Geriatrics and Palliative Care
Geriatrics and palliative care tests comprehensive assessment of older adults and relief of suffering in advanced illness. The exam emphasises function, cognition, falls, polypharmacy, goals of care and symptom control.
Core rules
- Comprehensive geriatric assessment covers medical, functional, cognitive, psychological, social and environmental domains.
- Delirium is acute, fluctuating and inattentive; it is a medical emergency, not normal ageing.
- Falls review includes medication, vision, gait, footwear, home hazards, blood pressure and vitamin D where indicated.
- Polypharmacy review asks whether each drug has a current indication and whether benefits exceed harms.
- Palliative care is active total care; opioids are titrated for pain and dyspnoea, with laxatives and monitoring.
- Advance care planning records preferences and a substitute decision-maker while capacity remains.
Worked example
A 78-year-old with mild dementia becomes confused after a urinary tract infection. The reasoning: this is delirium superimposed on dementia. Look for infection, constipation, retention, pain, dehydration and drug effects; treat the cause; avoid physical restraint and benzodiazepines; use orientation, lighting and family involvement; review the drug chart. Review analgesia and bowel regimen. Do not simply sedate.
Traps
Attributing acute confusion to dementia; stopping analgesia because of opioid fears; ignoring caregiver burden; discussing resuscitation without checking the patient’s values and capacity; and ignoring reversible causes of functional decline.