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