What are the major geriatric syndromes managed by board-certified geriatric physicians (Geriatricians)?

From the Guidelines

Board certified geriatric physicians manage several major geriatric syndromes, including cognitive impairment and dementia, delirium, falls and gait disorders, polypharmacy, frailty, urinary incontinence, malnutrition, pressure ulcers, sensory impairments, and depression, as outlined in the Geriatric 5Ms framework 1. These syndromes are characterized by the inability of the body to compensate and overcome cumulative impairments in multiple systems, and their management requires a comprehensive geriatric assessment and interdisciplinary approach to optimize functional status, quality of life, and mortality 1.

Key Geriatric Syndromes

• Cognitive impairment and dementia: management may involve medications like donepezil or memantine along with non-pharmacological approaches
• Delirium: requires identification and treatment of underlying causes while minimizing sedating medications
• Falls and gait disorders: prevention includes medication review, physical therapy, and home safety modifications
• Polypharmacy: management involves medication reconciliation and deprescribing unnecessary drugs
• Frailty: interventions focus on nutrition, exercise, and social support, with medication management playing a crucial role in reducing medication harm 1
• Urinary incontinence: may be treated with pelvic floor exercises, behavioral modifications, or medications
• Malnutrition: requires nutritional assessment and supplementation when needed
• Pressure ulcers: prevention includes regular repositioning and specialized support surfaces
• Sensory impairments: necessitate appropriate aids and environmental modifications
• Depression: may be treated with psychotherapy and medications like sertraline or mirtazapine

Comprehensive Geriatric Assessment

A comprehensive geriatric assessment is an interprofessional diagnostic process used to identify medical, psychosocial, cognitive, physical, and functional needs of older adults, guiding the development of a coordinated care plan to manage complexities of health conditions and optimize overall well-being 1.

Implementing the Geriatric 5Ms Framework

The Geriatric 5Ms framework consists of considering the mind, evaluating mobility and fall risk, reviewing and reconciling medications, asking what matters most to the patient, and assessing multicomplexity, providing clinicians with practical suggestions and resources for quickly and effectively applying the framework to the care of older adults 1. By prioritizing the management of these geriatric syndromes and implementing the Geriatric 5Ms framework, board certified geriatric physicians can improve functional status, quality of life, and mortality in older adults 1.

From the Research

Major Geriatric Syndromes

The following are major geriatric syndromes managed by board certified geriatric physicians:

• Delirium
• Falls
• Incontinence
• Frailty
• Functional decline
• Pressure ulcers
• Polypharmacy 2

Characteristics of Geriatric Syndromes

Geriatric syndromes are highly prevalent, multifactorial, and associated with substantial morbidity and poor outcomes 2. They share common risk factors, including:

• Older age
• Baseline cognitive impairment
• Baseline functional impairment
• Impaired mobility 2

Relationship between Polypharmacy and Geriatric Syndromes

Polypharmacy is a major health issue for older adults and is entangled with several geriatric syndromes, including:

• Frailty 3, 4
• Falls 5, 6, 4
• Cognitive decline 4

Management of Geriatric Syndromes

Board certified geriatric physicians manage geriatric syndromes using various approaches, including:

• Medication reconciliation to minimize polypharmacy 3
• Deprescribing to reduce the potential harmful effects of polypharmacy 4
• Fall prevention strategies to reduce the risk of falls 5, 6, 2