--- module: 043-01 language: en chapter: 43 title: "Ageing, Frailty, Polypharmacy, and Geriatric Assessment" module_title: "Foundations" source_sha256: 2ee14ee68c74818ed1a84102ec62f2cf2cd3625ec4dba2c15435bd8f5185fc42 --- # Ageing, frailty, polypharmacy, and geriatric assessment ## Orientation and physiological ageing ### Chronological age does not define reserve #### Disease, inactivity, nutrition, environment set loss ### Cardiovascular stiffness and reliance on atrial filling #### Reduced adrenergic and baroreflex response #### Less exercise reserve, more orthostatic hypotension ### Lungs lose recoil, clearance, cough strength #### Aspiration and infection risk rise ### Normal creatinine can hide low filtration ### Less water and lean mass, more fat #### Water-soluble drugs concentrate, lipid-soluble persist ### Dementia is not normal ageing ## Frailty and sarcopenia ### Vulnerability to stress across systems ### Physical phenotype or accumulated deficits #### Predict falls, delirium, disability, death ### Frailty is dynamic and can improve #### Score must not deny treatment automatically ### Sarcopenia: strength over mass #### Resistance exercise, nutrition, treat causes ## Comprehensive geriatric assessment ### Many domains into one coordinated plan ### Basic then instrumental activities #### Baseline decline as sensitive illness sign ### Observe transfers, gait, footwear, home ### Include caregivers, speak to the patient #### Private conversation detects abuse or coercion ## Atypical illness presentation ### Delirium, falls, immobility, functional decline ### Infection without fever or leukocytosis ### Infarction as breathlessness or confusion ### Do not attribute new symptoms to age #### Modest insults combine into severe delirium ## Delirium, dementia, and depression ### Delirium: acute fluctuating inattention #### Hypoactive form is frequently missed #### Predisposition plus precipitants ### Treat causes, protect senses and sleep #### Antipsychotics do not cure delirium ### Dementia: chronic decline affecting independence ### Depression can mimic or worsen cognition ### Tests affected by education, culture, senses ## Falls and mobility ### Usually multiple causes ### Ask prodrome, consciousness, time on floor ### Lying and standing pressure, gait, feet ### Combined prevention strategies #### Fear-driven inactivity worsens risk ### After a fall: injury and why no recovery #### Anticoagulation lowers head imaging threshold ## Polypharmacy and deprescribing ### Appropriateness over a fixed count ### Prescribing cascade treats adverse effects ### Distribution changes most, renal loss common ### Heightened sensitivity to sedatives, opioids ### Reconcile all products at transitions ### Deprescribe when harm exceeds benefit #### Some drugs need tapering #### Stopping prevention is not abandoning care ## Nutrition, swallowing, and continence ### Weight loss has many causes #### Albumin is not a standalone measure ### Dysphagia risks aspiration and malnutrition #### Texture change trades safety for enjoyment ### Transient versus chronic incontinence #### Catheters create infection and trauma ## Capacity, goals, and advance care ### Decision-specific and time-specific ### Understand, retain, weigh, communicate ### Support communication before judging incapacity #### Unwise choice alone is not incapacity ### Advance directives and appointed decision-makers ### Goals link prognosis to valued outcomes ## Rehabilitation and transitions ### Hospitalisation causes deconditioning ### Restore mobility, meals, senses, sleep early ### Task-specific rehabilitation goals ### Discharge safety depends on function #### Readmission arises from service gaps