Chapter 16: Geriatrics

A cornerstone of geriatric care is the comprehensive geriatric assessment, which evaluates cognitive function, physical capabilities, psychological well-being, nutritional status, and socioeconomic circumstances through standardized tools that measure both activities of daily living and instrumental activities of daily living, while also assessing functional abilities such as driving competence. Prevention and health maintenance in older adults require personalized approaches, as the effectiveness of preventive interventions varies; recommended vaccinations include tetanus-diphtheria-acellular pertussis, pneumococcal vaccines, and herpes zoster immunization. Pharmacological management in elderly patients demands heightened vigilance because aging alters how medications are absorbed, distributed, metabolized, and eliminated, significantly increasing vulnerability to adverse drug events, which account for a substantial proportion of hospital admissions in this population. When older adults are hospitalized, they face particular risks including delirium, a medical emergency characterized by acute cognitive changes, as well as iatrogenic complications; rehabilitation pathways vary and may include acute rehabilitation facilities, long-term care settings, outpatient programs, or home-based services. The chapter emphasizes that common geriatric syndromes such as immobility, falls, and incontinence are not inevitable consequences of aging but rather require systematic evaluation and intervention; additional prevalent concerns include sensory impairments, malnutrition, pressure injuries, and vertebral fractures. Palliative care principles become central when curative treatment is no longer appropriate, requiring careful pain management and symptom control. Finally, the chapter addresses legal and ethical considerations, including the distinction between legal competence and medical decision capacity, as well as the critical responsibility to recognize and report elder mistreatment.