Normal Aging and the Geriatric Assessment
What to know
Normal aging is physiologic change distinct from disease. Candidates must recognize expected declines: reduced renal clearance, decreased lean body mass and total body water, lower maximal heart rate and blunted baroreflex, reduced hearing (presbycusis) and vision (presbyopia, cataracts), decreased pulmonary elastic recoil, and modest cognitive slowing with preserved crystallized knowledge. The comprehensive geriatric assessment (CGA) is the organizing framework: function (ADLs/IADLs), cognition, mood, mobility, nutrition, sensory function, continence, social support, and goals of care. Screening tools to name: Katz (ADL), Lawton (IADL), Mini-Cog or MoCA, PHQ-2/9, Timed Up and Go, and the Clinical Frailty Scale.
Traps
Questions often test that aging itself is not a disease: falls, incontinence, weight loss, and confusion are never "normal aging" and demand evaluation. Another trap is attributing symptoms to age rather than to a treatable cause (e.g., calling hypothyroidism "old age"). Watch for over-reliance on serum creatinine in sarcopenic elders, where normal values mask reduced GFR. Also remember atypical presentations: infection without fever, MI without chest pain, depression presenting as somatic complaint.
Rule of thumb
"If it threatens function, it is a syndrome, not aging." Any new functional decline triggers a search for reversible contributors (medications, pain, vision/hearing, depression, delirium, environment).
Worked example
An 82-year-old reports slowing and "just getting old." CGA reveals a TUG of 18 seconds, orthostatic drop of 25 mmHg on a new antihypertensive, and a PHQ-9 of 12. The correct approach is deprescribing/optimizing the antihypertensive and treating depression-not accepting decline as inevitable.