WAPCP Primary key terms

Use of five or more medications at the same time, or use of more medicines than are clinically indicated. Raises risk of interactions, adverse effects, and falls, so prescribing should be reviewed regularly.

Consensus list of medications potentially inappropriate for adults aged 65 and older, grouped by drug class and clinical concern. Used to flag drugs whose risks usually outweigh benefits in older patients.

Structured, supervised process of stopping or reducing medicines when harms outweigh benefits, such as in frailty, limited life expectancy, or after adverse events. Includes a plan for monitoring withdrawal effects.

Cumulative effect of drugs blocking acetylcholine, including antihistamines, bladder antimuscarinics, and tricyclics. In older adults it is linked to confusion, constipation, urinary retention, and cognitive decline.

Acute, fluctuating disturbance of attention and awareness, often triggered by infection, medication, pain, or surgery. A medical emergency in older adults that requires finding and treating the cause.

Progressive, chronic decline in two or more cognitive domains that impairs independent function. Unlike delirium, it develops slowly and consciousness is preserved until late stages.

Age-related syndrome of reduced physiological reserve, marked by unintentional weight loss, exhaustion, weakness, slow walking, and low activity. Increases vulnerability to stressors, falls, and hospitalization.

Loss of skeletal muscle mass and strength with aging or chronic illness, causing weakness and impaired mobility. Managed with resistance exercise and adequate protein and vitamin D intake.

Structured review of gait, balance, vision, medications, footwear, home hazards, and orthostatic blood pressure to identify adults at risk of falling. Findings guide exercise, medication changes, and environmental modification.

Drop in systolic blood pressure of at least 20 mmHg, or diastolic of at least 10 mmHg, within three minutes of standing. Causes dizziness and falls; commonly related to volume loss or antihypertensive drugs.

Transient loss of consciousness from brief global cerebral hypoperfusion, with rapid complete recovery. Requires evaluation for cardiac, reflex, and orthostatic causes, especially in older adults.

Ongoing discussion of a person's values, goals, and preferences for future medical care, documented and shared with family and clinicians. Guides decisions when the patient loses decision-making capacity.

Patient-centered priorities that shape treatment choices, such as prolonging life, maintaining function, or comfort. Revisited when health status changes, particularly in serious or advanced illness.

Skeletal disorder of low bone mineral density and microarchitectural deterioration, causing fragility fractures. Screening and treatment focus on fracture risk, calcium, vitamin D, exercise, and bone-active drugs.

Calculator such as FRAX that estimates ten-year probability of major osteoporotic and hip fracture from clinical risk factors, with or without bone density. Helps decide who needs treatment.

Involuntary loss of urine, classified as stress, urgency, overflow, or functional types. Common in older adults and often improved by behavioral therapy, pelvic floor training, and medication review.

Non-cancerous enlargement of the prostate causing lower urinary tract symptoms such as hesitancy, weak stream, and nocturia. Treated with alpha blockers, 5-alpha reductase inhibitors, or surgery.

Presence of two or more chronic conditions in one person, often interacting to complicate treatment. Care focuses on function and patient priorities rather than single-disease guidelines applied separately.

Age- and risk-based timetable for recommended vaccines, including influenza, COVID-19, pneumococcal, shingles, and Tdap boosters. Reviewed at every preventive visit and updated when guidance changes.

Immunization against Streptococcus pneumoniae to prevent pneumonia, bacteremia, and meningitis. Recommended for older adults and people with certain chronic conditions, using conjugate and polysaccharide products per current guidance.

Recombinant zoster vaccine given in two doses to prevent shingles and postherpetic neuralgia. Recommended for adults aged 50 and older and for immunocompromised adults per current guidance.

Persistent neuropathic pain in the area of a prior shingles rash, lasting months after healing. More common with older age; treated with gabapentinoids, tricyclics, or topical lidocaine.

Testing asymptomatic people to detect cancer or precancer early, such as mammography, colonoscopy, or cervical cytology. Choice depends on age, risk, life expectancy, and patient preference.

Detection of colorectal cancer or adenomas in average-risk adults, typically starting at age 45. Options include stool-based tests, colonoscopy, and other imaging, each with different intervals.

Detection of a condition that would never have caused symptoms or death during a person's lifetime. Leads to unnecessary treatment and anxiety, and is a key reason to individualize screening.

Collaborative conversation in which clinician and patient weigh evidence, benefits, harms, and preferences before choosing an intervention. Used where guidelines recommend individualized rather than routine action.

Measurement of cholesterol and triglycerides to estimate cardiovascular risk and guide statin or lifestyle decisions. Timing and frequency depend on age, risk factors, and prior results.

Estimation of a person's likelihood of heart attack or stroke over a defined period using factors such as age, blood pressure, lipids, smoking, and diabetes. Guides preventive treatment decisions.

Persistently elevated arterial blood pressure, confirmed by repeated measurement, that increases risk of stroke, heart failure, and kidney disease. Managed with lifestyle change and antihypertensive medication.

Testing for prediabetes or type 2 diabetes in asymptomatic adults using fasting glucose, HbA1c, or oral glucose tolerance. Recommended for adults with overweight or obesity and other risk factors.

Advising on tobacco cessation, diet, physical activity, alcohol use, and sleep to prevent and manage chronic disease. Most effective when specific, goal-based, and repeated at follow-up visits.

Helping a person stop using tobacco through counseling, pharmacotherapy such as nicotine replacement or varenicline, and follow-up. The single most effective preventive intervention for many adults.

Excess body fat, usually defined by body mass index of 30 or higher, that raises risk of diabetes, heart disease, and joint disease. Treated with lifestyle change, medication, or bariatric surgery.

Use of a validated questionnaire such as the PHQ-2 or PHQ-9 to detect depressive symptoms in adults. Positive screens require clinical interview and suicide risk assessment before diagnosis.

Advising older adults on exercise, home safety, vision care, footwear, and medication review to reduce fall risk. Offered at routine visits and after any fall-related injury or near fall.

Scheduled encounter focused on risk assessment, screening, immunization, and counseling rather than acute complaints. An opportunity to update the problem list and align prevention with patient goals.

Ongoing, individualized program of screening, vaccination, counseling, and chronic disease monitoring across the lifespan. Adjusted for age, risk, comorbidity, and patient preferences.