CM12.1-5 | Geriatric Services — Practice Quiz

Correct. NPHCE uses ≥60 years as the cut-off for elderly, aligned with Indian legislation and WHO recommendations for developing nations.

NPHCE (launched 2010-11) defines elderly as ≥60 years, consistent with the Maintenance and Welfare of Parents and Senior Citizens Act 2007 and WHO criteria for low-income countries.

Incorrect. India's NPHCE defines elderly as those aged 60 years or above, not 55, 65, or 70. This is consistent with the Senior Citizens Act 2007.

Correct. MMSE has a well-documented education bias. A score of 19 may reflect limited formal schooling rather than true cognitive impairment. Education-adjusted norms or alternative validated tools are essential in the Indian context.

MMSE was validated in educated, literate populations. In elderly individuals with limited formal education, the test systematically underestimates cognitive function. An education-adjusted cut-off or alternative tool (e.g., Hindi Mental State Examination) should be used in the Indian community setting.

Incorrect. The MMSE can be used in older adults, and a score of 19 is below the typical cut-off of 23-24. However, the critical limitation here is education bias — not age. The test can be administered by trained community health workers.

Correct. Geriatric syndromes are hallmark multifactorial presentations of old age — falls, delirium, incontinence, frailty, pressure ulcers — that span multiple organ systems and require a comprehensive geriatric assessment approach.

Geriatric syndromes (falls, delirium, urinary incontinence, pressure ulcers, frailty) are multifactorial conditions unique to older adults that cut across organ systems. They arise from the accumulation of impairments and cannot be attributed to a single disease — distinguishing them from multi-morbidity.

Incorrect. Geriatric syndromes are NOT confined to a single organ, are NOT equivalent to multi-morbidity, and are NOT defined by infection or atypical presentation alone. They are multifactorial, cross-system conditions unique to older adults.

Correct. TUG is the standard functional mobility screening test. Slow TUG time (>12 seconds) predicts fall risk, mobility decline, and need for further functional assessment.

The TUG test measures the time taken to rise from a chair, walk 3 metres, turn, walk back, and sit down. A time >12 seconds is associated with increased fall risk and functional impairment in older adults. It is a quick, practical mobility screening tool for community and PHC settings.

Incorrect. Cognitive function is assessed by MMSE or MoCA; depression by GDS-15; nutritional status by MNA or BMI. TUG specifically tests mobility and fall risk.

Correct. Under NPHCE, District Hospitals (Tier 3) are mandated to establish dedicated geriatric OPD clinics and 10-bedded geriatric wards, staffed by physicians with geriatric training.

NPHCE has a 4-tier service delivery model. District hospitals form Tier 3 — they provide dedicated geriatric OPD, 10-bedded geriatric wards, physiotherapy, and a trained geriatric team. PHCs and sub-centres form lower tiers providing screening, home visits, and basic management. Regional Geriatric Centres at medical colleges form Tier 4.

Incorrect. Sub-centres and PHCs provide primary-level screening and basic care for the elderly but do not have dedicated geriatric OPD or wards. CHCs provide referral services but not the 10-bedded geriatric ward mandate. District Hospitals carry this responsibility under NPHCE Tier 3.

Correct. MMSE (cognition), GDS-15 (depression), TUG (mobility/falls), and Katz ADL (basic activities of daily living) together constitute a practical, validated community CGA toolkit appropriate for India's PHC setting.

Comprehensive geriatric assessment (CGA) at the community level uses validated, brief tools across four domains: cognition (MMSE), mood (GDS-15), mobility/fall risk (TUG), and functional independence (Katz ADL). This combination is practical for PHC staff and yields actionable care-planning information.

Incorrect. CAGE and AUDIT are alcohol screening tools; PHQ-9 is a depression screen validated mainly in working-age adults; APGAR and Hamilton scales are not standard geriatric community tools. The canonical geriatric toolkit is MMSE + GDS-15 + TUG + Katz ADL.

Correct. Regular weight-bearing exercise and calcium/vitamin D supplementation reduce the risk of developing osteoporosis — acting before the disease occurs. This is primary prevention per Leavell and Clark's model.

Primary prevention acts before disease onset to reduce risk. Weight-bearing exercise and adequate calcium/vitamin D intake prevent osteoporosis before it develops. DEXA screening is secondary prevention (early detection). Surgery is tertiary prevention (limiting disability from established disease).

Incorrect. Cataract surgery and hip replacement address established disease (tertiary prevention). DEXA screening detects disease early (secondary prevention). Only the exercise/calcium intervention acts before disease onset — the hallmark of primary prevention.

Correct. Social isolation independently increases the risk of dementia and cognitive decline in older adults, beyond its well-known association with depression. Cognitive engagement through social relationships is protective.

Social isolation is an independent risk factor for cognitive decline and dementia in the elderly, separate from its association with depression and anxiety. Cognitive stimulation through social interaction is protective; chronic isolation accelerates hippocampal atrophy. This is a key psychosocial determinant of elderly health emphasised in CM12.2.

Incorrect. Social isolation does not accelerate cataracts (UV exposure is the main modifiable risk). Type 1 diabetes is autoimmune with childhood onset. Social isolation is associated with higher (not lower) cardiovascular risk including hypertension. The established independent consequence is increased cognitive decline and dementia risk.

Correct. Lawton-Brody IADL specifically measures complex, instrumental activities needed for independent community living. These require more cognitive and social skill than basic ADLs and are often the first to decline in early dementia.

Katz ADL measures basic (physical) ADLs — bathing, dressing, toileting, transferring, continence, feeding. Lawton-Brody IADL assesses higher-order tasks needed for independent community living: shopping, food preparation, housekeeping, laundry, transportation, medication management, telephone use, and financial management. IADLs decline earlier and predict loss of independence.

Incorrect. Basic self-care tasks (bathing, dressing, toileting) are assessed by the Katz ADL index. Cognitive severity is measured by MMSE/CDR; depression by GDS-15. Lawton-Brody IADL covers complex community-living tasks.

Correct. UN World Population Ageing projections estimate that by 2050, approximately 19-20% of India's population will be aged ≥60 — roughly 300 million people — reflecting the ongoing demographic transition.

India's elderly population is growing rapidly. As of 2021, approximately 10.5% of the population was ≥60. UN projections estimate this will reach ~19-20% by 2050 — approximately 300 million elderly — driven by falling fertility rates and improving life expectancy. This demographic transition underpins the importance of geriatric public health planning.

Incorrect. 5-7% represents India's elderly proportion in the 1970s-1980s. The current figure (~2021) is already ~10.5%. By 2050, projections reach ~19-20%, not 30-35% (which is closer to Japan's current rate).