General Principles of Geriatric Care and Aging
The Framing Concepts
Geriatric care rests on recognizing heterogeneity: chronological age predicts little compared with functional status, comorbidity burden, and physiologic reserve. Candidates must know the major aging theories only at a conceptual level (stochastic damage versus programmed senescence) and should focus energy on clinically testable constructs: homeostenosis (reduced capacity to maintain homeostasis under stress), frailty phenotypes (unintentional weight loss, exhaustion, weakness, slow gait, low activity), and the distinction between disability in activities of daily living (ADLs: bathing, dressing, toileting, transferring, feeding, continence) and instrumental activities (IADLs: finances, medications, transportation, shopping, cooking, telephone use).
Assessment Tools to Name
Know the intended use of common instruments: the Mini-Mental State Examination and Montreal Cognitive Assessment for cognition, the Timed Up and Go and gait speed for mobility, the Morse or Hendrich scale for fall risk, and the Beers or STOPP/START criteria for medication review. Understand atypical disease presentation in older adults - delirium instead of fever, falls instead of chest pain, anorexia instead of abdominal pain - and the concept of failure to thrive.
Traps
Questions often blur normal aging with pathology: presbycusis, reduced renal reserve, and slowed reaction time are expected; incontinence, weight loss, and acute confusion are never normal. Another trap is conflating frailty with age, or treating a single abnormal vital sign as benign because the patient is elderly - blunted fever and tachycardia responses make sepsis harder to detect, not less serious.
Rule of Thumb
When a stem describes a new functional decline in an older adult, ask three questions in order: Is this delirium (acute, fluctuating, inattention)? Is there a treatable cause (infection, medication, metabolic, retention, pain)? What is the patient's baseline function and goals? Function, not diagnosis alone, drives the plan.