ABPTS GCS cheat sheet

Sarcopenia: age-related loss of muscle mass and strength; prevalence ~5-13% in 60-70 year olds, up to 50% in those >80.

Osteoporosis: T-score ≤ -2.5 at hip or spine; fragility fracture defines severe osteoporosis regardless of T-score.

Age-related changes: decreased skin elasticity, reduced thirst mechanism, impaired thermoregulation, decreased glomerular filtration rate (~1 mL/min/year after age 40).

Nerve conduction velocity decreases ~0.5-1.5 m/s per decade after age 30; distal more than proximal.

Balance control: older adults rely more on hip strategy and somatosensory input; vestibular and visual contributions decline.

Clinical reasoning: use Bayesian reasoning; pretest probability influenced by age, multimorbidity, and frailty.

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

Gait speed: <0.8 m/s indicates frailty and increased fall risk; >1.0 m/s generally community ambulator.

Cognitive changes: decreased processing speed and divided attention; dual-task cost higher in older adults.

Timed Up and Go (TUG): ≥12 s indicates increased fall risk; ≥13.5 s predictive of falls.

Berg Balance Scale: score <45/56 indicates increased fall risk; ≤40/56 high risk.

30-second Chair Stand: below age-normative values (e.g., <8 stands for women 60-64) indicates lower extremity weakness.

4-Stage Balance Test: unable to hold tandem stance 10 s predicts falls.

Mini-Mental State Examination (MMSE): <24/30 suggests cognitive impairment; adjust for education.

Geriatric Depression Scale (GDS-15): ≥5 suggests depression; ≥10 likely depression.

Grip strength: <26 kg men, <16 kg women (by some criteria) indicates weakness and frailty risk.

SPPB (Short Physical Performance Battery): score ≤9/12 indicates mobility disability; ≤7 severe.

Prognosis: gait speed <0.6 m/s predicts increased mortality and hospitalization risk.

Resistance training: 2-3 days/week, 2-3 sets of 8-12 reps at 60-80% 1RM to improve strength and function.

Balance training: progressive, challenging, include static and dynamic, eyes open/closed, dual-task; at least 3 times/week.

Aerobic exercise: 150 min/week moderate intensity or 75 min/week vigorous; in older adults, start low and progress slowly.

Stretching: hold 30-60 s, 2-4 reps, at least 2-3 days/week for flexibility.

Osteoporosis exercise: weight-bearing and resistance training; avoid spine flexion and twisting if vertebral fractures.

Fall prevention: multifactorial intervention including exercise, medication review, vision, home hazards.

Pain management: use multimodal approach; consider acetaminophen first, caution with NSAIDs (GI/renal risk).

Functional training: task-specific, context-specific; incorporate ADL and IADL training.

Assistive devices: cane in opposite hand for hip pain; walker for wide-based gait or severe balance impairment.

USPSTF: colorectal cancer screening ages 50-75; mammography 50-74 biennial; cervical cancer screening 21-65.

Osteoporosis screening: DXA for women ≥65 and men ≥70; earlier if risk factors.

Vaccinations: influenza annually, pneumococcal (PCV13/23), shingles (Shingrix), COVID-19, Tdap.

Physical activity guidelines: 150-300 min moderate or 75-150 min vigorous aerobic weekly; muscle strengthening ≥2 days/week.

Nutrition: protein 1.0-1.2 g/kg/day for healthy older adults; 1.2-1.5 g/kg/day for those with illness; vitamin D 800-1000 IU/day.

Smoking cessation: benefits at any age; combine counseling and pharmacotherapy.

Alcohol: recommended limits ≤1 drink/day for women, ≤2 for men; lower with comorbidities.

Fall prevention: annual screening for falls, exercise (Otago, Tai Chi), home modification, medication review.

Frailty: increased vulnerability to stressors due to decline in physiologic reserve; assessed by Fried phenotype or Frailty Index.

Multimorbidity: ≥2 chronic conditions; prevalence ~80% in adults ≥80; complicates management.

Delirium: acute onset, fluctuating course, inattention; often triggered by infection, medications, hospitalization.

Dementia: progressive cognitive decline; Alzheimer's most common; affects gait, balance, and safety.

Urinary incontinence: types (stress, urge, overflow, functional); pelvic floor exercises for stress/urge.

Pressure injuries: risk factors immobility, malnutrition, moisture; prevention includes repositioning q2h.

Polypharmacy: ≥5 medications; increases fall risk, adverse drug events; review medications regularly.

Orthostatic hypotension: drop ≥20 mmHg systolic or ≥10 mmHg diastolic within 3 min of standing; common cause of falls.

Sarcopenia: progressive loss of muscle mass and strength; diagnosis by low muscle mass + low strength/performance.

Medicare: Part A hospital insurance, Part B medical insurance, Part D prescription drugs; therapy covered under Part B.

Medicare therapy cap: no hard cap but requires medical necessity; KX modifier for above-threshold services.

Patient Self-Determination Act: requires healthcare facilities to inform patients of advance directives.

Ethical principles: autonomy, beneficence, nonmaleficence, justice; older adults may have fluctuating capacity.

Advocacy: address ageism, promote access to care, support caregiver needs.

Interprofessional collaboration: coordinate with physicians, nurses, social workers, pharmacists for comprehensive care.

Documentation: include functional outcomes, goal attainment, and medical necessity; use standardized measures.

Home health: eligible if homebound and skilled therapy needed; plan of care certified by physician.

Skilled nursing facility: covered for up to 100 days per benefit period with cost-sharing after day 20.