Geriatric Syndromes: Falls, Frailty, Incontinence, Delirium
What to know
Geriatric syndromes are multifactorial, shared-risk conditions. Falls: screen annually; evaluate gait/balance, vision, orthostatics, medications, footwear, home hazards; the Timed Up and Go and orthostatic vitals are core. Frailty: a state of reduced reserve; phenotype (weight loss, exhaustion, weakness, slow gait, low activity) and deficit-accumulation models both predict adverse outcomes. Urinary incontinence: classify as stress, urge, overflow, or functional; reversible causes follow the mnemonic DIAPPERS (Delirium, Infection, Atrophic vaginitis/urethritis, Pharmaceuticals, Psychological, Excess urine output, Restricted mobility, Stool impaction). Delirium: acute fluctuating inattention, hyperactive/hypoactive/mixed; hypoactive is most often missed. Prevention (orientation, sleep, mobility, hydration, avoiding restraints) beats pharmacologic treatment.
Traps
Don't reach for antipsychotics first in delirium-identify and treat the cause (infection, meds, retention, pain, withdrawal). Distinguish delirium from dementia (acute onset, fluctuating, inattention) and from depression. In falls, review culprit medications (sedatives, anticholinergics, antihypertensives, hypoglycemics). Overflow incontinence from retention can be worsened by anticholinergics-check post-void residual before treating "urge."
Rule of thumb
"Multifactorial in, multifactorial out": address all contributors simultaneously rather than seeking a single cause.
Worked example
A hospitalized 85-year-old becomes acutely confused at night. First steps: assess oxygenation, glucose, pain, bladder (retention), bowel, and medication list; reorient and mobilize; avoid restraints. Antipsychotics only for dangerous agitation, at lowest dose, shortest time.