Geriatric Syndromes Overview - The Geriatric Giants
- Common, complex health states in older adults; not single diseases.
- Result from accumulated impairments across multiple systems; shared risk factors.
- Key "Geriatric Giants" (📌 often "I"s):
- Immobility
- Instability (Falls)
- Incontinence (Urinary/Fecal)
- Intellectual Impairment (Dementia, Delirium)
- Iatrogenesis
- (Also: Malnutrition, Impaired Senses, Polypharmacy, Frailty)
- Significantly impact quality of life (QoL) & disability.
⭐ Delirium, an acute confusional state, is a frequent geriatric syndrome and often the first sign of an underlying illness like infection.
Cognitive Catastrophes - Mind Menders
- Delirium: Acute, fluctuating change in mental status.
- Core: Inattention, disorganized thinking, altered consciousness. Often reversible.
- Causes (📌 I WATCH DEATH): Infection, Withdrawal, Acute metabolic, Trauma, CNS, Hypoxia, Deficiencies, Endocrine, Acute vascular, Toxins, Heavy metals.
- Mgmt: Treat cause, supportive care, haloperidol (low dose) for severe agitation.
- Dementia: Chronic, progressive cognitive decline. Alert.
- Core: Memory loss + ≥1 (aphasia, apraxia, agnosia, executive dysfunction).
- Types: Alzheimer's (MC), Vascular, Lewy Body, Frontotemporal (FTD).
- Mgmt: Cholinesterase inhibitors, Memantine, support.
- Depression: Persistent low mood or anhedonia.
- Screen: Geriatric Depression Scale (GDS >5 significant).
- Mgmt: SSRIs (1st line), psychotherapy.
⭐ Delirium superimposed on dementia is common and worsens prognosis.
Mobility Meltdowns - Steady Steps
- Falls: Unintentional landing on lower surface; major cause of injury >65 yrs.
- Key Risks: Age >80, prior falls, muscle weakness, gait/balance issues, polypharmacy (≥4 drugs), cognitive/visual impairment, environmental hazards. 📌 (DAME: Drugs, Age-related, Medical, Environment).
- Complications: Fractures (hip), subdural hematoma, fear of falling (FOF), ↓mobility, institutionalization.
- Gait & Balance Assessment:
- Timed Up and Go (TUG): Rise from chair, walk 3m, turn, return, sit. >12 sec = ↑fall risk.
- Berg Balance Scale (BBS): Max score 56. <45 indicates ↑fall risk.
- Tinetti POMA (Performance Oriented Mobility Assessment).
- Management: Multifactorial approach.
- Exercise: Strength, balance (e.g., Tai Chi), endurance.
- Medication review: Minimize/stop psychotropics, review polypharmacy.
- Environmental modification: Grab bars, improved lighting, remove loose rugs.
- Vitamin D: 800-1000 IU/day, often with calcium.
⭐ Regular physical activity, especially balance and strength training, is the most effective single intervention to prevent falls in community-dwelling older adults.
Systemic Setbacks - Body Balance
- Frailty
- ↑ vulnerability to stressors. Phenotype (≥3/5): weight loss (≥5%/yr), exhaustion, ↓ grip, slow gait, ↓ activity.
- Clinical Frailty Scale (CFS): 1 (Very Fit) to 9 (Terminally ill).
- Sarcopenia
- Progressive ↓ of muscle mass, strength & function. Screen: SARC-F.
- Dx: Low muscle strength + low muscle quantity/quality (EWGSOP2 criteria).
- Malnutrition/Weight Loss
- Screen: Mini Nutritional Assessment (MNA). Causes: 📌 "MEALS ON WHEELS".
-
⭐ Serum albumin < 3.5 g/dL is a key marker for malnutrition & predictor of poor outcomes.
- Polypharmacy
- Concurrent use of ≥5 medications. ↑ risk of Adverse Drug Events (ADEs), falls.
- Medication review: Beers criteria, STOPP/START tools.
- Pressure Ulcers
- Localized skin/tissue injury, typically over bony prominences. Risk: Braden Scale.
- Prevention: regular repositioning, skin care, adequate nutrition.
- Sleep Issues
- Common: Insomnia, Obstructive Sleep Apnea (OSA).
- Prioritize non-pharmacological interventions first line treatment strategy for sleep issues in elderly population to avoid medication side effects and interactions with other drugs commonly used by older adults for chronic conditions management and overall health maintenance goals achievement and quality of life improvement and functional status preservation and independence promotion and cognitive function support and mood regulation and fall prevention and caregiver burden reduction and healthcare costs containment and patient satisfaction enhancement and adherence to treatment plan improvement and long term health outcomes optimization and healthy aging promotion and active lifestyle encouragement and social engagement facilitation and community participation support and self management skills development and empowerment of older adults to take control of their health and well being and make informed decisions about their care and treatment options and preferences and values and goals and expectations and needs and challenges and strengths and resources and opportunities and barriers and facilitators and enablers and disablers and determinants of health and health disparities and health equity and health literacy and health promotion and disease prevention and health protection and health surveillance and health policy and health systems and health services and health professionals and health research and health education and health communication and health advocacy and health activism and health movements and health reforms and health innovations and health technologies and health informatics and health economics and health ethics and health law and health humanities and health arts and health sciences and health professions education and interprofessional collaboration and team based care and patient centered care and person centered care and family centered care and community centered care and population health and public health and global health and 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and mental health care and behavioral health care and substance use disorder treatment and addiction medicine and pain management and complementary and alternative medicine and integrative medicine and traditional medicine and indigenous medicine and lifestyle medicine and preventive medicine and occupational medicine and environmental medicine and travel medicine and tropical medicine and disaster medicine and emergency medicine and critical care medicine and intensive care medicine and hospital medicine and primary care medicine and family medicine and internal medicine and pediatrics and obstetrics and gynecology and surgery and anesthesiology and radiology and pathology and laboratory medicine and pharmacology and toxicology and physiology and anatomy and biochemistry and microbiology and immunology and genetics and genomics and proteomics and metabolomics and transcriptomics and epigenomics and microbiomics and bioinformatics and biostatistics and epidemiology and public health and global health and health policy and health economics and health services research and health systems research and health education research and health communication research and health behavior research and health psychology and medical sociology and medical anthropology and medical history and medical ethics and medical law and medical humanities and medical arts and medical sciences and health professions and health workforce and health leadership and health management and health administration and health financing and health insurance and health regulation and health accreditation and health quality and health safety and health equity and health disparities and health literacy and health promotion and disease prevention and health protection and health surveillance. Non-pharmacological Rx first.
High‑Yield Points - ⚡ Biggest Takeaways
- Geriatric syndromes: Multifactorial conditions in older adults, not discrete diseases.
- Key syndromes: Delirium, falls, incontinence, frailty, pressure ulcers.
- Delirium: Acute, fluctuating mental status change, often due to underlying illness.
- Falls: Major morbidity/mortality cause; polypharmacy & gait instability are key risks.
- Urinary incontinence: Stress, urge, overflow, functional types; management is type-specific.
- Frailty: State of increased vulnerability; characterized by weakness, slow gait, and weight loss.
- Polypharmacy (≥5 medications) is a significant contributor to many geriatric syndromes and adverse drug events (ADEs).