Care of the Older Adult
Care of the older adult tests comprehensive geriatric assessment, falls, frailty, polypharmacy, delirium, dementia, incontinence, nutrition and advance care planning. The exam expects function and goals to shape management as much as diagnosis does.
Core rules
- Comprehensive geriatric assessment covers medical, functional, cognitive, psychological, social and environmental domains.
- Falls: ask about circumstances, syncope, medications, vision, feet, gait and continence; check lying and standing blood pressure.
- Review every drug against indication, dose, interactions and anticholinergic burden; use STOPP/START principles.
- Delirium is acute, fluctuating and attention-poor; use 4AT and look for infection, pain, constipation, urinary retention, drugs and environment.
- Dementia assessment includes collateral history, cognition, function and reversible causes; driving and capacity may need review.
Worked example
An 82-year-old woman falls at home and takes nine medicines. Check orthostatic BP, ECG, vision, gait, footwear and home hazards; stop sedatives and drugs causing hypotension where possible. Reasoning: falls are multifactorial; medication review is a high-yield intervention.
Traps
Attributing confusion to dementia; missing constipation or retention; tightening glycaemic control in frailty; and ignoring carer strain or advance preferences.