What defines a patient as geriatric?

Defining the Geriatric Patient

A geriatric patient is not defined solely by chronological age (≥65 years), but rather by the presence of frailty, multiple active diseases, and functional limitations that require a holistic, multidisciplinary approach to care. 1

Age-Based vs. Functional Definition

Chronological Age Threshold

• Age 65 years or older is the traditional cutoff used to define an "older person" in most medical contexts 1
• This chronological definition alone is inadequate and does not capture the true complexity of geriatric patients 1, 2
• The geriatric population becomes more prevalent in those above 80 years of age, where frailty and multiple diseases are more common 1

The True Geriatric Patient Definition

A geriatric patient is characterized by:

• High degree of frailty with reduced adaptive and regenerative capacity 1
• Multiple active diseases occurring simultaneously (multicomplexity) 1
• Functional limitations affecting activities of daily living (ADL), with jeopardized or lost independence 1
• Increased vulnerability to stress due to cumulative decline in physiological systems 1
• Need for rehabilitative, physical, psychological, and social care requiring holistic management 1

Why Biological Age Matters More Than Chronological Age

The critical distinction is that biological age should be established through comprehensive geriatric assessment rather than relying on chronological age alone 1. This is because:

• There are frequent discrepancies between physiological and chronological age 1
• Frailty predicts outcomes better than chronological age alone 3
• Approximately 25% of persons aged ≥85 years meet criteria for frailty, but many younger patients may also be frail 1, 3
• The goal is to distinguish fit from vulnerable older patients to adjust treatment appropriately 1

The Geriatric 5Ms Framework for Assessment

The American Geriatrics Society recommends using the "Geriatric 5Ms" framework to comprehensively define and assess geriatric patients 4, 5:

1. Mind: Cognitive and psychological health (dementia, delirium, depression) 4, 5
2. Mobility: Falls, movement limitations, and physical performance 4, 5
3. Medications: Polypharmacy and potentially inappropriate medications 4, 5
4. Multicomplexity: Multiple chronic conditions intersecting with social determinants 4, 5
5. What Matters Most: Patient priorities, values, and care preferences 4, 5

Key Clinical Characteristics That Define Geriatric Patients

Physiological Vulnerability

• Reduced functional reserves across multiple organ systems 3, 6
• Impaired immune function with decreased phagocytosis and increased infection risk 3
• Altered drug metabolism leading to increased adverse drug events 3
• Impaired thirst mechanisms increasing dehydration risk 3

Geriatric Syndromes

• Frailty as an independent mortality risk factor 3
• Falls as the most common injury mechanism 3
• Cognitive impairment/dementia affecting treatment decisions 3
• Delirium as acute cognitive impairment 3
• Polypharmacy with >700,000 emergency visits annually for adverse drug events 3
• Malnutrition with unintended weight loss >5% in 6 months 3

Functional and Social Factors

• Loss of independence in basic activities of daily living 1
• Social isolation as a mortality predictor 3
• Reduced rehabilitation capacity preventing return to baseline function 3

Common Pitfall to Avoid

Never define a patient as geriatric based solely on reaching age 65. 1, 2 The term "geriatric patient" should be reserved for those with the functional, physiological, and clinical characteristics described above, which may occur at varying chronological ages. A healthy, independent 75-year-old without frailty or functional limitations is an "older adult" but not necessarily a "geriatric patient" requiring specialized geriatric medicine approaches. 1