repletion reduces falls in deficient patients.

Alzheimer disease is the most common dementia; hallmark pathology is amyloid plaques and tau neurofibrillary tangles.

Dementia requires decline in ≥2 cognitive domains severe enough to impair independence, without delirium or major psychiatric cause.

Lewy body dementia features fluctuating cognition, visual hallucinations, parkinsonism, and severe neuroleptic sensitivity.

Frontotemporal dementia presents with early personality/behavior change or language impairment with relatively preserved memory.

Vascular dementia shows stepwise decline with focal neurologic findings and cerebrovascular risk factors.

Donepezil, rivastigmine, and galantamine (cholinesterase inhibitors) are used in mild-to-moderate Alzheimer disease; memantine is used in moderate-to-severe disease.

Rapid cognitive decline over weeks suggests delirium, subdural hematoma, infection, or metabolic derangement rather than a primary neurodegenerative process.

Driving and financial capacity assessments should be documented as dementia progresses; capacity is task-specific.

Hypertension in older adults: isolated systolic hypertension is common due to arterial stiffening; target systolic <130 mmHg is reasonable if tolerated.

Atrial fibrillation raises stroke risk; CHA2DS2-VASc guides anticoagulation, and HAS-BLED estimates bleeding risk.

Heart failure with preserved ejection fraction (HFpEF) predominates in older adults; SGLT2 inhibitors and diuretics are mainstays.

Acute coronary syndrome in older adults may present atypically with dyspnea, syncope, or confusion rather than classic chest pain.

Ischemic stroke: IV thrombolysis window is typically 4.5 hours; thrombectomy extends to 24 hours in selected large-vessel occlusion.

Post-stroke care includes dysphagia screening, DVT prophylaxis, blood pressure control, and secondary prevention with antiplatelet or anticoagulant therapy.

Orthostatic hypotension is defined as a fall of ≥20 mmHg systolic or ≥10 mmHg diastolic within 3 minutes of standing.

Aortic stenosis murmur is a harsh systolic crescendo-decrescendo murmur radiating to the carotids; syncope and exertional dyspnea are red flags.

Type 2 diabetes in older adults: HbA1c target is often <7.5% for healthy adults and <8.0–8.5% for frail patients with hypoglycemia risk.

Metformin is first-line therapy; avoid in eGFR <30 mL/min and use caution at eGFR 30–45.

Sulfonylureas and insulin carry the highest hypoglycemia risk in older adults; hypoglycemia can present as confusion or falls.

Hypothyroidism is common and presents with fatigue, constipation, and cognitive slowing; TSH is the screening test.

Hyponatremia in older adults is often due to thiazide diuretics, SIADH, or volume depletion; correct sodium slowly to avoid osmotic demyelination.

CKD is defined by eGFR <60 mL/min/1.73 m² or albuminuria for ≥3 months; stage 5 is eGFR <15.

Hyperkalemia risk rises with ACE inhibitors, ARBs, spironolactone, and CKD; monitor potassium after initiation.

Osteoporosis screening: DEXA recommended for women ≥65 and men ≥70; FRAX estimates 10-year fracture risk.

Osteoarthritis is treated with exercise, weight loss, acetaminophen, topical NSAIDs, and intra-articular corticosteroids; avoid systemic NSAIDs in CKD or heart failure.

Gout flares are treated with colchicine, NSAIDs, or corticosteroids; allopurinol is for urate lowering after flare resolution.

Polymyalgia rheumatica presents with proximal shoulder/hip girdle pain and elevated ESR/CRP; treat with low-dose prednisone.

Giant cell arteritis: temporal headache, jaw claudication, vision loss; treat with high-dose corticosteroids immediately and biopsy.

Rheumatoid arthritis features symmetric small-joint synovitis with morning stiffness >1 hour; DMARDs prevent joint destruction.

Fracture risk increases with falls, low bone mineral density, and long-term glucocorticoid use; bisphosphonates are first-line pharmacologic therapy.

Vitamin D and calcium supplementation reduce fracture risk when deficient; weight-bearing exercise improves bone density.

Septic arthritis is a medical emergency; joint aspiration with cell count and culture is diagnostic.

Parkinson disease triad: resting tremor, bradykinesia, and rigidity; levodopa-carbidopa is the most effective therapy.

Depression in older adults may present with somatic complaints or cognitive slowing (pseudodementia); screen with PHQ-2/PHQ-9.

SSRIs are first-line for late-life depression; avoid tricyclics due to anticholinergic and cardiac effects.

Benzodiazepines increase fall, fracture, and delirium risk in older adults and should be avoided long-term.

Peripheral neuropathy in older adults is often diabetic; assess with monofilament, vibration, and reflexes.

Epilepsy in older adults commonly results from stroke or neurodegeneration; levetiracetam is often preferred due to fewer drug interactions.

Serotonin syndrome features agitation, hyperthermia, clonus, and autonomic instability from serotonergic drug combinations.

Substance use, including alcohol, is underrecognized in older adults; screen with AUDIT-C and assess for withdrawal risk.

Pneumonia in older adults may lack fever and present with confusion, weakness, or falls; obtain chest imaging and oxygen saturation.

Urinary tract infection diagnosis requires symptoms; asymptomatic bacteriuria should not be treated except in pregnancy or before urologic procedures.

Influenza vaccine is recommended annually; high-dose or adjuvanted formulations are preferred for adults ≥65.

Pneumococcal vaccination: PCV20 or PCV21 for adults ≥65 who have not received prior pneumococcal conjugate vaccine.

Recombinant zoster vaccine (2 doses) is recommended for adults ≥50; it is not contraindicated by prior shingles.

Tetanus-diphtheria booster every 10 years; Tdap once if not previously given.

Sepsis in older adults may present with altered mental status and hypotension; early antibiotics and fluids improve outcomes.

Antibiotic choice in older adults must account for renal function; adjust doses for eGFR and monitor for C. difficile.

Beers Criteria identify potentially inappropriate medications in older adults, including benzodiazepines, anticholinergics, and long-acting sulfonylureas.

Start low and go slow: initiate at 25–50% of the adult dose and titrate based on response and renal/hepatic function.

Anticholinergic burden scales quantify cumulative risk of confusion, falls, and urinary retention.

NSAIDs increase risk of GI bleeding, AKI, and heart failure in older adults; avoid chronic use.

Warfarin interactions are numerous; DOACs are often preferred in nonvalvular atrial fibrillation but require renal dosing.

Medication reconciliation at transitions of care reduces adverse drug events and readmissions.

Deprescribing is appropriate when harms exceed benefits; taper rather than abruptly stop benzodiazepines, opioids, and antidepressants.

Renal dosing: use Cockcroft-Gault or eGFR to adjust renally cleared drugs such as gabapentin, metformin, and antibiotics.

Pain in older adults is often undertreated; use the numeric rating scale or PAINAD for patients with dementia.

Acetaminophen is first-line for mild-to-moderate pain; maximum 3 g/day is generally recommended in older adults.

Opioids are appropriate for moderate-to-severe pain; start low, monitor for constipation and sedation, and co-prescribe a bowel regimen.

Meperidine and codeine should be avoided in older adults due to neurotoxicity and variable metabolism.

Hospice eligibility generally requires a prognosis of ≤6 months and focus on comfort rather than curative treatment.

Advance care planning includes health care proxy, living will, and POLST/MOLST documentation.

Palliative care is appropriate at any stage of serious illness alongside curative treatment, not only at end of life.

Dyspnea at end of life is treated with low-dose opioids and oxygen if hypoxemic; anxiety with benzodiazepines.

Colorectal cancer screening is recommended through age 75; individualize from 76–85 based on life expectancy and preference.

Mammography screening is recommended for women 50–74; individualize for older women based on health status and life expectancy.

Bone density screening: women ≥65 and men ≥70; repeat interval depends on baseline results.

Nutrition screening tools (MNA, MUST) identify malnutrition risk; unintentional weight loss >5% in 6 months warrants evaluation.

Vitamin D supplementation is recommended for older adults with deficiency or limited sun exposure; 800–1000 IU/day is common.

Physical activity: ≥150 minutes/week of moderate activity plus strength and balance training reduces falls and frailty.

Smoking cessation at any age reduces cardiovascular and pulmonary risk; offer counseling and pharmacotherapy.

Hearing and vision screening should be part of routine geriatric assessment; sensory impairment contributes to delirium and falls.

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

Informed consent requires capacity, disclosure of risks/benefits/alternatives, and voluntariness.

Health care proxy or durable power of attorney for health care designates a surrogate decision-maker when capacity is lost.

Advance directives guide care preferences; POLST/MOLST is a medical order, not a substitute for an advance directive.

Nursing home admission is guided by functional impairment, caregiver burden, and safety; Medicare does not cover long-term custodial care.

Medicare covers skilled nursing facility care for up to 100 days per benefit period after a qualifying hospital stay.

Elder mistreatment includes physical, emotional, sexual, financial abuse, neglect, and self-neglect; report suspected cases per state law.

Confidentiality and HIPAA apply to older adults; surrogate access requires proper authorization.