IM25.1-22 | Geriatrics — Glossary

Clinical risk stratification tool for 2-day stroke risk after TIA: Age ≥60 + BP ≥140/90 + Clinical features (weakness 2, speech 1) + Duration (≥60 min = 2, 10–59 min = 1) + Diabetes = maximum 7; score ≥4 = moderate/high risk.

Class of drugs (donepezil, rivastigmine, galantamine) that inhibit acetylcholinesterase to increase synaptic acetylcholine; approved for mild-to-moderate Alzheimer dementia and DLB; modest but clinically meaningful cognitive and functional benefit.

Benign tumour of the vestibulocochlear nerve; presents with unilateral progressive SNHL, tinnitus, and vestibular symptoms; excluded by MRI internal auditory meatus in cases of asymmetrical hearing loss.

Six basic self-care tasks (bathing, dressing, toileting, transferring, continence, feeding) assessed by the Katz scale; intact ADL indicates preserved basic physical function.

A legal document specifying a patient's preferences for medical treatment in the event of future incapacity; legally recognised in India following Supreme Court judgment in Common Cause v. Union of India (2018).

Progressive disease of the macula; dry form: drusen + RPE atrophy, managed with AREDS2 supplements; wet form: choroidal neovascularisation causing rapid central vision loss and metamorphopsia — emergency anti-VEGF treatment required.

The principle and goal of supporting elderly individuals to remain in their own homes and communities for as long as safely possible, rather than moving to institutional care; the preferred option for most older adults.

Discrimination or prejudice based on a person's age; in medicine, manifests as withholding beneficial treatment, diagnostic work-up, or ICU/surgical access solely on the basis of chronological age; ethically impermissible — decisions must be based on clinical prognosis and patient values.

The most common dementia (60–70%), characterised by amyloid-β plaques and neurofibrillary tau tangles with progressive hippocampal then neocortical neurodegeneration; presents with insidious memory-first decline; treated with AChEIs and memantine.

The prevailing pathogenetic theory of Alzheimer disease: amyloid-β accumulation (from abnormal APP cleavage) is the initiating event, triggering tau hyperphosphorylation, neuronal dysfunction, synapse loss, and dementia.

A rigid or semi-rigid orthosis supporting the ankle and foot in dorsiflexion; used in foot drop (peroneal nerve palsy, hemiplegia) to prevent toe-drag and improve gait safety and efficiency.

A physiological reduction in appetite and food intake seen in older adults, driven by delayed gastric emptying, increased postprandial cholecystokinin, and altered central satiety signalling; predisposes to PEM and sarcopaenia.

Intravitreal injections of vascular endothelial growth factor inhibitors (ranibizumab, bevacizumab, aflibercept) to suppress choroidal neovascularisation in wet AMD and diabetic macular oedema; stabilises or improves vision in 70–90% of treated cases.

The cumulative anticholinergic effect of all medications taken simultaneously; high burden in elderly patients causes cognitive impairment, constipation, urinary retention, dry mouth, blurred vision, and delirium; first-generation antihistamines, TCAs, and bladder antimuscarinics are high-burden drugs.

High-dose antioxidant vitamins (C, E, zinc, copper, lutein, zeaxanthin) shown in AREDS2 clinical trial to slow progression of intermediate to advanced dry AMD by approximately 25%; does not apply to early AMD or wet AMD.

The presence of bacteria in urine without symptoms of urinary tract infection; common in elderly women (20–50%) and men (5–20%); does NOT require antibiotic treatment except before genitourinary procedures.

Chronic inflammation leading to atrophy of the gastric mucosa, resulting in reduced gastric acid (achlorhydria) and loss of intrinsic factor; affects ~30% of elderly adults; impairs absorption of vitamin B12, iron, calcium, and zinc; a major cause of B12 deficiency in the elderly.

The patient's right to make informed decisions about their own care; in geriatric medicine, takes precedence over beneficence in capacitous patients even when the clinician disagrees with the decision.

Validated 10-item ADL outcome measure (0–100); score >60 predicts home discharge; 20–60 indicates benefit from inpatient rehabilitation; most widely used stroke rehabilitation outcome measure.

American Geriatrics Society list of potentially inappropriate medications in older adults (last updated 2023); covers drugs to avoid, drugs requiring dose reduction, and drug-disease interactions in the elderly.

The ethical duty to act in the patient's best interest; balanced against autonomy when a capacitous patient refuses treatment and against non-maleficence when aggressive treatment causes more harm than benefit.

Burning of wood, dung, crop residue, or charcoal for cooking and heating; a major cause of COPD in Indian women; produces PM2.5, CO, and VOCs causing airway inflammation comparable to tobacco smoke.

Class of antiresorptive drugs incorporated into bone matrix; ingested by osteoclasts during resorption, inhibiting mevalonate pathway → osteoclast apoptosis → reduced bone resorption; first-line osteoporosis treatment; oral agents (alendronate, risedronate) must be taken fasting with water, upright for 30 minutes.

Neuromuscular blocking agent injected into specific spastic muscles; inhibits acetylcholine release at the neuromuscular junction; reduces focal spasticity for 12–16 weeks; enables physiotherapy; repeatable.

A spectrum of non-cognitive symptoms occurring in up to 90% of dementia patients over the illness course: agitation, aggression, psychosis (hallucinations, delusions), depression, apathy, wandering; managed non-pharmacologically first.

Stroke caused by embolism from an intracardiac source, most commonly left atrial appendage thrombus in atrial fibrillation; characterised by sudden maximum-deficit onset, cortical distribution, haemorrhagic transformation risk; secondary prevention requires anticoagulation.

The physical, emotional, social, and financial strain experienced by informal caregivers (typically family members) of elderly or disabled individuals; assessed with the Zarit Caregiver Burden Interview; unrecognised caregiver burden is a risk factor for elder abuse and inadequate care.

Surgical removal of carotid plaque in symptomatic carotid stenosis ≥70%; reduces 5-year ipsilateral stroke risk by approximately 50% (NNT=6 for 70–99% stenosis); should be performed within 2 weeks of index event for maximum benefit.

Opacity of the crystalline lens causing painless, gradual vision loss; most common cause of reversible blindness worldwide; treated by phacoemulsification and intraocular lens implantation; free under India's NPCB+VI programme.

Amyloid-β deposition in cortical and leptomeningeal blood vessels; causes lobar intracerebral haemorrhage (typically elderly); associated with Alzheimer pathology; anticoagulation carries high rebleeding risk.

Rapidly developing focal or global disturbance of cerebral function lasting >24 hours due to vascular cause; classified as ischaemic (80–85%) or haemorrhagic (15–20%).

Stroke risk stratification tool in atrial fibrillation: congestive heart failure, hypertension, age ≥75 (2 pts), diabetes, stroke/TIA (2 pts), vascular disease, age 65–74, sex female; score ≥2 in men / ≥3 in women = anticoagulation recommended.

A validated comorbidity scoring tool assigning weights to 17 conditions (myocardial infarction, diabetes, renal disease, malignancy, etc.) to generate a score predicting 10-year mortality; used in geriatric medical assessment.

Supreme Court of India judgment upholding the right to die with dignity and the right to refuse treatment via advance directives; established the legal mechanism for executing, registering (with the local Collector), and implementing living wills through a Medical Board process.

A multidimensional, interdisciplinary diagnostic process evaluating the medical, functional, cognitive, psychological, and social needs of elderly patients, resulting in an integrated, prioritised care plan.

Hearing loss from outer or middle ear pathology (wax, otosclerosis, CSOM); audiometrically: air conduction worse than bone conduction; Rinne test: bone > air (negative = conductive); Weber: lateralises to worse ear.

Validated delirium screening tool; positive when features 1 (acute onset + fluctuating course) and 2 (inattention) are present, plus either feature 3 (disorganised thinking) or 4 (altered consciousness); sensitivity 94%, specificity 89%.

Rehabilitation technique for upper limb hemiparesis: constraining the unaffected arm forces repetitive use of the paretic arm, driving neuroplasticity and motor recovery; most effective when the paretic arm has wrist extension ≥20° and finger extension ≥10°.

Progressive, preventable, and treatable disease characterised by persistent airflow limitation (post-bronchodilator FEV₁/FVC <0.70) due to airway and/or alveolar abnormalities from noxious particle/gas exposure; the third leading cause of death globally.

An acute neuropsychiatric syndrome characterised by acute onset, fluctuating course, inattention, and disorganised thinking or altered consciousness; diagnosed clinically using the Confusion Assessment Method (CAM); reversible with treatment of the underlying cause.

A monoclonal antibody targeting RANKL; inhibits osteoclast formation, function, and survival; administered 60 mg SC every 6 months; suitable in CKD where bisphosphonates are contraindicated; do not stop abruptly — rebound vertebral fracture risk.

Electronic device amplifying and processing sound for patients with hearing loss; modern digital aids selectively amplify affected frequencies, reduce background noise, and provide Bluetooth connectivity; bilateral fitting preferred for presbycusis; associated with reduced dementia risk when used consistently.

Class of anticoagulants (apixaban, rivaroxaban, dabigatran, edoxaban) preferred over warfarin in non-valvular AF for stroke prevention; equal or superior efficacy, lower intracranial haemorrhage risk, no routine INR monitoring; contraindicated in mechanical heart valve and rheumatic mitral stenosis.

Home-based care services for elderly individuals including home health aides, nursing visits, physiotherapy, meals delivery, and telehealth; designed to support ageing-in-place and are the first tier of social intervention.

Elder Abuse Suspicion Index; a validated 6-item clinical screening tool that can be administered in a consultation to identify patients at risk of or experiencing elder abuse; suitable for primary care and outpatient settings.

Any single or repeated act, or lack of appropriate action, within a relationship where there is an expectation of trust that causes harm or distress to an older person; includes physical, psychological, financial, sexual, neglect, and abandonment forms.

Evidence-based perioperative care bundle reducing hospital stay by 1–3 days and complication rates by 30–50%: pre-operative carbohydrate loading, minimal fasting, regional anaesthesia, early feeding within 24 hours, and early mobilisation day 1.

European Working Group on Sarcopaenia in Older People (2019 revision); defines sarcopaenia diagnosis criteria: probable sarcopaenia = low grip strength; confirmed sarcopaenia = low strength + low muscle mass; severe sarcopaenia = all three criteria plus low physical performance (gait speed <0.8 m/s or SPPB ≤8).

The most prevalent form of elder abuse in India; involves theft, misappropriation, or misuse of an elderly person's money, property, or assets, often by family members or caregivers; addressed by the Maintenance and Welfare of Parents and Senior Citizens Act 2007.

Hip fracture surgery within 48 hours of hospital admission; delays >48 hours are associated with increased mortality, pain, delirium, pressure ulcer incidence, and hospital-acquired pneumonia.

Any fracture resulting from a fall from standing height or less (a force insufficient to fracture normal bone); diagnostic of osteoporosis regardless of DEXA result; the most important clinical trigger for bone protection therapy.

A clinical syndrome of decreased reserve and resistance to stressors resulting from cumulative physiological decline; defined by the Fried phenotype as meeting ≥3 of 5 criteria: weight loss, exhaustion, weakness, slow gait speed, low physical activity.

The integration of frailty assessment (CFS or Fried phenotype) into surgical decision-making: frailty predicts post-operative mortality, delirium, and failure to return home; frail patients require prehabilitation for elective surgery and enhanced post-operative monitoring and rehabilitation.

WHO Fracture Risk Assessment Tool; estimates 10-year probability of hip fracture and major osteoporotic fracture based on clinical risk factors (with or without BMD); guides treatment decisions in osteopenia.

A dementia syndrome typically presenting at 50–65 years with prominent behavioural change (disinhibition, loss of empathy, compulsive behaviour) preceding or overshadowing memory impairment; AChEIs are not beneficial.

18-item comprehensive rehabilitation outcome measure (18–126) covering self-care, sphincter control, transfer, locomotion, communication, and social cognition; more sensitive than Barthel to rehabilitation change.

A validated depression screening tool designed for the elderly that avoids somatic items overlapping with physical illness; 15-item short version score ≥5 indicates probable depression.

The four common clinical syndromes through which most serious illness manifests in the elderly (coined by Bernard Isaacs, 1965): immobility, instability (falls), incontinence, and intellectual impairment (delirium and dementia).

The branch of internal medicine focused on health care of elderly individuals (aged ≥60 years in India/WHO developing-country definition), with emphasis on multimorbidity, functional status, and holistic patient-centred care.

The systematic, goal-directed, evidence-based process of restoring functional independence in elderly patients following disease, injury, or surgery, delivered by an interdisciplinary team and guided by validated outcome measures.

The most common secondary cause of osteoporosis; prednisolone ≥5 mg/day for ≥3 months is sufficient to cause significant BMD loss; bone protection therapy (bisphosphonate or denosumab) should be co-prescribed from the outset of glucocorticoid therapy in elderly patients.

A structured clinical encounter with a patient and/or their surrogate to clarify the patient's values and preferences, align these with medically appropriate options, and agree on a care plan; uses frameworks such as SPIKES; particularly important in geriatric and end-of-life care.

Global Initiative for COPD spirometric grading: GOLD 1 (FEV₁ ≥80%), GOLD 2 (50–79%), GOLD 3 (30–49%), GOLD 4 (<30%) — all with confirmed airflow obstruction (FEV₁/FVC <0.70); combined with symptom and exacerbation risk for ABE grouping.

Measured by a handgrip dynamometer; a surrogate for overall muscle strength and nutritional status; <27 kg in men and <16 kg in women indicates probable sarcopaenia; independently predicts hospital complications, prolonged ICU stay, and mortality.

Bony enlargements at DIP (Heberden's) and PIP (Bouchard's) joints respectively, from osteophytic overgrowth in hand OA; hard, non-tender in established disease; may be warm/tender in early/active phase.

Substitution of LMWH for warfarin in the peri-operative period when warfarin is held; indicated in patients with high thromboembolic risk (e.g., mechanical valve, recent VTE, high CHA₂DS₂-VASc AF); LMWH started when INR falls below therapeutic range and stopped 24 hours before surgery.

The progressive narrowing of physiological homeostatic reserve with ageing, meaning the elderly person can maintain normal function at rest but decompensates more readily and severely when stressed by illness, drugs, or environmental challenge.

Evidence-based multicomponent intervention reducing delirium incidence by approximately 30% in hospitalised elderly; components include reorientation, sleep hygiene, early mobilisation, vision/hearing correction, and oral hydration.

The most common and most frequently missed subtype of delirium; characterised by excessive somnolence, withdrawal, and reduced responsiveness; often misattributed to depression or post-operative fatigue.

Serum albumin <3.5 g/dL; reflects both chronic protein depletion and acute-phase response (albumin is a negative acute-phase reactant); each unit decrease below 3.5 g/dL is associated with ~30% increased hospital mortality; should be interpreted alongside CRP.

Indira Gandhi National Old Age Pension Scheme; provides monthly pension to BPL elderly aged 60 and above (₹200/month for ages 60–79, ₹500/month for ages ≥80); a key state social intervention for destitute elderly in India.

Age-related decline in immune function characterised by thymic involution, reduced naive T-cell output, and diminished vaccine responsiveness, increasing susceptibility to infections and malignancy.

Device-based respiratory exercise promoting sustained maximal inspiration to expand alveoli and prevent post-operative atelectasis; used as prophylaxis in elderly surgical patients, particularly with pre-existing lung disease.

The low-grade chronic inflammatory state characteristic of ageing, characterised by elevated circulating IL-6, TNF-α, and CRP; drives muscle protein catabolism via the ubiquitin-proteasome pathway, contributing to sarcopaenia even when caloric intake appears adequate.

Chronic, low-grade sterile systemic inflammation characteristic of the aged organism, driven by senescent cell SASP and underlying atherosclerosis, Alzheimer disease, type 2 diabetes, and sarcopenia.

Eight higher-order daily living tasks (telephone use, shopping, food preparation, housekeeping, laundry, transport, medication management, finances) assessed by the Lawton scale; IADLs are lost before ADLs in most progressive conditions.

The zone of brain tissue surrounding the dense ischaemic core that is ischaemic but not yet infarcted; has residual perfusion below the functional threshold but above the cell-death threshold; the therapeutic target for reperfusion.

Recombinant tissue plasminogen activator; the standard reperfusion therapy for ischaemic stroke within 4.5 hours of symptom onset; dose 0.9 mg/kg (max 90 mg), 10% bolus then 90-min infusion; contraindicated if haemorrhage on CT, INR therapeutic, or recent major surgery.

The ethical duty of fair distribution of resources and equitable treatment; in geriatric medicine requires that clinical decisions be based on prognosis and benefit rather than age alone; prohibits ageism in resource allocation.

Occlusion of a major intracranial artery (typically MCA, ICA terminus, or basilar); identified on CT angiography; the target lesion for mechanical thrombectomy; causes large territorial infarction if not recanalised.

The minimum amount of the branched-chain amino acid leucine required per meal to initiate muscle protein synthesis; approximately 2.5 g in young adults but 3–4 g in the elderly (anabolic resistance); leucine-enriched protein supplements may help overcome this threshold in sarcopaenic patients.

Dementia characterised by fluctuating cognition, recurrent well-formed visual hallucinations, and spontaneous parkinsonism within 12 months of cognitive onset; neuroleptic sensitivity is a defining and potentially fatal feature — typical antipsychotics and risperidone must be avoided.

Supplemental oxygen ≥15 hours/day in severe COPD (PaO₂ ≤55 mmHg at rest) or PaO₂ 56–59 with cor pulmonale; proven survival benefit in NOTT and MRC trials; target SpO₂ 88–92% in CO₂ retainers.

Mnemonic for X-ray features of osteoarthritis: Loss of joint space (cartilage loss), Osteophytes, Subchondral Sclerosis, Subchondral cysts.

MacArthur Competence Assessment Tool for Treatment; a structured bedside clinical tool for assessing capacity comprising four domains: understanding, appreciation, reasoning, and expression of choice; used to determine whether a patient can give valid informed consent.

Indian law creating a legal obligation on children and heirs to maintain elderly parents and senior citizens; provides for maintenance tribunals that can order up to ₹10,000/month; mandates old-age homes in every district for BPL elderly.

DSM-5 term for dementia: significant cognitive decline in one or more domains, documented by neuropsychological testing, with functional impairment in daily activities, not occurring exclusively during delirium.

Endovascular mechanical removal of thrombus from large vessel occlusion (MCA, basilar) using stent retriever or aspiration catheter; within 24 hours of onset in selected patients; NNT 2.6 for functional independence at 3 months.

An NMDA receptor antagonist approved for moderate-to-severe Alzheimer dementia (MMSE <20); can be combined with AChEI; provides modest benefit in cognition and function.

The ability to understand, retain, weigh, and communicate information relevant to a specific decision; presumed present unless demonstrated otherwise; assessed using structured tools such as the MacCAT-T; decision-specific and time-specific.

The perception of straight lines as wavy or distorted; the cardinal symptom of wet AMD (choroidal neovascularisation causing macular distortion); detected by Amsler grid; indication for urgent vitreoretinal referral.

Anthropometric measurement of the mid-upper arm used as a surrogate for muscle mass and nutritional status; <22 cm in women and <23 cm in men indicates significant muscle depletion; useful for bedbound patients where accurate weight measurement is unavailable.

The most widely validated nutritional screening and assessment tool for elderly patients; the MNA-SF (6-item short form) screens for nutritional risk: 12–14 = normal nutritional status, 8–11 = at risk, 0–7 = malnourished; recommended for all hospitalised elderly patients.

A 30-point validated cognitive screening instrument assessing orientation, registration, attention, recall, language, and visuospatial ability; scores 24–30 = normal, 18–23 = mild impairment, 0–17 = severe impairment.

7-point global disability scale (0 = no symptoms to 6 = death); mRS ≤2 at 3 months post-stroke = good functional outcome; used in clinical trials as primary stroke outcome measure.

A 30-point cognitive screening tool more sensitive than MMSE for mild cognitive impairment; adds visuospatial, executive function, and verbal fluency domains; score <26 is the standard MCI cutoff.

India's policy framework (1999, revised 2011) governing health care, social security, and welfare provisions for older persons; coordinates geriatric care services across central and state government.

A severe adverse reaction to antipsychotics (especially typicals and risperidone) in Lewy body dementia; characterised by acute parkinsonism, profound sedation, confusion, and potential neuroleptic malignant syndrome; has approximately 50% mortality in severe cases.

The brain's capacity to reorganise neural connections in response to experience, training, and injury; the physiological basis of motor and cognitive recovery after stroke and the rationale for intensive task-specific rehabilitation.

Positive pressure ventilation via face mask; indicated in COPD exacerbation with type 2 respiratory failure and acidosis (pH <7.35); reduces intubation rates and in-hospital mortality; target pH improvement within 1–2 hours.

The ethical duty to avoid causing harm; in geriatric medicine includes avoiding polypharmacy (using Beers and STOPP-START criteria), avoiding futile treatment, and avoiding ageist withholding of beneficial care.

A reversible cause of cognitive impairment characterised by the triad: gait ataxia (magnetic/apraxic gait), urinary incontinence, and cognitive impairment; treated by ventriculoperitoneal (VP) shunting.

Allied health discipline enabling patients to perform meaningful occupations (tasks, roles) through ADL retraining, assistive technology, and home modification; essential for safe discharge planning and maintaining functional independence in the community.

Commercially available protein-energy formulations providing 300–600 kcal/day in addition to regular diet; recommended by ESPEN for malnourished elderly (MNA-SF ≤11); protein target 1.2–1.5 g/kg/day; leucine-enriched formulations may specifically benefit sarcopaenia.

Fall in systolic BP ≥20 mmHg or diastolic ≥10 mmHg within 3 minutes of standing; common in elderly on antihypertensives or with autonomic neuropathy; a major falls risk factor; identified by lying-standing BP measurement.

Most common joint disease; progressive loss of articular cartilage with subchondral bone remodelling, osteophyte formation, and synovial inflammation; predominantly affects knee, hip, hands, and spine in elderly; not primarily inflammatory but has secondary synovitis.

WHO: systemic skeletal disease characterised by low bone mass and microarchitectural deterioration; DEXA T-score ≤−2.5; predisposes to fragility fractures.

Individually prescribed home exercise programme for fall prevention in elderly: 17 leg-strengthening and balance exercises with graduated difficulty; demonstrated 35% reduction in falls and falls-related injuries in community-dwelling elderly.

An endoscopically placed tube through the abdominal wall into the stomach used for long-term enteral feeding (>4 weeks) when oral intake is impossible; indicated for persistent dysphagia (e.g., post-stroke, MND); the decision to place PEG in advanced dementia requires a goals-of-care discussion as evidence does not show survival or quality-of-life benefit.

The practice of allowing blood pressure up to 220/120 mmHg in ischaemic stroke not treated with reperfusion, to maintain cerebral perfusion pressure in the penumbra where autoregulation is impaired; aggressive BP lowering in this setting extends infarct size.

Allied health discipline addressing impairments and activity limitations through exercise, manual therapy, respiratory interventions, and movement training; in geriatric rehabilitation focuses on gait, balance, strength, and respiratory function.

The concurrent use of five or more medications; associated with drug-drug interactions, adverse drug events, falls, and cognitive impairment in the elderly.

Acute confusional state in the post-operative period; occurs in 15–25% of elderly general surgical patients and up to 50% after hip fracture surgery; prevented by the HELP bundle; independently associated with prolonged hospital stay, cognitive decline, and mortality.

Major depressive disorder occurring in 30–40% of stroke survivors; associated with worse functional outcome and increased mortality; responds to SSRI therapy (fluoxetine, citalopram have most evidence); should be actively screened for at follow-up visits.

Major depressive disorder occurring in 30–40% of stroke survivors; a major barrier to rehabilitation engagement and outcome; treated with SSRI (fluoxetine 20 mg has best evidence from FLAME trial for both mood and motor recovery).

Age-related bilateral, symmetrical, progressive sensorineural hearing loss predominantly affecting high frequencies (consonants first — speech intelligibility); the most common cause of hearing loss in the elderly; managed with bilateral digital hearing aids.

Age-related loss of accommodation due to hardening of the crystalline lens; causes near vision difficulty; universal from age 50; corrected with reading glasses (convex lenses).

Progressive optic nerve damage from elevated intraocular pressure; characterised by insidious peripheral visual field loss (arcuate scotomata) and optic disc cupping; asymptomatic until advanced; first-line treatment is topical prostaglandin analogues (latanoprost).

A state of nutritional deficiency characterised by inadequate intake or utilisation of protein and energy; in elderly patients presents as unintentional weight loss, muscle wasting, weakness, hypoalbuminaemia, impaired immunity, and poor wound healing.

Apparent cognitive impairment caused by severe depression; distinguished from true dementia by: patient complaining of memory problems (rather than minimising), mood change preceding cognitive symptoms, and cognitive improvement with antidepressant treatment.

Supervised multimodal programme of exercise training (aerobic + strength), education, and psychological support for COPD patients from GOLD 2 onwards; increases 6-minute walk distance by mean 43 metres; most effective non-pharmacological COPD intervention.

Graphical representation of hearing thresholds (dB) at each frequency (250–8000 Hz) for each ear; air and bone conduction plotted separately; presbycusis shows bilateral downward-sloping high-frequency loss; 4 kHz notch indicates noise-induced hearing loss.

A potentially fatal complication of initiating nutritional support in severely malnourished patients; characterised by severe hypophosphataemia (with cardiac, respiratory, and neurological failure), hypokalaemia, and hypomagnesaemia due to insulin-driven intracellular electrolyte shifts; prevented by starting nutrition at 50% (10 kcal/kg/day) and supplementing thiamine and electrolytes.

Six-point scoring tool for major adverse cardiac events in non-cardiac surgery: high-risk surgery, ischaemic heart disease, heart failure, cerebrovascular disease, insulin-dependent diabetes, creatinine >2 mg/dL; ≥3 points = >11% MACE risk.

Age-related progressive loss of skeletal muscle mass, strength, and physical performance; defined by EWGSOP2 as probable sarcopaenia (low grip strength alone), confirmed sarcopaenia (low strength + low mass), or severe sarcopaenia (all three + low physical performance); independently predicts falls, disability, hospitalisation, and mortality.

Age-related progressive loss of skeletal muscle mass and strength; contributes to falls, functional decline, frailty, and metabolic dysfunction; a component of the Fried frailty phenotype.

Vitamin C (ascorbic acid) deficiency; characterised by perifollicular haemorrhages (pathognomonic — corkscrew hairs with surrounding petechiae), gingival bleeding and hypertrophy, poor wound healing, and subperiosteal haemorrhages causing bone pain; treated with vitamin C 500–1000 mg/day.

Hearing loss from cochlear hair cell or auditory nerve damage; audiometrically: bone conduction thresholds elevated equally to air conduction; Rinne test: air > bone (positive); Weber: lateralises to better ear.

Objective lack of social contact and/or subjective experience of loneliness in an older adult; strongly associated with increased all-cause mortality, cognitive decline, depression, and delayed healthcare presentation.

Velocity-dependent increase in muscle tone after upper motor neuron injury (stroke, spinal cord injury); develops weeks after the acute event; treated with physiotherapy, splinting, botulinum toxin type A injections (focal), and oral baclofen (generalised).

Validated evidence-based screening tools for identifying potentially inappropriate medications (STOPP) and potentially omitted medications (START) in elderly patients; version 2 lists 87 STOPP and 34 START criteria.

Demyelination of the posterior columns (loss of vibration sense and proprioception) and lateral corticospinal tracts (spastic weakness) of the spinal cord, caused by vitamin B12 deficiency; may also cause peripheral neuropathy and reversible cognitive impairment; treated with parenteral hydroxocobalamin.

Supplemental hydrocortisone IV given to patients on chronic glucocorticoid therapy during surgery to prevent adrenal crisis from HPA axis suppression: 50–100 mg IV 8-hourly for major surgery, tapering to baseline over 24–48 hours post-operatively.

DEXA bone mineral density expressed as standard deviations from the mean peak bone mass of a young healthy adult; T-score ≤−2.5 = osteoporosis; −1.0 to −2.5 = osteopenia; ≥−1.0 = normal.

Recombinant PTH 1-34; anabolic agent stimulating bone formation; 20 mcg SC daily; indicated for severe osteoporosis with multiple fractures or inadequate antiresorptive response; maximum 24 months.

A validated fall-risk assessment: patient rises from a standard chair, walks 3 metres, turns, walks back, and sits; normal <12 seconds; >14 seconds indicates significant fall risk in community-dwelling elderly.

Surgical replacement of all three compartments of the knee joint (medial, lateral, patellofemoral); the most effective intervention for end-stage knee OA with pain and functional impairment; not contraindicated by age alone.

Brief episode of neurological dysfunction from focal brain ischaemia, symptoms typically <1 hour, without evidence of acute infarction on DWI-MRI; a neurological emergency with 10–15% risk of stroke within 90 days.

Respiratory failure characterised by both hypoxia (PaO₂ <8 kPa) AND hypercapnia (PaCO₂ >6 kPa); indicates ventilatory pump failure; common in severe COPD exacerbation; treated with controlled oxygen (target SpO₂ 88–92%) and NIV.

Serum 25-hydroxyvitamin D <20 ng/mL; in the elderly causes proximal myopathy (fall risk), osteomalacia (bone pain, Looser zones, fractures), and exacerbates sarcopaenia; treated with cholecalciferol 800–2000 IU/day maintenance, or loading doses for severe deficiency.

Stroke of the posterior inferior cerebellar artery (PICA) or vertebral artery supplying the lateral medulla; characterised by ipsilateral Horner syndrome, facial pain/numbness, cerebellar ataxia, palatal/pharyngeal palsy, and contralateral loss of pain/temperature in the limbs.

Acute neurological emergency caused by thiamine (vitamin B1) deficiency; characterised by the classic triad of ophthalmoplegia, ataxia, and confusion; treated with IV thiamine 200–300 mg before any glucose administration; occurs in severely malnourished or alcohol-dependent elderly patients.