Geriatrics
Showing 25 of 25 topics
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Advanced dementia is a terminal neurodegenerative condition characterized by profound cognitive and functional dependence, dysphagia, recurrent infections, and increasing vulnerability to burdensome interventions. Care should prioritize the patient's previously expressed values, careful hand feeding when consistent with goals, symptom relief, avoidance of nonbeneficial interventions, and explicit planning for future infections and hospitalizations.
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In advanced dementia, tube feeding does not improve survival, prevent aspiration pneumonia, or heal pressure injuries. Offer 'comfort feeding only' and align with goals of care.
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Anticoagulation for atrial fibrillation in older adults should be based on thromboembolic risk, bleeding risk modification, kidney function, drug interactions, goals, and patient preferences. Advanced age alone is not a reason to withhold stroke prevention, and direct oral anticoagulants are preferred over warfarin for most eligible patients without mechanical valves or moderate-to-severe rheumatic mitral stenosis.
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Aspiration prevention in dysphagia requires identification of swallowing impairment, appropriate positioning and feeding pace, oral hygiene, texture or liquid modification when demonstrated to help, medication review, and shared decisions about feeding goals. Feeding tubes do not eliminate aspiration risk and should not be presented as a universal solution.
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Asymptomatic bacteriuria is bacteria in the urine without urinary symptoms attributable to infection. In most older adults, including those in long-term care, screening and antibiotic treatment do not improve outcomes and expose patients to adverse drug effects, Clostridioides difficile infection, and antimicrobial resistance.
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In older adults, prioritize deprescribing BZDs due to falls, cognitive impairment, and delirium risk. Use slow tapers (5–10% q2–4 wks), CBT‑I/CBT‑A, and safer alternatives; coordinate across prescribers.
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Constipation in older adults is common, frequently medication related, and potentially serious when it leads to fecal impaction, urinary retention, delirium, or stercoral injury. Management begins by excluding obstruction or impaction, correcting reversible causes, and using a scheduled bowel regimen matched to stool consistency, mobility, diet, and opioid exposure.
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Delirium superimposed on dementia is an acute change in attention, awareness, and cognition occurring in a patient with preexisting cognitive impairment. The key diagnostic clue is a new fluctuating departure from baseline; treatment requires identification of precipitating illness plus multicomponent nonpharmacologic care, not routine sedative or antipsychotic use.
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Recognize physical, emotional, financial abuse, and neglect. Screen sensitively, document carefully, ensure safety, and follow mandatory reporting laws.
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Reduce falls via exercise (balance/strength), medication review, vision/footwear optimization, orthostatic hypotension management, and home hazard reduction.
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Falls in older adults are usually multifactorial events rather than isolated accidents. Evaluation should identify injury, syncope or acute illness, medication effects, gait and balance impairment, orthostatic hypotension, sensory deficits, environmental hazards, and osteoporosis risk, then convert those findings into an individualized prevention plan.
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Goals-of-care conversations clarify what matters most to an older adult and translate those priorities into treatment recommendations. High-quality conversations address understanding of illness, prognosis, function, acceptable burdens, surrogate decision makers, and preferences for future crises rather than reducing the discussion to a code-status checkbox.
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Differentiate conductive vs sensorineural loss; treat reversible causes and refer for amplification or implantable devices. Address communication strategies and safety.
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Early surgical repair with collaborative co management, delirium prevention, analgesia with regional techniques, and early mobilization improves outcomes.
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Screen routinely; treat with protein‑energy repletion, micronutrient correction, and address causes. Beware refeeding syndrome in high‑risk patients.
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Orthostatic hypotension is a sustained fall in blood pressure after standing, commonly defined as a decrease of at least 20 mm Hg systolic or 10 mm Hg diastolic within 3 minutes. In older adults it may reflect medications, volume depletion, autonomic failure, deconditioning, or acute illness, and treatment should target symptoms and cause rather than a standing number alone.
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For very high‑risk patients (multiple/vertebral fractures or very low T‑scores), start anabolic therapy (teriparatide, abaloparatide, romosozumab) then transition to antiresorptive to maintain gains.
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Osteoporosis in older adults is a systemic skeletal disorder that increases fragility-fracture risk. Management combines fracture-risk assessment, fall prevention, adequate calcium and vitamin D, and antiresorptive or anabolic therapy based on fracture history, bone density, clinical risk, kidney function, and treatment goals.
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Pain management in older adults should prioritize function and comfort while minimizing delirium, falls, bleeding, kidney injury, constipation, and respiratory depression. Nonpharmacologic and nonopioid approaches are preferred when effective, but undertreated pain is also harmful and opioids remain appropriate for selected acute, cancer-related, and severe persistent pain.
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Polypharmacy review in older adults should identify medications without a current indication, drugs with unfavorable benefit-to-harm balance, prescribing cascades, duplications, and medicines that conflict with the patient's goals. STOPP/START and Beers Criteria are screening aids, not substitutes for individualized clinical judgment.
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Systematically reduce anticholinergic load and inappropriate meds using tools (Beers, STOPP/START, ACB scale). Substitute safer alternatives and monitor outcomes.
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Pressure injury prevention in older adults requires systematic risk recognition, frequent skin inspection, pressure redistribution, individualized repositioning, moisture and continence management, adequate nutrition, and minimization of friction and shear. Prevention plans should be based on mobility and tissue tolerance rather than a fixed turning schedule applied to every patient.
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Structured transitional care lowers readmissions: risk stratify, reconcile meds, schedule follow‑up within 48–72 h, ensure teach‑back education, and provide 24/7 contact.
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Transitions of care are high-risk periods for medication errors, missed follow-up, duplicate testing, and loss of clinical ownership. Safe discharge for an older adult requires an accurate reconciled medication list, clear explanation of what changed and why, pending-result management, follow-up responsibility, functional and equipment planning, and communication with the next care setting.
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Address reversible causes (cataracts), provide AMD‑specific care, and connect to low‑vision services and supports for independence and safety.
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