Geriatrics
Geriatrics — Common Issues
Geriatrics

Geriatrics — Common Issues

Falls, delirium, dementia, polypharmacy, pressure ulcers.

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◆Falls

  • •Comprehensive evaluation: medications (anticholinergics, benzos, antihypertensives), vision, gait/balance, vit D, home safety
  • •Get up and go test: <12 seconds normal
  • •Best intervention: multifactorial — PT (strength + balance) + vit D + medication review + home modifications

◆Delirium

  • •Acute fluctuating attention/consciousness + cognitive disturbance
  • •Causes: infection (UTI, pneumonia), metabolic, medications, hypoxia, withdrawal
  • •First-line non-pharmacologic: reorientation, sleep hygiene, mobilization, family presence, sensory aids
  • •AVOID benzodiazepines (worsen) except for alcohol/benzo withdrawal
  • •Low-dose antipsychotic (haloperidol or quetiapine) for severe agitation

◆Polypharmacy

  • •Beers criteria: drugs to avoid in elderly
  • •Anticholinergics (diphenhydramine, oxybutynin, TCAs) → falls, AMS, urinary retention
  • •Long-acting benzos → falls
  • •First-gen antihistamines → confusion
  • •Antipsychotics in dementia → ↑mortality (FDA boxed warning)

◆Pressure ulcers

  • •Stage 1: non-blanchable erythema; Stage 2: partial-thickness skin loss; Stage 3: full-thickness skin loss (subQ visible); Stage 4: muscle/bone exposed
  • •Prevention: turn q2h, off-loading mattress, nutrition (protein, vitamins), moisture management
  • •Treat: debride necrotic tissue; appropriate dressings; antibiotics only if cellulitis or osteomyelitis

◆Advance directives

  • •Living will: written wishes for end-of-life
  • •Durable power of attorney: surrogate decision-maker
  • •POLST: portable medical orders for serious illness
  • •If no directive: surrogate hierarchy (spouse → adult children → parents → siblings, etc.) varies by state

High-yield pearls

  • ◆Acute change in mental status in elderly → think UTI or pneumonia FIRST
  • ◆Don't use diphenhydramine in elderly (anticholinergic)
  • ◆Cholinesterase inhibitors can cause syncope (bradycardia) — caution in elderly with falls
  • ◆Mini-Cog for cognitive screening; MoCA more sensitive for MCI
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