Geriatric Syndromes
Managing an increasing number of interrelated conditions calls for recognizing the symptom clusters of different geriatric syndromes. A geriatric syndrome is "a multifactorial condition that involves the interaction between identifiable situation-specific stressors and underlying age-related risk factors, resulting in damage across multiple organ systems," as shown in Figure 1. These syndromes are strongly linked to functional decline. Examples include dizziness as well as functional impairment, frailty, delirium, depression, cognitive impairment, falls, and urinary incontinence.
FIGURE 21. Geriatric syndromes.
Experts state that "evaluating functional status, frailty, and other geriatric syndromes while simultaneously addressing individual disease processes is at the heart of geriatric approach to primary care." It is especially important to recognize these syndromes because symptoms may cluster in patterns unfamiliar to the patient.
Cognitive Impairment.
A number of parameters affects assessment of health status; however, evidence suggests that self-report continues to be reliable in older adults, especially for prevalence of chronic conditions.30–34 When compared with healthy peers, older adults with mild cognitive impairment provide sufficient history to reveal concurrent disorders. Use simple sentences with prompts to elicit necessary information. For patients with more severe impairments, confirm key symptoms with family members or caregivers in the patient's presence and with his or her consent. To avoid invalid assumptions, explore how older patients view themselves and their situations. Listen for their priorities and coping skills. These insights strengthen your partnerships with both patients and families as you evolve plans for care and treatment.
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