I85PREP
⌘ K
ABPS Geriatric Medicine study materials
ABPS Geriatric Medicine study resources

ABPS Geriatric Medicine practice questions

One question at a time. Build your ABPS Geriatric Medicine understanding.

First 50 of 200 questions. Each one lists the choices, the correct answer, and an explanation. The checker at the top of this page saves progress in this browser when it is available.

Continue in the practice tool above to load more questions, 50 at a time.

Question 1Normal Aging and Geriatric Assessment

Which change in body composition is most characteristic of normal aging in older adults?

  1. Increase in total body water with decreased fat mass
  2. Increase in bone density with loss of subcutaneous fat
  3. Loss of lean muscle mass with increased fat mass Correct answer.
  4. Increase in lean muscle mass with decreased fat mass

Explanation

Normal aging typically produces sarcopenia (loss of lean muscle mass) and a relative increase in adipose tissue, while total body water falls. These shifts affect drug distribution and nutritional needs.

Question 2Normal Aging and Geriatric Assessment

A 78-year-old has a resting heart rate of 70 bpm at rest but reaches only 130 bpm during maximal exercise testing. Which age-related cardiovascular change best explains the blunted peak rate?

  1. Increased beta-adrenergic receptor sensitivity
  2. Increased resting stroke volume
  3. Decreased maximum heart rate with age Correct answer.
  4. Enhanced baroreceptor responsiveness

Explanation

Maximum heart rate declines progressively with age, largely due to reduced beta-adrenergic responsiveness and sinoatrial node changes. Resting heart rate is relatively preserved.

Question 3Normal Aging and Geriatric Assessment

Which renal change is expected in a healthy 80-year-old compared with a healthy 30-year-old?

  1. Decreased glomerular filtration rate Correct answer.
  2. Increased glomerular filtration rate
  3. Increased renal blood flow
  4. Increased renal concentrating ability

Explanation

GFR and renal blood flow decline with age even in the absence of kidney disease. Concentrating ability and thirst also diminish, raising dehydration risk.

Question 4Normal Aging and Geriatric Assessment

An older adult reports reduced ability to taste salty foods. Which explanation is most consistent with normal aging?

  1. Decline in olfactory function with preserved taste
  2. Increased salivary production altering taste
  3. Age-related reduction in taste sensitivity Correct answer.
  4. Complete loss of all taste buds by age 70

Explanation

Taste sensitivity, particularly for salt and bitter, declines modestly with age. Olfactory loss is more pronounced and often contributes more to altered food enjoyment.

Question 5Normal Aging and Geriatric Assessment

Which finding on history is most suggestive of a delirium rather than dementia in an older hospitalized patient?

  1. Progressive language impairment over months
  2. Insidious decline in memory over several years
  3. Stable cognitive function with isolated word-finding difficulty
  4. Acute onset with fluctuating attention and awareness Correct answer.

Explanation

Delirium is characterized by acute onset, fluctuating course, and inattention. Dementia typically has an insidious, progressive course without acute fluctuation.

Question 6Normal Aging and Geriatric Assessment

A 72-year-old scores 24/30 on the Mini-Mental State Examination and has 12 years of education. What is the most appropriate interpretation?

  1. Indicates delirium requiring immediate sedation
  2. Normal for age and education
  3. Definitely diagnostic of Alzheimer disease
  4. Suggests cognitive impairment warranting further evaluation Correct answer.

Explanation

A score below the education-adjusted cutoff suggests possible cognitive impairment and should prompt further assessment. Screening tools are not diagnostic.

Question 7Normal Aging and Geriatric Assessment

Which instrument is specifically designed to screen for delirium at the bedside?

  1. Confusion Assessment Method Correct answer.
  2. Katz Index of Independence
  3. Mini-Cog
  4. Geriatric Depression Scale

Explanation

The Confusion Assessment Method (CAM) uses acute onset/fluctuation, inattention, disorganized thinking, and altered consciousness to identify delirium. The other tools assess depression, cognition, or function.

Question 8Normal Aging and Geriatric Assessment

An 82-year-old needs help with bathing, dressing, and transferring but manages finances and medications independently. Which domain is primarily impaired?

  1. Basic activities of daily living Correct answer.
  2. IADL only, with preserved ADLs
  3. Instrumental activities of daily living
  4. Executive function only

Explanation

Bathing, dressing, and transferring are basic activities of daily living (ADLs). Instrumental activities include finances, medications, shopping, and transportation.

Question 9Normal Aging and Geriatric Assessment

Which screening tool is most appropriate for assessing fall risk in a community-dwelling older adult?

  1. Geriatric Depression Scale
  2. Timed Up and Go test Correct answer.
  3. Mini Nutritional Assessment
  4. Mini-Mental State Examination

Explanation

The Timed Up and Go test assesses mobility and gait and is a validated fall-risk screen. The other tools assess cognition, mood, or nutrition.

Question 10Normal Aging and Geriatric Assessment

A 75-year-old has lost 8% of body weight over 6 months and reports poor appetite. Which tool best quantifies nutritional risk?

  1. Mini Nutritional Assessment Correct answer.
  2. Numeric Pain Rating Scale
  3. Clock Drawing Test
  4. Barthel Index

Explanation

The Mini Nutritional Assessment is a validated tool for detecting malnutrition risk in older adults. Unintentional weight loss warrants formal nutritional screening.

Question 11Normal Aging and Geriatric Assessment

Which physiologic change contributes most to reduced drug clearance of renally excreted medications in older adults?

  1. Decreased glomerular filtration rate Correct answer.
  2. Increased hepatic blood flow
  3. Increased glomerular filtration rate
  4. Increased serum albumin

Explanation

Age-related decline in GFR reduces clearance of renally eliminated drugs, increasing risk of accumulation and toxicity. Serum albumin also tends to fall, raising free drug fractions.

Question 12Normal Aging and Geriatric Assessment

An older adult's serum albumin is low. What effect does this have on highly protein-bound drugs?

  1. Decreased free fraction of drug
  2. Reduced volume of distribution
  3. Increased free fraction of drug Correct answer.
  4. No change in free fraction

Explanation

With hypoalbuminemia, fewer binding sites are available, so more drug circulates unbound. This increases the free fraction and can enhance pharmacologic and toxic effects.

Question 13Normal Aging and Geriatric Assessment

Which statement best describes normal age-related change in hearing?

  1. Unilateral conductive loss in most older adults
  2. Predominant loss of low-frequency sounds
  3. Bilateral high-frequency sensorineural loss Correct answer.
  4. Preserved high-frequency hearing with loss of speech discrimination

Explanation

Presbycusis is typically a bilateral, symmetric high-frequency sensorineural hearing loss. Speech discrimination often declines as well, affecting communication.

Question 14Normal Aging and Geriatric Assessment

A 70-year-old has a blood pressure of 150/70 mm Hg. Which age-related vascular change most explains the widened pulse pressure?

  1. Decreased systolic pressure
  2. Increased venous capacitance
  3. Increased cardiac contractility
  4. Increased arterial stiffness Correct answer.

Explanation

Arterial stiffening with age raises systolic pressure and lowers diastolic pressure, widening pulse pressure. This reflects reduced large-artery compliance.

Question 15Normal Aging and Geriatric Assessment

Which finding is considered a normal age-related change rather than pathology?

  1. Sudden unilateral vision loss
  2. New urinary incontinence
  3. Presbyopia requiring reading glasses Correct answer.
  4. New focal neurologic deficit

Explanation

Presbyopia, the loss of near accommodation, is a universal age-related change. New incontinence, sudden vision loss, and focal deficits are pathologic and require evaluation.

Question 16Normal Aging and Geriatric Assessment

Which feature distinguishes a comprehensive geriatric assessment from a standard medical evaluation?

  1. Multidimensional assessment of function, cognition, mood, and social support Correct answer.
  2. Focus solely on the presenting chief complaint
  3. Exclusion of caregiver input
  4. Reliance on laboratory testing alone

Explanation

Comprehensive geriatric assessment is multidimensional, evaluating medical, functional, cognitive, affective, and social domains to build an integrated care plan.

Question 17Normal Aging and Geriatric Assessment

A 79-year-old has a gait speed of 0.5 m/s. What is the most appropriate interpretation?

  1. Normal for age
  2. Diagnostic of Parkinson disease
  3. Suggestive of frailty and increased adverse outcomes Correct answer.
  4. Indicative of hyperthyroidism

Explanation

Gait speed below roughly 0.6 m/s is a marker of frailty and predicts falls, disability, and mortality. It should prompt further functional and medical evaluation.

Question 18Normal Aging and Geriatric Assessment

Which screening instrument is used to assess depression in older adults while minimizing somatic symptom overlap?

  1. Mini-Mental State Examination
  2. Braden Scale
  3. Geriatric Depression Scale Correct answer.
  4. Confusion Assessment Method

Explanation

The Geriatric Depression Scale focuses on mood and anhedonia rather than somatic symptoms, reducing confounding by medical illness. It is validated in older populations.

Question 19Normal Aging and Geriatric Assessment

Which measurement is the single best indicator of frailty phenotype in an older adult?

  1. Body mass index alone
  2. Serum sodium level
  3. Grip strength Correct answer.
  4. Hemoglobin A1c

Explanation

Low grip strength is one of the core frailty phenotype criteria and correlates with disability and mortality. It reflects global muscle function.

Question 20Normal Aging and Geriatric Assessment

An older adult scores 26/30 on the Montreal Cognitive Assessment. Which interpretation is most appropriate?

  1. Indicates delirium
  2. Definitive diagnosis of vascular dementia
  3. Possible cognitive impairment warranting clinical correlation Correct answer.
  4. Normal cognition for all older adults

Explanation

The MoCA is more sensitive than the MMSE for mild cognitive impairment, and a score around 26 may fall in the impaired range depending on education and baseline. Results require clinical correlation.

Question 21Geriatric Syndromes (falls, frailty, incontinence, delirium)

Which of the following best defines a fall according to the World Health Organization definition used in geriatric assessment?

  1. Any unsteadiness reported by the patient while walking on level ground
  2. Any episode of loss of consciousness resulting in injury
  3. An event in which a person comes to rest inadvertently on the ground or floor or other lower level Correct answer.
  4. A near-miss stumble that does not result in contact with the ground

Explanation

The WHO definition centers on an inadvertent coming to rest at a lower level, excluding intentional change of position and excluding events such as a seizure or a major external force. A stumble without landing is not a fall, and subjective unsteadiness alone is not a fall.

Question 22Geriatric Syndromes (falls, frailty, incontinence, delirium)

A 78-year-old woman has fallen twice in the past year. Which single intervention has the strongest evidence for reducing falls in community-dwelling older adults with gait and balance impairment?

  1. Structured exercise programs targeting balance and strength Correct answer.
  2. Home installation of grab bars alone
  3. Prescribing vitamin D for all older adults regardless of level
  4. Routine use of hip protectors during waking hours

Explanation

Multicomponent and targeted balance-and-strength exercise programs have the most consistent evidence for reducing falls in community-dwelling older adults with gait or balance problems. Single interventions such as grab bars alone or hip protectors have weaker or more limited effect.

Question 23Geriatric Syndromes (falls, frailty, incontinence, delirium)

Which of the following is the most important modifiable risk factor for falls that should be reviewed in every older adult presenting after a fall?

  1. Dietary sodium intake
  2. Handedness
  3. Family history of osteoporosis
  4. Medication burden, especially sedatives and antihypertensives Correct answer.

Explanation

Psychotropic medications, sedative-hypnotics, and drugs causing orthostasis or hypoglycemia are among the most modifiable fall risk factors and should be reviewed at every post-fall encounter. Other listed factors are not established modifiable fall risks.

Question 24Geriatric Syndromes (falls, frailty, incontinence, delirium)

An 82-year-old man is brought in after a fall with a positive Dix-Hallpike maneuver reproducing vertigo and nystagmus. What is the most appropriate management?

  1. Recommend bed rest for two weeks
  2. Prescribe a long-term vestibular sedative
  3. Perform an Epley canalith repositioning maneuver Correct answer.
  4. Refer for urgent MRI of the brain

Explanation

The findings are consistent with benign paroxysmal positional vertigo, for which canalith repositioning (Epley) is the first-line treatment and is highly effective. Sedatives worsen fall risk, and imaging is not indicated for classic BPPV.

Question 25Geriatric Syndromes (falls, frailty, incontinence, delirium)

Which of the following is the best validated single-item screening question to identify fall risk in an older adult in the office?

  1. Do you feel dizzy when you stand up?
  2. Do you use a cane?
  3. Have you fallen in the past year? Correct answer.
  4. Do you exercise regularly?

Explanation

Asking about a fall in the past year is a validated single-item screen for fall risk and predicts future falls. Other questions may be useful but are not the primary validated screen.

Question 26Geriatric Syndromes (falls, frailty, incontinence, delirium)

A 90-year-old nursing home resident has a timed up-and-go test of 18 seconds. What does this finding most likely indicate?

  1. Normal mobility for age
  2. Increased fall risk requiring multifactorial assessment Correct answer.
  3. Need for immediate hip replacement
  4. Cognitive impairment

Explanation

A timed up-and-go of 12 seconds or more is generally considered abnormal and is associated with increased fall risk. It should prompt a multifactorial fall risk assessment.

Question 27Geriatric Syndromes (falls, frailty, incontinence, delirium)

Which of the following best describes frailty as a clinical syndrome?

  1. A purely psychological condition characterized by low motivation
  2. A single chronic disease with predictable progression
  3. A state of increased vulnerability to stressors due to decline in physiologic reserve across multiple systems Correct answer.
  4. A normal and inevitable part of aging that requires no intervention

Explanation

Frailty is a syndrome of diminished physiologic reserve across multiple systems leading to increased vulnerability to stressors. It is distinct from normal aging and from a single disease, and it is potentially modifiable.

Question 28Geriatric Syndromes (falls, frailty, incontinence, delirium)

Which of the following is a component of the Fried frailty phenotype?

  1. Hospitalization in the past year
  2. Unintentional weight loss Correct answer.
  3. Polypharmacy of five or more medications
  4. Recurrent falls

Explanation

The Fried phenotype includes unintentional weight loss, exhaustion, low physical activity, slow gait speed, and weak grip strength. Polypharmacy, falls, and hospitalization are not part of the phenotype, though they may be associated.

Question 29Geriatric Syndromes (falls, frailty, incontinence, delirium)

A 75-year-old man has unintentional weight loss, self-reported exhaustion, low activity, and slow gait. Which additional finding would meet the Fried criteria for frailty?

  1. Anemia
  2. Mild cognitive impairment
  3. Weak grip strength Correct answer.
  4. Elevated blood pressure

Explanation

Three or more of the five Fried criteria (weight loss, exhaustion, low activity, slow gait, weakness) define frailty. The patient already has four; weak grip strength would add the fifth criterion.

Question 30Geriatric Syndromes (falls, frailty, incontinence, delirium)

Which of the following is the most appropriate first-line intervention to prevent or reverse frailty in an older adult?

  1. Routine use of appetite stimulants
  2. Long-term corticosteroid therapy
  3. Prolonged bed rest to conserve energy
  4. Progressive resistance exercise with adequate protein intake Correct answer.

Explanation

Progressive resistance exercise combined with adequate protein intake is the cornerstone of frailty prevention and management. Bed rest worsens frailty, and appetite stimulants are not first-line therapy.

Question 31Geriatric Syndromes (falls, frailty, incontinence, delirium)

Which of the following best describes the relationship between frailty and surgical outcomes?

  1. Frailty reduces the risk of postoperative delirium
  2. Frailty only affects cosmetic outcomes
  3. Frail older adults have increased risk of postoperative complications, delirium, and mortality Correct answer.
  4. Frailty has no effect on postoperative outcomes

Explanation

Frailty is a strong predictor of adverse postoperative outcomes, including complications, delirium, functional decline, and mortality. Preoperative frailty assessment is recommended to inform risk and planning.

Question 32Geriatric Syndromes (falls, frailty, incontinence, delirium)

A 70-year-old woman reports involuntary loss of urine with coughing and sneezing. Which type of urinary incontinence is most likely?

  1. Functional incontinence
  2. Urge incontinence
  3. Stress incontinence Correct answer.
  4. Overflow incontinence

Explanation

Stress incontinence is characterized by urine loss with increased intra-abdominal pressure such as coughing, sneezing, or laughing. Urge incontinence is associated with urgency, and overflow with incomplete emptying.

Question 33Geriatric Syndromes (falls, frailty, incontinence, delirium)

Which of the following is the most appropriate first-line behavioral therapy for urge incontinence in an older adult?

  1. Restriction of all fluids
  2. Long-term antibiotic prophylaxis
  3. Bladder training with timed voiding and pelvic floor muscle training Correct answer.
  4. Immediate indwelling catheter placement

Explanation

Behavioral therapy including bladder training, timed voiding, and pelvic floor muscle training is first-line for urge incontinence. Catheters, antibiotics, and fluid restriction are not appropriate first-line measures.

Question 34Geriatric Syndromes (falls, frailty, incontinence, delirium)

An 80-year-old man with diabetes and new urinary incontinence has a palpable bladder after voiding. What should be suspected?

  1. Functional incontinence
  2. Overflow incontinence from urinary retention Correct answer.
  3. Urge incontinence
  4. Stress incontinence

Explanation

A palpable bladder after voiding suggests incomplete emptying and retention, leading to overflow incontinence. This may relate to diabetic neuropathy, medications, or outlet obstruction and warrants evaluation.

Question 35Geriatric Syndromes (falls, frailty, incontinence, delirium)

Which of the following is a potentially reversible cause of urinary incontinence in older adults that should be screened for?

  1. Female sex
  2. Family history of hypertension
  3. Urinary tract infection Correct answer.
  4. Age over 65 years

Explanation

Urinary tract infection is a common reversible contributor to incontinence and should be evaluated. Age, sex, and family history are non-modifiable, and reversible causes such as infection, constipation, and medications should be sought.

Question 36Geriatric Syndromes (falls, frailty, incontinence, delirium)

Which of the following medications is most likely to precipitate urinary retention and overflow incontinence in an older man with benign prostatic hyperplasia?

  1. Oxybutynin Correct answer.
  2. Atorvastatin
  3. Acetaminophen
  4. Amlodipine

Explanation

Anticholinergic medications such as oxybutynin can precipitate urinary retention, particularly in men with benign prostatic hyperplasia. The other agents are not strongly associated with retention.

Question 37Geriatric Syndromes (falls, frailty, incontinence, delirium)

Which of the following is the most characteristic feature of delirium?

  1. Acute onset with fluctuating course and inattention Correct answer.
  2. Preserved attention with gradual memory loss
  3. Stable orientation with no diurnal variation
  4. Insidious onset over months with stable course

Explanation

Delirium is characterized by acute onset, fluctuating course, and inattention, often with altered level of consciousness. Dementia typically has an insidious onset with stable or slowly progressive course.

Question 38Geriatric Syndromes (falls, frailty, incontinence, delirium)

Which of the following is the most appropriate first-line pharmacologic treatment for an older adult with hyperactive delirium who is a danger to self or others after nonpharmacologic measures have failed?

  1. High-dose chlorpromazine
  2. Long-term benzodiazepine monotherapy
  3. Haloperidol at the lowest effective dose for the shortest time Correct answer.
  4. Routine anticholinergic therapy

Explanation

Antipsychotics such as haloperidol are used at the lowest effective dose for the shortest duration when nonpharmacologic measures fail and the patient is dangerous. Benzodiazepines are generally avoided except in specific withdrawal states, and anticholinergics worsen delirium.

Question 39Geriatric Syndromes (falls, frailty, incontinence, delirium)

Which of the following is a key nonpharmacologic strategy for preventing delirium in hospitalized older adults?

  1. Routine use of physical restraints
  2. Minimizing family involvement
  3. Promoting sleep hygiene with orientation and mobility protocols Correct answer.
  4. Keeping the room dark and quiet at all times

Explanation

Multicomponent nonpharmacologic programs including sleep hygiene, orientation, mobility, hydration, and family involvement reduce delirium incidence. Restraints and sensory deprivation increase risk.

Question 40Geriatric Syndromes (falls, frailty, incontinence, delirium)

Which of the following screening tools is most commonly used to detect delirium at the bedside?

  1. Geriatric Depression Scale
  2. Confusion Assessment Method Correct answer.
  3. Braden Scale
  4. Mini-Mental State Examination

Explanation

The Confusion Assessment Method is a widely used validated bedside tool for delirium based on acute onset, inattention, disorganized thinking, and altered consciousness. The MMSE assesses cognition but does not specifically diagnose delirium.

Question 41Geriatric Syndromes (falls, frailty, incontinence, delirium)

An 85-year-old woman with known dementia becomes acutely confused and agitated two days after hip surgery. Which of the following is the most likely diagnosis?

  1. Progression of dementia
  2. New-onset depression
  3. Delirium superimposed on dementia Correct answer.
  4. Normal postoperative fatigue

Explanation

Acute confusion and agitation after surgery in a patient with dementia is most consistent with delirium superimposed on dementia. Delirium is common postoperatively and requires evaluation for precipitants.

Question 42Geriatric Syndromes (falls, frailty, incontinence, delirium)

Which of the following is the most important first step in managing a hospitalized older adult with new delirium?

  1. Apply physical restraints
  2. Immediately start an antipsychotic
  3. Transfer to a psychiatric unit
  4. Identify and treat underlying precipitants such as infection, medications, or pain Correct answer.

Explanation

The cornerstone of delirium management is identifying and treating the underlying cause, such as infection, medication effects, pain, or metabolic derangement. Antipsychotics are reserved for dangerous behavior after nonpharmacologic measures.

Question 43Geriatric Syndromes (falls, frailty, incontinence, delirium)

Which of the following is a recognized risk factor for postoperative delirium in older adults?

  1. High educational level
  2. Preoperative cognitive impairment Correct answer.
  3. Younger age
  4. Absence of comorbidity

Explanation

Preoperative cognitive impairment is one of the strongest risk factors for postoperative delirium. Older age and comorbidity also increase risk, while higher education and absence of comorbidity are protective.

Question 44Geriatric Syndromes (falls, frailty, incontinence, delirium)

An older adult with delirium is agitated and pulling at intravenous lines. After addressing pain, environment, and orientation, which of the following is the most appropriate next step?

  1. Apply wrist restraints continuously
  2. Use the lowest effective dose of an antipsychotic for the shortest duration while monitoring for adverse effects Correct answer.
  3. Discharge home immediately
  4. Start chronic benzodiazepine therapy

Explanation

When nonpharmacologic measures fail and the patient poses a danger, the lowest effective dose of an antipsychotic for the shortest duration is appropriate, with monitoring for QT prolongation, sedation, and extrapyramidal effects. Restraints and chronic benzodiazepines are avoided.

Question 45Geriatric Syndromes (falls, frailty, incontinence, delirium)

Which of the following best explains why delirium is often underrecognized in older adults with hypoactive features?

  1. Hypoactive delirium is not associated with adverse outcomes
  2. Hypoactive delirium only occurs in patients without dementia
  3. Hypoactive delirium presents with withdrawal and lethargy rather than agitation, so it is mistaken for fatigue or depression Correct answer.
  4. Hypoactive delirium always resolves spontaneously within hours

Explanation

Hypoactive delirium is characterized by lethargy, reduced activity, and withdrawal, and is frequently mistaken for fatigue, depression, or the patient being 'good and quiet.' It carries adverse outcomes similar to hyperactive delirium and requires active screening.

Question 46Geriatric Syndromes (falls, frailty, incontinence, delirium)

Which medication class is most strongly associated with drug-induced delirium in older adults because of its anticholinergic effects?

  1. Beta blockers
  2. Proton pump inhibitors
  3. Loop diuretics
  4. Bladder antimuscarinics Correct answer.

Explanation

Anticholinergic burden is a leading reversible contributor to delirium in older adults, and bladder antimuscarinics are a common source. Reducing or stopping these agents is part of delirium management. Other drug classes can cause delirium but are less directly linked to central anticholinergic toxicity.

Question 47Geriatric Syndromes (falls, frailty, incontinence, delirium)

Which finding on assessment most reliably distinguishes delirium from dementia in an older adult?

  1. Family history of cognitive decline
  2. Presence of memory impairment
  3. Acute onset with fluctuating course and inattention Correct answer.
  4. Gradual decline over several years

Explanation

Delirium is defined by an acute change in attention and awareness with a fluctuating course, which separates it from the insidious, progressive course of dementia. Memory impairment occurs in both, so it does not discriminate. The key discriminator is acuity plus inattention.

Question 48Geriatric Syndromes (falls, frailty, incontinence, delirium)

An 82-year-old woman has three falls in six months. She takes a benzodiazepine nightly and has orthostatic hypotension. Which single action best addresses a modifiable fall risk in her case?

  1. Advising bed rest to prevent further falls
  2. Deprescribing the sedative-hypnotic and reassessing blood pressure Correct answer.
  3. Adding vitamin D without medication review
  4. Prescribing a walking frame without further review

Explanation

Falls are multifactorial, and medication review with deprescribing of sedative-hypnotics plus attention to orthostatic hypotension targets two identified contributors. Multifactorial intervention is more effective than single measures. Bed rest increases deconditioning and fall risk rather than reducing it.

Question 49Geriatric Syndromes (falls, frailty, incontinence, delirium)

An 88-year-old man with urge incontinence is started on an antimuscarinic bladder agent. Which adverse effect most warrants caution in this population?

  1. Hyperkalemia
  2. Peripheral edema
  3. New cognitive impairment and confusion Correct answer.
  4. Hyperthyroidism

Explanation

Antimuscarinic bladder medications carry central anticholinergic risk, including confusion and cognitive decline, which is especially concerning in older adults and those with cognitive impairment. This is why agents with lower central penetration or beta-3 agonists are often preferred. The other listed effects are not characteristic of this drug class.

Question 50Geriatric Syndromes (falls, frailty, incontinence, delirium)

A previously independent 79-year-old is admitted with pneumonia and becomes drowsy and disoriented. Which management approach is most consistent with current evidence for delirium care?

  1. Transfer to a quiet room and limit all family contact
  2. Routine antipsychotic prescription for all delirious patients
  3. Treat the underlying cause with multicomponent nonpharmacologic support Correct answer.
  4. Immediate physical restraint to prevent wandering

Explanation

Delirium management centers on identifying and treating the precipitant while providing multicomponent nonpharmacologic support such as orientation, sleep hygiene, hydration, and mobilization. Antipsychotics are reserved for severe distress or danger and are not routine. Restraints and isolation tend to worsen delirium.