Geriatric Syndromes, Multimorbidity, and Frailty
What the candidate must understand
Geriatric syndromes are multifactorial conditions that do not fit single-disease models: falls, delirium, incontinence, pressure injuries, sleep problems, frailty, and elder mistreatment. Delirium is acute, fluctuating, and inattentive; dementia is chronic and progressive. Delirium is a medical emergency and is often the only sign of infection, medication toxicity, or pain in an older adult.
Frailty is a state of reduced reserve and increased vulnerability. Know the two dominant models: the physical phenotype (unintentional weight loss, exhaustion, low activity, slow gait, weak grip; three or more criteria = frail) and the deficit accumulation index (count of health deficits). Sarcopenia, frailty, and multimorbidity overlap but are not identical. Multimorbidity means two or more chronic conditions; it complicates guideline application because single-disease guidelines often conflict in older adults.
Traps
- Missing delirium because the patient is "pleasantly confused" or because baseline dementia exists (delirium superimposed on dementia).
- Attributing incontinence to aging alone when it may be reversible (urinary tract infection, constipation, medication, mobility limitation).
- Treating each condition separately and creating polypharmacy.
- Confusing frailty with disability; a frail person may be independent, and a disabled person may not be frail.
Rule of thumb
For delirium, use the Confusion Assessment Method features: acute onset and fluctuating course, inattention, plus either disorganized thinking or altered level of consciousness. For frailty, screen with gait speed or the FRAIL scale, then target the modifiable components: nutrition, strength, medication burden, and social support.