Understanding Geriatric Syndromes and Delirium

Geriatric Syndrome

Clinical conditions in older persons that do not fit into discrete disease categories.

Examples of Geriatric Syndromes

Delirium, Orthostasis, Falls, Incontinence, Frailty, Dysphagia, Malnutrition, Functional decline, Depression, Sensory deficits, Impaired gait, Osteoporosis, Pressure ulcers, Insomnia, Dementia, Constipation.

Core Features of Delirium

Disturbance in attention and awareness, acute onset (hours to days), fluctuating course, memory impairment, and disorientation.

Subtypes of Delirium

Hyperactive (agitated), hypoactive (subdued), and mixed.

Difference Between Delirium and Dementia

Delirium has an acute onset, fluctuating alertness, and inattention. Dementia has a slow onset and maintains alertness.

Common Caregiver Description Indicating Delirium

"The patient is not himself/herself."

Most Supported Pathophysiologic Theory of Delirium

Neurotransmitter disruption—especially of acetylcholine and dopamine.

Major Risk Factors for Delirium

Age, dementia, acute illness, medication (anticholinergics, sedatives, opioids), infection, surgery, alcohol/psych drug withdrawal.

Percent of ICU Patients Experience Delirium

Up to 80%.

Effective Delirium Prevention Strategies

Orientation protocols, cognitive stimulation, minimizing restraints, early mobilization, sleep hygiene, ensuring hearing/vision aids, hydration.

Assessment to Determine Cause of Delirium

Medication review, history, physical exam, labs for infection, MI, electrolytes, drug levels/screens.

Critical Concern of Falls in Older Adults

They can lead to loss of independence, decreased quality of life, injury, or death.

Epidemiology of Falls in Older Adults

1/3 of community-dwelling and 50-75% of LTC residents fall yearly.

Categories of Fall Risk Factors

1) Patient characteristics, 2) Disorders, 3) Medications, 4) Environmental hazards.

Medications that Increase Fall Risk

Benzodiazepines, sedatives, antipsychotics, antihypertensives, diabetes medications.

Tools Used in Fall Assessment

History, physical exam, "Timed Up and Go" test, gait/balance observation, medication review.

Key Questions in Fall Risk Screening

Have you fallen in the past year? Do you feel unsteady when standing or walking? Do you worry about falling?

Syncope

A transient, self-limited loss of consciousness due to acute global impairment of cerebral blood flow.

Main Types of Syncope

1) Neurally mediated (vasovagal), 2) Orthostatic hypotension, 3) Cardiac syncope.

Physiological Mechanism Preventing Orthostatic Hypotension

Baroreceptor reflex increases sympathetic tone to raise blood pressure on standing.

Causes of Orthostatic Hypotension

Acute: dehydration, MI, sepsis, medications. Chronic: autonomic dysfunction (e.g., Parkinson's), baroreceptor insensitivity.

Orthostatic Hypotension Definition

A drop in SBP ≥ 20 mmHg or DBP ≥ 10 mmHg within 3 minutes of standing.

Symptoms Associated with Orthostatic Hypotension

Dizziness, lightheadedness, blurred vision, weakness, nausea, dyspnea, neck pain, angina.

Prevalence of Orthostatic Hypotension in Older Adults

20% in those ≥65, 30% in those >75, 50% in frail LTC residents.

Hemodynamic Changes Causing Syncope When Standing

Blood pooling in lower extremities → reduced venous return → decreased cardiac output → cerebral hypoperfusion.