Chapter 82: Primary Care of Older Adults

Understanding normal aging as a heterogeneous biological process requires familiarity with competing theoretical frameworks, including evolutionary and physiological models that explain cellular senescence and the progressive loss of physiological reserve. Age-related changes occur systematically across body systems, including the integumentary, respiratory, cardiovascular, and gastrointestinal systems, and these changes necessitate adjustment of standard laboratory reference ranges for clinical interpretation. The clinical assessment of older adults demands a comprehensive approach that extends beyond chronological age, incorporating tools such as the Annual Wellness Visit and geriatric screening instruments that evaluate cognitive status, functional capacity, nutritional adequacy, sensory abilities, and mood. Older adults frequently present with atypical or minimally specific symptoms that obscure underlying acute conditions, requiring heightened clinical vigilance. The chapter emphasizes health promotion strategies tailored to individual preferences and functional status rather than generic recommendations. Geriatric syndromes represent common multifactorial conditions such as falls, delirium, incontinence, and malnutrition that significantly impair quality of life and require systematic identification using validated assessment tools. Medication management becomes increasingly complex due to polypharmacy and age-related alterations in pharmacokinetics and pharmacodynamics, making evidence-based deprescribing strategies essential. The chapter addresses special populations including those aging in place, LGBTQ older adults experiencing accumulated health disparities, and those experiencing social isolation with its documented negative health consequences. Throughout, the emphasis remains on maintaining functional independence, preserving dignity, and supporting individual autonomy while managing multiple chronic conditions simultaneously.