IM25.{1-2,18} | Geriatric Foundations and Assessment — Summary & Reflection

KEY TAKEAWAYS

Geriatric medicine addresses the health of individuals aged ≥60 years (WHO developing-country threshold). India has 103 million elderly (LASI 2017–18), projected to 300 million by 2050 — the demographic transition is urgent and already underway.

Key epidemiological principles:
- Multimorbidity (≥2 chronic conditions) is the norm in elderly Indians (40%)
- Atypical disease presentation is universal — silent MI, confusion as UTI presentation, apathetic thyrotoxicosis
- The geriatric giants (Isaacs 1965): immobility, instability/falls, incontinence, intellectual impairment — the common clinical syndromes through which disease manifests in the elderly
- Frailty (Fried criteria: weight loss, exhaustion, weakness, slow gait, low activity — ≥3 of 5 = frail) is a distinct syndrome predicting adverse outcomes

Pathophysiology: homeostenosis (reduced reserve), inflammaging, sarcopenia, immunosenescence; GFR declines with age but creatinine may appear normal — ALWAYS dose drugs by calculated eGFR

Comprehensive Geriatric Assessment (CGA) — 5 domains:
1. Medical (Charlson CCI, medication reconciliation)
2. Functional (ADL/Katz, IADL/Lawton)
3. Cognitive (MMSE 24–30 normal; MoCA <26 = MCI)
4. Psychological (GDS ≥5 = probable depression)
5. Social/environmental + Frailty (CFS 1–9)

Management principles: polypharmacy review (STOPP/START Beers criteria); fall prevention (TUG test; multifactorial intervention); early rehabilitation; goals of care/advance care planning (Indian Supreme Court 2018 — advance directives valid); caregiver support

REFLECT

Return to Krishnamurthy from the opening hook — the 80-year-old with hypertension, diabetes, osteoarthritis, falls, confusion, and poor appetite on eight medications from multiple specialists. Having completed this module, you now have a framework to transform that list of problems into an action plan. Which CGA domain would you address first, and why? Consider the role of medication reconciliation — could polypharmacy explain his falls, confusion, and poor appetite simultaneously? And consider the demographic context: if 40% of your future clinical practice will involve patients like Krishnamurthy, how does a single-disease-guideline approach fail him — and what does the CGA framework offer instead? Reflect on what it means to care for a person rather than a list of diagnoses.