Geriatrics, Preventive Medicine, and Multisystem Care
Core concepts
Geriatrics rewards function over disease labels: ADLs and IADLs, gait and falls, polypharmacy, delirium, dementia, incontinence, pressure injury, advance care planning, and elder mistreatment. Preventive medicine covers USPSTF screening ages, immunizations, smoking cessation, and counseling. Delirium is acute, fluctuating, and inattentive; dementia is chronic and progressive. Beers criteria highlight potentially inappropriate medications in older adults, especially benzodiazepines, anticholinergics, and antipsychotics.
Traps
- Treating delirium with sedatives before searching for the cause.
- Missing urinary retention, constipation, pain, or infection as delirium triggers.
- Assuming a stable chronic dementia patient has suddenly demented rather than delirious.
- Applying adult screening intervals to patients with limited life expectancy.
- Overlooking falls caused by orthostatic hypotension from antihypertensives.
- Failing to ask about driving, home safety, and caregiver burden.
Worked example
An 84-year-old becomes confused and agitated overnight after admission for a hip fracture. He is disoriented and cannot sustain attention. The best next step is a focused search for triggers: pain, urinary retention, constipation, hypoxia, infection, medications, and sensory deprivation. Antipsychotics are reserved for dangerous agitation at the lowest dose. Rule of thumb: delirium is a symptom, not a diagnosis; find the cause.