Assessment and Management of the Older Adult
Core concepts
A geriatric assessment is multidimensional, not just a physical exam. Expect questions that test whether you recognize the domains: physical health, functional status (ADLs/IADLs), cognition, mood, nutrition, sensory function, social support, and advance care planning. Know the difference between a comprehensive geriatric assessment (CGA), which is team-based and produces an integrated care plan, and a focused assessment. Familiarize yourself with validated screening tools by name and purpose (e.g., Mini-Cog for cognition, PHQ-2/9 for depression, Mini Nutritional Assessment, Timed Up and Go for mobility) and with atypical presentations of illness in older adults: delirium instead of fever, falls instead of chest pain, functional decline instead of dysuria.
Traps
Questions often reward the least invasive, most person-centered next step. A common trap is choosing an extensive workup when the stem describes a reversible cause (dehydration, constipation, medication effect, urinary retention). Another trap conflates normal aging with pathology: presbycusis and slowed processing are expected; sudden functional loss is not. Watch for ageist assumptions in distractors (e.g., "this is expected at her age").
Rule of thumb
When a stem shows acute change from baseline, think delirium, infection, medication, or metabolic cause first-not a new chronic diagnosis. Assess function and cognition at baseline so you can detect change.
Worked example
An 82-year-old with known dementia becomes suddenly more confused over two days. The best next action is to screen for an acute medical cause (infection, dehydration, drug effect, pain, retention) rather than adjust dementia medications-acute change signals delirium superimposed on dementia.