Geriatrics

Overview

Geriatrics is commonly referred to as the last general medicine specialty because of its expectations to manage all conditions within the frailty context. 

Patient cohort

Geriatrics is medical specialty which specialises in patients with frailty- functional decline. Geriatric departments are predominantly hospital based with a large inpatient cohort. Geriatricians also run falls clinics and perform inpatient and community comphrensive geriatric assessments. 

Common Geriatric Admission policies

• Age > 65 years or > 75 years

• Evidence of frailty: requires assistance with activities of daily living (ADLs)

• Presentations

  • Falls

  • Not coping @ home, functional decline

  • Poor memory

  • Sepsis

UK Training: 

• Internal medical training: 3 years

• Specialty training: 4 years

  • Subspecialties- Stroke, Rehab

In the UK, the medical stroke services are run by geriatrics, in Australia they are run by the neurologists. 

Physiology & Pathology

Physiology

Body systems: all

Life cycle: over 65 or 75yrs or reduction in ability to perform activities of daily living (ADLs). 

Pathology

Geriatrics is defined as the study of Frailty. Frailty describes the functional decline and loss of physiologic reserve. There is a strong correlation with age however not all elderly individuals are frail and some young individuals are frail (e.g. severe disability, cerebral palsy). Geriatricians generally see only individuals over 65 years who ideally have frailty. 

Geriatrics commonly covers pathologies of old age: 

• Psychiatry: Alzheimer's Disease, Lewy Body Dementia, Frontal Temporal Disease, Anxiety & Depression

• Neurology: Stroke, Parkinson's Disease, Brain Cancer, Motor Neuron Disease 

• Endocrine: HypoThyroidism, HypoNatraemia 

• Cardiology: Congestive Heart Failure (CHF), Ischaemic Heart Disease

• Respiratory: COPD (Chronic Obstructive Pulmonary Disease), Lung Cancer, Pneumonia (including aspiration)

• Gastrointestinal: Colorectal Cancer, Gastroenteritis, GORD, malnutrition

• Urinary: Hypertension (disease), Acute Kidney Injury (AKI), CKD (Chronic Kidney Disease), Urinary Tract Infections (UTI) 

• Reproductive: Benign Prostatic Hypertrophy, Prostate Cancer

• Skin: pressure sores, Cellulitis and Necrotising Fasciitis 

• Musculoskeletal: Osteoporosis, Osteoarthritis, Fractures

• Haematological & Immune: Anaemia, Sepsis, Multiple Myeloma, CLL (Chronic Lymphocytic Leukaemia) 

• End of Year 

Clinical

Presentations

Core

• Not coping at home

• General decline- reduced exercise tolerance, weight loss

• Falls

• Reduction in memory

• Confusion

• Incontinence

• Fevers 

• Constipation

• Dying

Examination

• AE Resus 

• Neurology, Mental State, Cardiovascular, Respiratory, Gastrointestinal, Musculoskeletal

• Capacity Assessments

Investigations

Simple bedside

• ECG ?arrhythmias

Body Samples

• Septic screen: chest, urine, blood cultures

• Regular bloods: full blood count, white cell count, liver function tests, CRP, 

• Geriatric bloods: B12, folate, TSH, blood glucose, calcium-magnesium-phosphate

Imaging

• CT- Head: confusion

• Chest XR ?infection

Management

Comprehensive Geriatric Assessment (MDT)

• • Physio

  • Occupational therapist

  • Dietician

  • Optician

  • Audiometrist

  • Memory clinic

  • Mood- geriatric depression scale

Lifestyle

• Exercise

• Smoking or alcohol cessation

• Befriending service

• Chaplancy

Medications

• Statins

• Anti hypertensives

• Dementia medications: memantine & anticholinergics

• Osteoporosis medications

• Symptomatic relief- laxatives, morphine, diazepam

Procedures

Due to the frailty of this patient cohort, procedures are only performed when the benefits outweigh the risks. Major operations are often not appropriate due to the lack of physiologic reserve required for recovery. 

Common geriatric procedures: 

• Pacemaker

• Endoscopy

• Cystoscopy

Wider

Geriatrics is a holisitic specialty that encompasses everything that is important to an elderly person. These are often non-medical issues that have a significant impact on their quality of life: 

• Relationships & loneliness

• Death, dying & End of Life

• Mobility, falls, eyesight, hearing, 

• Capacity- power of attorney: health & financial

• Finances, pensions & housing

• Carer support & carer burden/ stress

• MDT- physio, OT, dietician, GP, medical specialties (geriatrics), optician, audiologist, 

Written in 2025

Resources and References