Geriatric Giants in Emergency Medicine

Chung Wai Mun, Malaysia

“Geriatric giants” or also known as geriatric syndromes are a collection of common clinical conditions in older adults which impact their health and well-being. It is not only applicable in geriatric medicine but also in the context of emergency medicine.

Geriatric syndromes are associated with multifactorial origins, involving multiple organ systems. These syndromes are unique and distinct from specific diseases. It particularly results from interactions between physical, intellectual, functional, psychological, and social factors. The older adults may present more than one of the following:

Frailty: Age-associated decline in physiological reserve results in increased vulnerability to stressors.

Delirium: A medical emergency signified by acute and fluctuating disturbance in attention and cognition, which is often triggered by an underlying medical condition.

Falls: A common complaint to emergency departments in older adults. It often comes with significant injuries, including fractures and head trauma.

Instability and imbalance gait:  Age-related changes in musculoskeletal and neurological systems may lead to walking and balance difficulties.

Cognitive impairment and dementia: A spectrum of deficits in cognitive domains including memory, executive function etc. Older adults may present with concurrent delirium or depression.

Incontinence: Quality of life of older adults can be significantly disturbed due to inability in controlling the bladder or bowel function.

Malnutrition: Inadequate oral intake, lack of absorption, or utilization of nutrients may lead to nutritional deficiencies.

Polypharmacy: The use of multiple medications for multiple medical conditions may lead to drug-drug interactions, side effects, and decrease in medication adherence.

Early recognition of geriatric giants is essential. A suitable and practical comprehensive assessment in the emergency room is crucial for patient-centered care. Multidisciplinary care with good communication skills has been evolving as an effective approach in management. Medication optimization has been able to overcome polypharmacy. Lastly, geriatric-focused education can help enhance staff knowledge and skills.