Geriatrics

Caring for Older Adults in Clinical Settings

Geriatrics focuses on the healthcare of older adults, typically those aged 65 and older. As the population ages, medical assistants frequently encounter geriatric patients in primary care, specialty clinics, and long-term care settings. Understanding age-related physiological changes, common chronic conditions, and communication strategies is essential for safe, effective, patient-centered care. This topic is high-yield on the Certified Medical Assistant (CMA/AAMA) exam and related certification tests. ^[1]

Essential Terminology for Geriatric Care

• Geriatrics – The branch of medicine dedicated to the health and well-being of older adults.
• Gerontology – The broader study of aging, including social, psychological, and biological aspects.
• Activities of Daily Living (ADLs) – Basic self-care tasks (bathing, dressing, eating, toileting, transferring, continence).
• Instrumental Activities of Daily Living (IADLs) – More complex tasks needed for independent living (managing finances, preparing meals, shopping, transportation, medication management).
• Polypharmacy – The concurrent use of multiple medications (often >5), which increases the risk of adverse drug events, interactions, and nonadherence. ^[2]
• Frailty – A state of increased vulnerability to stressors due to age-related decline in physiologic reserve. Often characterized by unintentional weight loss, exhaustion, weakness, slow gait speed, and low physical activity.
• Presbycusis – Age-related hearing loss, especially for high-frequency sounds.
• Presbyopia – Age-related difficulty focusing on near objects.

Age-Related Body Changes and Chronic Diseases

Physiological Changes of Aging

Normal aging affects every organ system. The medical assistant must recognize these changes to avoid mistaking them for disease and to anticipate alterations in medication response and treatment tolerance. ^[3]

• Cardiovascular: Decreased arterial compliance (stiffness), reduced baroreceptor sensitivity, increased risk of orthostatic hypotension.
• Respiratory: Decreased lung elasticity and chest wall compliance; reduced cough reflex.
• Renal: Reduced glomerular filtration rate (GFR) – affects drug clearance.
• Musculoskeletal: Sarcopenia (loss of muscle mass), decreased bone density (osteoporosis), reduced joint flexibility.
• Neurologic: Slowed nerve conduction, diminished proprioception, increased risk of falls.
• Integumentary: Thinner, less elastic skin; reduced subcutaneous fat; slower wound healing.

Common Chronic Conditions in Geriatrics

• Hypertension, heart failure, atrial fibrillation
• Type 2 diabetes mellitus
• Osteoarthritis and osteoporosis
• Chronic obstructive pulmonary disease (COPD)
• Dementia (most commonly Alzheimer disease) and delirium
• Depression and anxiety
• Urinary incontinence
• Hearing and vision impairment

Atypical Illness Presentations and Geriatric Syndromes

• Atypical presentation of illness: Older adults may not present with classic symptoms. For example, a myocardial infarction may present as confusion, weakness, or nausea rather than chest pain. ^[4]
• Delirium: Acute, fluctuating change in attention and cognition. Needs prompt differentiation from dementia. Common triggers: infection, medications, dehydration, surgery.
• Falls: A leading cause of injury and functional decline. Always ask about recent falls or fear of falling.
• Weight loss: Unintentional loss of >5% body weight in 6–12 months requires investigation (malignancy, depression, dementia, medication side effects).
• Functional decline: New difficulty with ADLs or IADLs signals worsening health status.

Essential Screening Tests for Older Adults

Key Assessments for the Medical Assistant

• Vital signs: Always check orthostatic vital signs (lying, sitting, standing) – a drop in systolic BP ≥20 mmHg or diastolic ≥10 mmHg within 3 minutes suggests orthostatic hypotension. ^[5]
• Pain assessment: Use age-appropriate pain scales (numeric 0–10, Wong-Baker FACES, PAINAD for dementia).
• Cognitive screening: The Mini-Cog or Montreal Cognitive Assessment (MoCA) is commonly used. The Mini-Cog involves a three-word recall and clock-drawing test.
• Functional assessment: Ask about ability to perform ADLs and IADLs; use tools like the Katz Index or Lawton-Brody Scale.
• Fall risk screening: Timed Up and Go (TUG) test >12 seconds indicates increased fall risk. The STEADI tool from CDC is evidence-based. ^[6]
• Medication reconciliation: Bring all prescriptions, OTC medications, herbs, and supplements to every visit. Check for Beers Criteria potentially inappropriate medications. ^[2]

Preventive Care and Disease Management Approaches

• Preventive care: Immunizations (influenza, pneumococcal, shingles, Tdap, COVID-19), cancer screenings (colon, breast, cervical), and bone density screening (DXA scan) per guidelines.
• Fall prevention: Exercise (balance and strength training), home safety assessment, medication review, vision check, proper footwear. ^[6]
• Medication management: Use pill organizers, clear instructions, “brown bag” reviews. Simplify dosing schedules (once-daily if possible).
• Nutrition: Encourage protein intake to preserve muscle; vitamin D and calcium for bone health; hydration to prevent constipation and urinary tract infections.
• Chronic disease management: Self-monitoring (blood pressure, glucose), lifestyle counseling, adherence support.
• Advance care planning: Discuss advance directives, code status, and healthcare proxy early and revisit routinely.

Minimizing Risks and Preventing Complications

• Anticoagulant safety: Warfarin or DOACs require monitoring for bleeding risk. Falls while on anticoagulants can be dangerous.
• Consequences of polypharmacy: Risk of falls, cognitive impairment, urinary retention, electrolyte disturbances, and drug-disease interactions.
• Restraint reduction: Physical or chemical restraints should be avoided; use alternative fall-alarms, supervised mobility, and environmental modifications.
• Elder abuse and neglect: Be alert for unexplained injuries, poor hygiene, weight loss, withdrawal, or change in financial patterns. Mandatory reporting laws apply for suspected abuse. ^[7]
• Infection control: Older adults are at higher risk for infections and complications. Practice hand hygiene, encourage vaccinations, and recognize early signs of infection.

Critical Exam Content and Mnemonics

• Know the Beers Criteria – a list of medications to avoid or use with caution in older adults (e.g., benzodiazepines, anticholinergics, non-COX-selective NSAIDs).
• Remember that delirium is acute and reversible; dementia is chronic and progressive. Delirium may be superimposed on dementia.
• Orthostatic hypotension is a common side effect of antihypertensives, diuretics, and antidepressants – always check orthostatic vitals.
• For the CMA exam: “Age-related changes” often appear as scenario questions. For example, decreased renal function means lower doses of renally-cleared medications.
• Communication tips: face the patient, speak slowly and clearly, reduce background noise, allow extra time, use simple written materials with large font. ^[8]
• Memory aid for fall risk factors: “I HATE FALLING” – I (Inflammation of joints/feet), H (Hypotension), A (Auditory/visual deficits), T (Tremors/ataxia), E (Equilibrium problems), F (Foot problems), A (Arrhythmias), L (Leg weakness), L (Low blood sugar), I (Illness), N (Neurologic deficits), G (Gait impairment). ^[6]

References & Sources

1. American Association of Medical Assistants (AAMA). CMA (AAMA) Certification/Recertification Exam Content Outline. Accessed 2025. https://www.aama-ntl.org/cma-aama-exam
2. American Geriatrics Society Beers Criteria® Update Expert Panel. “American Geriatrics Society 2023 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults.” J Am Geriatr Soc. 2023;71(7):2052-2081. https://doi.org/10.1111/jgs.18372
3. Touhy TA, Jett KF, Ebersole P, Hess P. Ebersole & Hess’ Gerontological Nursing & Healthy Aging. 6th ed. Elsevier; 2021. https://www.elsevier.com/books/ebersole-and-hess-gerontological-nursing-and-healthy-aging/touhy/978-0-323-67836-4
4. Ignatavicius DD, Workman ML, Rebar CR, Heimgartner NM. Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. 10th ed. Elsevier; 2021. https://www.elsevier.com/books/medical-surgical-nursing/ignatavicius/978-0-323-61112-5
5. Freeman R, Wieling W, Axelrod FB, et al. “Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome.” Clin Auton Res. 2011;21(2):69-72. https://doi.org/10.1007/s10286-011-0119-5
6. Centers for Disease Control and Prevention (CDC). STEADI – Older Adult Fall Prevention. Accessed 2025. https://www.cdc.gov/steadi/
7. National Center on Elder Abuse (NCEA). Reporting Abuse. U.S. Administration for Community Living. Accessed 2025. https://ncea.acl.gov/
8. Tabloski PA. Gerontological Nursing. 4th ed. Pearson; 2021. https://www.pearson.com/en-us/subject-catalog/p/gerontological-nursing/P200000006501