7 Geriatric Conditions You Should Not Overlook

By Rebekah McCallister

Ann Intern Med

A large study of elderly adults has shown that 50% of them have at least 1 condition that can affect their ability to perform activities of daily living (ADL), such as bathing or dressing on their own (. 2007;147:156-164).

This study, which included an analysis of >11,000 older Americans (aged ≥65 years) enrolled in the national Health and Retirement Study, demonstrated that 50% these participants had a moderate-to-severe form of at least 1 of 7 common geriatric conditions:

• Cognitive impairment
• Falls resulting in injury
• Incontinence (requiring pads/absorbent undergarments)
• Low body mass index (<18.5 kg/m²)
• Dizziness (persistent or troublesome)
• Vision impairment (despite corrective lenses)
• Hearing impairment (despite hearing aid).

These conditions were about as prevalent&#8212;and some resulted in as much disability&#8212;as chronic medical conditions.

This is the first study to look at the prevalence of geriatric conditions and their relationship to dependency in ADL, noted lead investigator Christine T. Cigolle, MD, MPH, of the University of Michigan Health System and the VA Ann Arbor Healthcare System's Geriatric Research, Education and Clinical Center (GRECC).

"The focus in medicine has long been on diseases, and how to diagnose and treat them. But that focus often isn't helpful in regard to older adults; they tend to have 1 or more of these geriatric conditions, which are not considered diseases and can be missed by physicians," Dr Cigolle said.

"Our study is the first to look at all 7 of these common conditions together, and we found that they are very common and increase dramatically in prevalence with age," she added. "To me, that says that clinicians need to ask patients about these issues. In many situations, they may be able to help manage the condition before it leads to disability."

Experts have debated how to classify such conditions. Some are called geriatric syndromes, and others fall outside of the categories normally used by physicians.

The lack of consistent terminology has been an obstacle to the appropriate diagnosis and treatment of these conditions, said coinvestigator Caroline S. Blaum, MD, MS, of the University of Michigan and the VA Ann Arbor Healthcare System GRECC.

She said that overcoming such barriers will enable elderly patients to receivethe best healthcare possible, noting, "Geriatric conditions are integral to the health and function of older adults and should be addressed in their care."

This study showed a strong association between the 7 conditions evaluated and dependence on others to perform ADL. Only 2.6% of participants without any of these conditions were reliant on the help of others. That proportion increased in tandem with the numberof geriatric conditions, with 8.1% of participants with 1 condition, 19.4% of those with 2 conditions, and 45% of those with ≥3 conditions needing assistance with ADL.

All 7 geriatric conditions increased in prevalence with advancing age. For example, 55% of those with cognitive impairment were aged ≥80 years. Overall, 39% of those aged 65 to 69 years had ≥1 condition compared with 82% of those aged ≥90 years.

Factors other than increasing age that were associated with the presence of multiple geriatric conditions included female gender, belonging to a minority ethnic group, being unmarried,and having less education and a lower net worth.