From the Guidelines
Comprehensive geriatric assessment is the cornerstone of quality geriatric care, addressing medical, functional, psychological, and social domains to maximize function and quality of life while respecting patient preferences. The American Geriatrics Society (AGS) guidelines provide comprehensive information for geriatric care education, highlighting normal physiologic aging changes, such as decreased cardiac output, reduced lung elasticity, diminished renal function, and altered pharmacokinetics 1. Psychological and social changes involve adapting to retirement, bereavement, and changing family dynamics, with elderly patients often experiencing role reversals with adult children becoming caregivers.
Geriatric patients frequently present atypically with diseases, such as heart attacks manifesting as confusion rather than chest pain, infections presenting without fever, and pain being underreported 1. Key risks in geriatric care include polypharmacy, iatrogenic illness from treatments, immobilization leading to functional decline, and inappropriate institutionalization when community supports might suffice. Health promotion should focus on age-appropriate screenings, fall prevention, immunizations, and nutritional assessment, as malnutrition and dehydration are common issues in older adults, affecting up to two-thirds of hospitalized patients 1.
Rehabilitation services should aim to maintain independence through physical therapy, occupational therapy, and home modifications. House calls provide valuable assessment of the patient's actual living environment and functional status. Long-term care options range from independent living to skilled nursing facilities, each with specific regulations regarding care standards. Understanding Medicare, Medicaid, and supplemental insurance is essential for addressing financial aspects of geriatric care.
Elder abuse recognition requires vigilance for physical injuries, unexplained withdrawals from accounts, or sudden isolation. Functional status evaluation using tools like the Katz ADL or Lawton IADL scales helps determine appropriate interventions. Common geriatric conditions require specific approaches, such as:
- Hearing and vision loss needing regular screening
- Pneumonia requiring lower threshold for treatment
- Cardiovascular conditions often presenting atypically
- Oral health affecting nutrition and quality of life
- Urinary incontinence never being considered normal aging
- Falls requiring multifactorial assessment
- Cognitive impairments needing thorough evaluation to distinguish delirium from dementia
- Depression being often underdiagnosed but highly treatable in older adults
A comprehensive geriatric assessment should include high-priority aging-related domains, such as physical and cognitive function, emotional health, comorbid conditions, polypharmacy, nutrition, and social support, as recommended by the American Society of Clinical Oncology (ASCO) guideline update 1. By prioritizing these domains and addressing the unique needs of older adults, healthcare providers can promote healthy aging, prevent or mitigate age-related diseases, and improve quality of life for this vulnerable population.
From the Research
Geri Syllabus
- The American Geriatrics Society (AGS) provides guidelines for the care of older adults, including the importance of comprehensive geriatric assessment (CGA) in identifying and managing geriatric conditions and syndromes 2, 3, 4, 5.
- CGA is a multidimensional and multidisciplinary diagnostic process that evaluates functional capacities and impairments in geriatric patients, and is essential for planning therapeutic interventions 5.
Medical Knowledge
- Normal underlying physiologic changes due to aging in various body systems, such as cardiovascular, respiratory, and musculoskeletal systems, must be considered in the care of older adults.
- Unique modes of presentation for care, including atypical presentations of specific diseases in elderly patients, such as pneumonia, hypertension, and dementia, require careful evaluation and management.
- Risks and adverse outcomes in geriatric care, including polypharmacy, iatrogenic illness, immobilization, and over-dependency, must be identified and addressed through CGA and other interventions 2, 3, 6.
Syllabus
Normal Psychological, Social, and Environmental Changes of Aging
- Reactions to common stresses, such as retirement, bereavement, relocation, and ill health, can have significant impacts on the mental and physical health of older adults.
- Changes in family relationships and social support networks can affect health care and well-being in older adults.
- Environmental factors, such as housing and accessibility, can also impact the health and independence of older adults.
Unique Modes of Presentation for Care
- Atypical presentations of specific diseases, such as dementia, delirium, and depression, require careful evaluation and management in older adults.
- CGA can help identify and manage geriatric syndromes, such as falls, incontinence, and malnutrition, which are common in older adults 2, 3.
Risks and Adverse Outcomes in Geriatric Care
- Polypharmacy is a significant risk in older adults, and CGA can help reduce inappropriate medication use and optimize treatment 6.
- Iatrogenic illness, immobilization, and over-dependency are also significant risks in geriatric care, and require careful management and prevention strategies.
- CGA can help identify and address these risks, and promote health and well-being in older adults 2, 3, 5.
Means for Promoting Health and Health Maintenance
- Screening for and assessment of risk factors, such as falls, malnutrition, and social isolation, can help promote health and prevent illness in older adults.
- Services available to promote rehabilitation or maintenance of an independent lifestyle, such as physical therapy, occupational therapy, and home care, can help older adults maintain their independence and quality of life.
- Indications and benefits of the house call in the assessment and management of elderly patients can also promote health and well-being in older adults 2.