Geriatric Medicine
Frailty, falls, delirium, dementia, continence and polypharmacy.
- Frailty and Sarcopenia Distinguishing frailty from multimorbidity and normal ageing, scoring it with the eFI and Rockwood Clinical Frailty Scale, and why resistance exercise plus protein is the only intervention that reverses sarcopenia.
- Comprehensive Geriatric Assessment The five CGA domains, why the coordinated interdisciplinary process itself (not just the assessment breadth) improves the odds of going home alive, and how it's delivered from acute frailty units to primary care.
- Falls Why falls need a multifactorial risk assessment rather than a single cause, how to distinguish a mechanical fall from syncope, and why strength-and-balance training beats any single intervention alone.
- Delirium Screening with the 4AT, why hypoactive delirium is the subtype most often missed, the PINCH ME search for reversible precipitants, and why antipsychotics are dangerous in Lewy body disease.
- Dementia Screening tools from GPCOG to ACE-III, the reversible-cause work-up before any dementia label is applied, and why diagnosis is only the start of structured post-diagnostic support.
- Alzheimer Disease Amyloid and tau pathology behind the classic memory-led decline, hippocampal atrophy on MRI, and why cholinesterase inhibitors pair with mild-to-moderate disease and memantine with moderate-to-severe.
- Vascular Dementia Why subcortical small vessel disease rarely looks classically stepwise, the early executive-over-memory deficit pattern, and why management is stroke secondary prevention rather than a cognitive drug.
- Lewy Body and Frontotemporal Dementia Why DLB's antipsychotic sensitivity can be fatal, the 1-year rule against Parkinson's disease dementia, and why behavioural variant FTD is so often mistaken for a primary psychiatric illness.
- Polypharmacy and Deprescribing Distinguishing appropriate from problematic polypharmacy with STOPP/START, spotting a prescribing cascade before it triggers another prescription, and how to taper safely rather than stopping everything at once.
- Malnutrition in Older People Screening with MUST, the multifactorial causes behind poor intake in older people, the food-first stepped approach to treatment, and identifying refeeding risk before nutrition support starts.
- Continence in Older People Working through DIAPPERS for reversible causes of new incontinence, why a rectal exam catches overflow from impaction, and choosing mirabegron over an antimuscarinic in frail patients.
- Osteoporosis in Older People Why FRAX/QFracture risk, not the DEXA T-score alone, drives treatment decisions, the bisphosphonate practicalities and rare complications, and why orthogeriatric care after a fragility fracture must include secondary prevention.
- Capacity and Best Interests Decisions Applying the Mental Capacity Act's two-stage test decision-by-decision, why an unwise choice isn't evidence of incapacity, and what makes a best interests decision more than just the clinician's own judgement.
- Discharge Planning and Social Care Why discharge planning has to start on admission, how the discharge-to-assess model works, and the difference between means-tested Care Act social care and fully-funded NHS Continuing Healthcare.