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Geriatrics Overview

Thomas Horton

4 M’s of Age-Friendly Care

Endorsed by the IHI to provide best evidence-based care to older patients across all settings of care:

  • What **M**atters Most: Understand each patients specific healthcare goals in the short and long term. Ask “what matters most” and align the care plan with what matters.
  • **M**edication: Aim to reduce adverse drug events in the elderly by thorough med rec and avoiding potentially inappropriate medications (e.g. Beers Criteria) when possible
  • **M**entation: Identify, treat, and manage dementia, depression, and delirium across various settings of care.
  • **M**obility: Assess and optimize mobility

Vanderbilt’s FACETS Inpatient Geriatrics Curriculum:

Physiological Changes with Aging

  • Cardiovascular: Decreased vascular compliance and increased stiffness (intimal thickening). Decreased cardiac output. Maximum achievable HR decreases. Increase in systolic BP with decrease in diastolic BP (wider PP).
  • Endocrine/Immune: Impairment of glucose tolerance (insulin resistance). Decreased sympathetic response to stress. Impairment of T-cell immunity and increased susceptibility to infection.
  • Gastrointestinal: Decreased GI absorption, gastric emptying, motility, acid secretion, and hepatic blood flow. Reduced appetite and alterations of taste and smell.
  • Musculoskeletal: Decreased bone density, muscle mass and strength. Increased fracture risk.
  • Neurologic: Reduced cortical volume. Blunted vision, auditory function, and vibrotactile sensation. Decreased autonomic neural response. Slowed cognition and reflexes.
  • Pulmonary: Increased chest wall rigidity. Decreased respiratory muscle strength. Decreased FEV1; FVC. Diminished ventilatory response to hypercapnia and hypoxia.
  • Renal: Increased glomerulosclerosis. Decreased GFR and renal clearance of drugs/metabolites (↓ 1mL/min per year after age 40; Cr may stay the same due to reduced muscle mass). Reduced tubular function.