Geriatric Syndromes and Frailty
Introduction
There are basic physiologic changes that occur in the human body beyond age 65. Aging is marked by a loss of complexity of systems; cells are replaced more slowly and less effectively, resulting in a reduced ability to maintain homeostasis in variable circumstances. There is a loss of reserve that is present in youth—both physical and mental—to address the stresses of life and illness.
The term geriatric syndrome
is used to capture those clinical conditions in older persons that are common, but do not fit into discrete disease categories. Geriatric syndromes differ from similar groups of signs and symptoms in younger individuals because the person exhibiting them carries four risk factors: older age, baseline cognitive impairment, baseline functional impairment, and impaired mobility.
If a patient is older and has baseline cognitive, functional, or mobility limitations, they are already using up reserve physical and mental energy to maintain homeostasis in day-to-day life. This set of circumstances might be described as prefrail (see the section Frailty
). The development or progression of a geriatric syndrome in a person who is prefrail may suggest a tipping point has been reached that could result in a devastating outcome.
A growing body of research shows geriatric syndromes are independently associated with an increased risk of adverse outcomes like hospital admission, institutionalization, and mortality. In one study, 55% of hospitalized adults who required a skilled nursing facility (SNF) stay met criteria for three or more coexisting syndromes (Bell et al., 2016). The presence of three or more syndromes predicts poor outcomes and yet the syndromes are commonly missed by hospital clinicians who are focused on the single acute issue that precipitated the hospital stay.
By communicating new or worsening geriatric syndromes to other providers along the continuum of care, beginning early interventions designed to prevent progression toward a catastrophic event, and educating families regarding prevention strategies to use at home, nurse practitioners (NPs) may significantly improve outcomes for older adults. To do this, NPs must be aware of geriatric syndromes and be able to track them in a consistent, evidence-based manner.
It is the purpose of this section to offer awareness of geriatric syndromes and tools for practitioners to use to monitor them in older adults. We focus on eight geriatric syndromes: incontinence, falls, delirium/altered mental status (AMS), weight loss, depression, pain, dementia, and impairment in activity of daily living (ADL) or instrumental activity of daily living (IADL).