Geriatrics is a specialized medical field focused on the health and care of older adults. While chronological age, often cited as 65 years and older, provides a general boundary, it does not solely define who is considered a geriatric patient. The practice recognizes that a person’s functional status and overall health complexity are far more important indicators than the number of years they have lived.
Defining the Geriatric Patient
A geriatric patient is an older individual whose health status is characterized by complexity that goes beyond simple chronological age. This population is generally defined by the presence of multiple chronic health conditions requiring intricate care management. Unlike a healthy elderly person, the geriatric patient has decreased physiological reserve, making them vulnerable to adverse health outcomes.
This increased vulnerability is frequently seen in the presence of multimorbidity, the coexistence of numerous diseases or conditions. Managing these multiple conditions often leads to polypharmacy, typically defined as the regular use of five or more different medications. This high volume of prescriptions dramatically increases the risk of drug-drug interactions, adverse side effects, and cognitive impairment. The accumulation of these medical and medication issues often leads to a decline in the patient’s ability to perform daily activities.
Functional decline is a defining feature of the geriatric patient, measured by the loss of capacity to perform Activities of Daily Living (ADLs) and Instrumental Activities of Living (IADLs). ADLs include basic self-care tasks like bathing, dressing, feeding, and transferring from a bed to a chair. IADLs involve more complex functions necessary for independent living, such as managing finances, preparing meals, and using transportation. Impairment in these activities signifies the need for specialized geriatric care to maintain independence and quality of life.
Unique Health Conditions of Aging
The specialized nature of geriatric care stems from geriatric syndromes, which are multifactorial health problems that do not fit into discrete disease categories. These syndromes are challenging because they often present atypically in older adults, masking underlying acute illness. For instance, a urinary tract infection might present as acute confusion, or delirium, rather than the typical fever and painful urination seen in younger individuals.
One of the most prevalent geriatric syndromes is frailty, a state of increased vulnerability resulting from age-related declines in multiple body systems. Frailty is characterized by unintentional weight loss, exhaustion, low physical activity, slowed walking speed, and muscle weakness. This physical vulnerability significantly increases the risk of hospitalization, disability, and mortality following a minor stressor, such as a respiratory infection.
Delirium, a sudden and fluctuating disturbance in attention and cognition, is a common syndrome and a medical emergency in this population. It is frequently triggered by infection, dehydration, or medication changes, and is distinct from progressive conditions like dementia. Falls are also a major concern, often signaling underlying issues like gait instability, muscle weakness, or adverse drug effects. Falls can lead to serious injuries, including hip fractures, which dramatically reduce a person’s future mobility and independence.
Incontinence, both urinary and fecal, is a common but underreported issue that significantly impacts quality of life. This condition is treatable and can be caused by underlying diseases, neurological issues, or certain medications. The physiological changes of aging, such as decreased kidney function, mean that medication dosages must be carefully adjusted to prevent drug accumulation and toxicity.
The Role of Comprehensive Geriatric Assessment
The unique and complex needs of the geriatric patient require a structured, holistic evaluation known as the Comprehensive Geriatric Assessment (CGA). The CGA is a multidisciplinary process that goes far beyond a standard physical examination to create a thorough, integrated care plan. This assessment is typically conducted by a team, ensuring all aspects of the patient’s well-being are considered. The team may include:
- A geriatrician
- A nurse
- A social worker
- A pharmacist
- A physical therapist
- An occupational therapist
The CGA systematically evaluates several domains often overlooked in routine medical care, beginning with functional status. This assessment uses validated tools to determine a patient’s current level of independence with both Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). The evaluation also includes a thorough screening of cognitive status to identify or monitor conditions like dementia or mild cognitive impairment. Psychological status is assessed to screen for mood disorders, particularly depression, which is common in older adults.
A detailed medication review is a central component of the CGA, aiming to identify and safely eliminate inappropriate or unnecessary drugs, a process known as deprescribing. Furthermore, the assessment looks at the patient’s socio-environmental situation, including the safety of their home environment, social support, and financial resources. By systematically gathering this broad range of data, the CGA team develops a cohesive care strategy that addresses all identified problems and focuses on preserving functional ability and enhancing overall quality of life.