Chapter 27: Older Adult

Older Adult distinguishes between primary aging, which involves the inevitable decline of physiological reserves, and secondary changes resulting from disease or lifestyle. A cornerstone of geriatric medicine is the recognition of geriatric syndromes, which are multifactorial conditions such as frailty, falls, urinary incontinence, and cognitive impairment that arise from the interplay of age-related vulnerabilities and acute stressors. The text details systemic physiological shifts, including increased systolic blood pressure, decreased maximum heart rate, reduced lung elasticity, and sarcopenia, the loss of lean muscle mass. Sensory changes are highlighted, such as presbyopia and presbycusis, alongside the importance of distinguishing benign memory lapses from the "3 Ds": delirium, dementia, and depression. The clinical encounter is reimagined to prioritize effective communication, adjusting the environment for sensory deficits, and utilizing validated tools like the 10-Minute Geriatric Screener. Assessment focuses heavily on functional status, evaluating a patient’s ability to perform Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). Furthermore, the chapter emphasizes medication safety through the Beers Criteria to prevent polypharmacy and adverse drug events. Health promotion is individualized, moving away from strict age-based cutoffs for cancer screenings toward decisions based on life expectancy and personal values. Finally, the chapter addresses the necessity of advance care planning, including durable power of attorney and palliative care, to ensure that medical interventions align with the patient's goals and dignity.