Geriatrics Study Guide

📖 Core Concepts Geriatrics – Medical specialty focused on diagnosing, preventing, and treating disease in older adults (individualized, not age‑based). 5 M’s of Geriatrics – Mind, Mobility, Multicomplexity, Medications, Matters most to the patient; framework for comprehensive assessment. Physiological Reserve – Declines with age, so mild stressors (e.g., low‑grade fever) can cause severe complications. Atypical Presentation – Older patients often show vague symptoms (confusion, falls, delirium) instead of classic disease signs. Frailty – Syndrome of reduced reserve manifested by weight loss, weakness, exhaustion, low activity, and slowed gait; scores 0‑5. Polypharmacy – Use of ≥5 medications; raises drug‑interaction and adverse‑event risk. Cognitive Aging – Fluid abilities (speed, working memory) decline; crystallized knowledge stays stable. Shared Decision Making – Aligns treatment with patient’s goals (function, quality of life, longevity). 📌 Must Remember Frailty score 3–5 → doubles postoperative complication risk & higher chance of nursing‑facility discharge. Dementia prevalence: Alzheimer’s accounts for 40‑80 % of cases. Mild Cognitive Impairment (MCI) affects 10‑20 % of adults >65 y; a bridge to dementia. Medication error rate: ≈ 1/3 of older adult regimens contain a potential error. Falls: Leading cause of ER visits/hospitalization for ≥65 y; modifiable risk factors include meds, balance, environment. Malnutrition prevalence: 12‑50 % in hospitalized/institutionalized elders. Depression → ↑ risk of MCI and may persist after depressive symptoms resolve. 🔄 Key Processes Frailty Assessment Assign 1 point for each: unintentional weight loss, weakness, exhaustion, low activity, slowed walking. Total 0 = robust, 1‑2 = pre‑frail, 3‑5 = frail. Medication Review (Polypharmacy Reduction) List all meds (prescription + OTC). Identify potentially inappropriate medications (PIMs). Apply “start low, go slow” dosing; deprescribe non‑essential agents. Atypical Illness Evaluation When an older patient presents with confusion, delirium, falls, or low‑grade fever, broaden differential to include infection, MI, electrolyte disturbance, medication side‑effects. Shared Decision‑Making Workflow Elicit patient’s Matters Most (function vs longevity). Present risks/benefits in plain language. Document decision and advance directives if appropriate. 🔍 Key Comparisons Geriatrics vs. Gerontology Geriatrics: clinical care of older adults. Gerontology: study of biological/social aging processes. Frailty vs. Normal Aging Frailty: ≥3 of 5 criteria, predicts adverse outcomes. Normal aging: gradual loss of fluid cognition, no functional decline. Delirium vs. Dementia Delirium: acute, fluctuating, reversible, often triggered by minor stressors. Dementia: chronic, progressive, irreversible (most cases). ⚠️ Common Misunderstandings “All elderly patients present with classic disease signs.” – False; atypical presentations dominate. “Polypharmacy is inevitable in older adults.” – Not true; regular medication reconciliation can safely reduce meds. “Mild cognitive impairment is just normal aging.” – Incorrect; MCI is a distinct, higher‑risk state for dementia. “Falls are always due to environmental hazards.” – Only 30 % are; medication side‑effects and frailty are major contributors. 🧠 Mental Models / Intuition “Reserve Tank” Model: Imagine each organ as a tank of reserve. Age shrinks the tank; even a small “hole” (minor illness) can empty it quickly → explains atypical severity. “5 M’s Checklist” – Run through the list for every new older patient; if any M is unchecked, you likely missed a key issue. 🚩 Exceptions & Edge Cases Renal & Hepatic Impairment: Even “normal” lab values may hide reduced clearance; dose‑adjust all renally cleared drugs by estimated GFR. Depression‑related MCI: Cognitive decline may improve once depression is treated, but risk of progression remains elevated. Advance Directives: Patients with early‑stage dementia can still create valid directives; revisit when capacity wanes. 📍 When to Use Which Screen for Cognitive Impairment → Use MoCA (more sensitive) for subtle deficits; MMSE for quick baseline. Assess Frailty → Use Frailty Scale (5‑point) for surgical risk; consider Clinical Frailty Scale for broader functional status. Medication Review Tool → Apply Beers Criteria for PIMs; use STOPP/START if available. Fall Risk Intervention → Prioritize medication adjustment first, then balance training and home safety. 👀 Patterns to Recognize “Fever → Delirium → Fall” chain in older adults. Polypharmacy + New Symptom → suspect drug side‑effect or interaction. Weight loss + Weakness + Low Activity → flag frailty early. Sudden change in ADLs → may indicate delirium, infection, or worsening chronic disease. 🗂️ Exam Traps Distractor: “All older adults present with high fevers in infection.” – Wrong; low‑grade fever is common and may trigger delirium. Distractor: “Polypharmacy is defined as >10 meds.” – The exam usually accepts ≥5 as the threshold. Distractor: “Frailty is diagnosed only with gait speed.” – Frailty requires ≥3 of 5 criteria, not just gait speed. Distractor: “Depression does not affect cognition.” – Depression increases MCI risk and can mimic cognitive impairment. Distractor: “Advance directives are only needed for terminal illness.” – They are useful anytime the patient wants to state future preferences.