Geriatric Syndromes: Definition and Clinical Significance
Geriatric syndromes are clinical conditions in older adults that do not fit into discrete disease categories but are characterized by the inability of the body to compensate and overcome cumulative impairments in multiple systems, resulting in functional decline and decreased quality of life. 1
Core Geriatric Syndromes
Dementia: A permanent cognitive impairment often present in elderly patients as a comorbid condition, significantly affecting treatment decisions and outcomes 1
Delirium: An acute confusional state that is often overlooked but represents a significant risk factor for poor outcomes in older adults 1
Depression: Highly prevalent in older adults, particularly those with cancer and other chronic conditions 1
Falls: Significantly more common in older patients with cancer than those without, representing a major cause of morbidity 1, 2
Frailty: A state of increased vulnerability characterized by decreased physiologic reserve and resistance to stressors 1, 3
Sarcopenia: Age-related loss of muscle mass and function, affecting mobility and independence 3
Incontinence: Both urinary and fecal incontinence are common and significantly impact quality of life 1, 2
Polypharmacy: The concurrent use of multiple medications (often defined as >4 drugs), increasing risk of adverse drug events 1, 4
Malnutrition and Weight Loss: Common in older adults and associated with poor outcomes 3
Sensory Impairments: Including hearing and visual impairments that exacerbate existing challenges 1
Pressure Ulcers: Resulting from immobility and poor nutrition 2
Lack of Social Support: A significant factor affecting health outcomes in older adults 5
Prevalence and Impact
Geriatric syndromes are highly prevalent, with studies showing that 60.3% of older patients with cancer report one or more geriatric syndromes compared to 53.2% of those without cancer 1
The frequency and coincidence of geriatric syndromes increase significantly with age - while 20% of adults aged 60-69 may have no syndromes, 48% of those aged 80+ have more than four syndromes simultaneously 4
In a large screening study of 11,344 individuals aged 65+, the prevalence rates were: 30.4% for frailty, 42.9% for sarcopenia, 29.3% for risk of weight loss, and 28.1% for dementia 3
Shared Risk Factors
Four major shared risk factors have been identified across common geriatric syndromes:
- Older age
- Baseline cognitive impairment
- Baseline functional impairment
- Impaired mobility 2
Vascular disorders and vascular aging are increasingly recognized as key etiological factors in many geriatric syndromes 6
Clinical Assessment
Comprehensive geriatric assessment is an interprofessional diagnostic process that identifies medical, psychosocial, cognitive, physical, and functional needs of older adults 1
Validated screening tools for geriatric syndromes include:
- Mini-Cog, Montreal Cognitive Assessment (MoCA), or Saint Louis University Mental Status Examination for cognitive assessment
- Patient Health Questionnaire (PHQ-2/PHQ-9) or Geriatric Depression Scale for depression
- Confusion Assessment Method (CAM) for delirium 1
The Rapid Geriatric Assessment (RGA) is a brief screening tool that can identify frailty, sarcopenia, risk for weight loss, and dementia in older adults 3
Clinical Implications
Geriatric syndromes are associated with higher healthcare utilization, including increased hospitalizations and emergency department visits 5
Patients described as "frail" in clinical notes have significantly more geriatric syndromes (average 4.85) compared to non-frail patients (average 2.35) 5
Medications such as anticholinergics, antipsychotics, benzodiazepines, corticosteroids, and opioids can worsen cognitive impairment and other geriatric syndromes in older adults 1
Management of geriatric syndromes requires a multidimensional approach that moves away from the traditional disease-based medical model to a more person-centered approach focused on individual goals 1
Prevention and Management
Implementing comprehensive geriatric assessments reduces disability, hospitalization, and institutionalization while improving quality of life 1
Deprescribing unnecessary or inappropriate medications using established criteria such as STOPP/START or Beers criteria is recommended for older adults with multiple geriatric syndromes 1
Maintaining daily functioning, quality of life, dignity, and independence should be the main goals when managing geriatric syndromes 1
Geriatric syndromes are frequently overlooked due to the absence of a systematic approach and the normalization of age-related pathologies 1