Geriatric Focus Course

Geriatric Syndromes Outline

I. Objectives
A. Define the term geriatric syndrome
B. List and describe the Classic Geriatric Syndromes.
C. Describe how to screen for selected geriatric syndromes in a
clinical
setting.
II. Geriatric Syndromes
A. Definition - Certain common conditions in older patients that
reflect a
decrease in a persons physiologic reserve caused
by combination of
normal age changes and multiple
comorbid conditions.
B. Looking for and treating geriatric syndromes improves
function and
quality of life, and decreases risk of illness
and injury
C. Screening for them is incorporated into the medical history or
review of
systems portion of the clinical visit
D. Further screening and testing occurs during the physical
exam portion of
the clinical visit
III. Classic Geriatric Syndromes
A.
Dementia
Delirium
Dizziness
Falls and gait
abnormalities

Frailty
Poor nutrition
Sleep disorders
Urinary incontinence

B. Some published lists of geriatric syndromes include additional

syndromes
IV. Descriptions of individual Geriatric Syndrome
A. Dementia
1. Definition Progressive deterioration of cognition in
multiple
domains including memory and at least one
of the following:
orientation, learning, language
comprehension, and judgment that
is severe
enough to interfere with daily life.
2. Causes Alzheimers disease and vascular dementia
are common,
but there are many others
3. Results progressive decrease in function with
increasing
problems in behavior and physical
function

4. Screening
a. Usually initiated by physician observing
something unusual
in the patients behavior,
appearance or thinking, or a concern
brought up
by the patient or the caregivers
b. Screening tools include:
-Mini Mental Status Exam (MMSE)
-Three item recall after 1 minute
-Clock drawing
-Mini-cog combines three item recall and
clock drawing test.
c. Comparing MMSE and Mini-cog:
Detecting Dementia: Sensitivity and Specificity
MMSE
Mini-Cog

Sensitivity
91%
99%

Specificity
92%
93%

Speed of Administration

MMSE
Mini-Cog

Patients with
Dementia
7.3 minutes
3.2 minutes

Patients Without
Dementia
5.6 minutes
2.5 minutes

d. Positive findings in screening trigger further

investigation
for treatable causes of
declining cognitive function and
confirmatory
diagnostic testing
B. Delirium
1. Definition an acute confusional state with disturbance
of
consciousness and reduced ability to focus
attention developing
over a short time and
fluctuating over the course of the day
2. Multitude of causes drug side effects, infection,
dehydration,
endocrine disorders, myocardial
infarction, stroke, breathing
problems, sensory
problems, fatigue, anemia, and others.
3. Results - Can cause serious and life-threatening
complications and
loss of function and occurs
commonly in hospitalized older adults

4. Detection requires frequent assessment throughout the

day
C. Dizziness
1. Definition generic word used to describe feelings of
spinning,
almost fainting, falling, lightheadedness, or
unsteadiness.
2. Causes Inner ear problems, low blood pressure,
medication side effects, and many others
3. Results difficulty walking, falls, fear of falls
4. Screening
a. Ask Do you ever feel dizzy?
b. If yes, ask further questions and focus exam to
look for
contributing causes
D. Gait abnormalities
1. Definition of Gait Problems difficulty walking, walking
slowing,
feeling unsteady and weak
2. Causes neurologic disorders, vestibular, disorders,
musculoskeletal disorders and pain,
deconditioning, medication
side effects, and many
others
3. Results falls, fear of falling, restriction of function that
worsens
deconditioning
4. Screening
1. Observation of patient walking under normal
circumstances
2. Standardized testing up and go test
E. Falls
1.
comes to rest
2.
problems,
environmental
3.
4.
falls

Definition unintentional event in which a person

on the ground
Causes usually multifactorial, including sensory
musculoskeletal changes,
hazards, medications
Results: Fear of falls, injury, and death
More information will be presented in the outline about

F. Frailty
1. Clinical definition impairment in mobility, balance,
muscle
strength, cognition, nutrition, endurance,
and physical activity
2. State of increased vulnerability to adverse outcomes
3. Prevalence increases with chronologic age, and at some
point is
likely for all individuals

4. No single disease causes it, but it is the cumulative

manifestation of
clinical loss of reserve in many systems
5. Frail people have increased needs for assistance, doctor
visits and
hospitalizations
6. Recognizing frailty and predicting increased risk of
adverse
outcomes helps the clinician make
better recommendations
regarding care, such
as taking fewer risks with procedures,
and
moving toward a more palliative approach
G. Poor nutrition
1. Definition: Inadequate intake of calories and/or
nutrients to meet
metabolic needs
2. Common Causes
a. Inadequate food choices - Older adults need fewer
calories
than younger adults, but need the
same nutrients
b. Limited access to food limited abilities to afford,
buy,
prepare, and eat food
c. Difficulty chewing and swallowing
3. Results Over and underweight, weakness, falls,
osteoporosis,
diabetes
4. Screening
a. Ask: Do you have any trouble getting enough
food? and
Do you have any trouble chewing or
swallowing?
b. Measure weight, Body Mass Index, lab tests for
diabetes and
protein stores
H. Sleep Problems
1. Definition Difficulty falling or staying asleep, or nonrestorative
sleep
2. Common Causes
a. Poor sleep hygiene (habits that interfere with
normal sleep
cycle): caffeine, excessive
napping, stimulating activities in
evening such as
television or Internet surfing
b. Depression, dementia, medication side effects,
pain,
frequent urination
3. Results chronic fatigue, depression, heart disease,
falls, driving
accidents, decreased cognitive
function
4. Screening Ask Do you have trouble sleeping at night
or feel
sleepy during the day?
I. Urinary Incontinence

1. Definition involuntary leakage of urine.

2. It is never normal in older patients.
2. Causes broad categories
a. Conditions of the lower urinary tract infection,
prostate disease, stool impaction
distorting
bladder outlet
b. Drug side effects
c. Increased urine production high blood sugar,
excess fluid intake
d. Impaired ability or willingness to reach toilet
dementia, mobility issues, bathroom
not wheelchair
accessible, restraints, lack
of needed assistance
e. Delirium
f. Psychological
4. Results embarrassment, decreased quality of life,
depression,
falls, fractures, skin problems, sleep
disturbance, and impaired
sexuality
5. Prevalence:
a. Community dwelling women 15-30%
b. Community dwelling men 5-10%
c. Nursing home residents as high as 70%
d. Half of patients do not self-report this problem to
a doctor
6. Screening: Routinely ask all older patients about
incontinence
a. In the last year, have you lost urine or gotten wet?
b. If yes to above, then ask: In the last year have
you lost urine
on at least 6 days?
Resources
Harlow E, Lyons W. Assessment. In: Ham R, ed. Primary Care
Geriatrics, A Case-Based Approach, Sixth Edition Philadelphia, PA:
Elsevier Saunders: 2014.
Reuben D, Rosen S. Principles of Geriatric Assessment. Geriatric
Medicine and Gerontology. New York, NY: McGraw Hill Medical: 2009:
141-152.
Sloane P, Warshaw, G, Potter J, Flaherty E, Ham R. Principles of
primary care of older adults. In: Ham R, ed. Primary Care Geriatrics, A
Case-Based Approach, Sixth Edition Philadelphia, PA: Elsevier
Saunders: 2014.