Geriatric Syndromes | The Sobering Predictors of Mortality
Written By Kobi Nathan, Pharm.D., M.Ed., CDP, BCGP, AGSF
Sleep Disorders
December 8, 2023

The term “geriatric syndromes” characterizes common health conditions occurring in older adults affecting functionality and quality of life.

The concept of geriatric syndromes in older adults remains poorly defined.

These syndromes do not fit into a specific disease category and are caused by multiple poorly understood factors.

Because of the numerous factors influencing geriatric syndromes, a combination of treatment strategies may be used to manage and reduce the risk of these syndromes.

It is essential to know that most of these conditions are expected with the aging process.

However, there are many things a person can do to prevent, manage, and possibly cure geriatric syndromes to improve quality of life.


Examples of geriatric syndromes

The most common geriatric syndromes affecting older patients include falls, urinary incontinence or overactive bladder, urinary tract infection, sleep problems, cognitive function problems such as delirium and dementia, and osteoporosis.

Many other common clinical conditions are also considered geriatric syndromes and contribute to their prevalence.

These are:

  • Pressure ulcers
  • Visual impairment
  • Hearing impairment
  • Frailty
  • Dizziness
  • Fainting
  • Poor nutrition and eating problems
  • Muscle wasting or loss
  • Weight loss
  • gait or balance impairment

Many of these geriatric syndromes impact each other, leading to further functional decline and reduced quality of life.

It is essential to be aware of these geriatric syndromes to know what you or a loved one can do to prevent or manage it and, when appropriate, to talk to a healthcare provider.

What are the four functional domains of geriatric syndromes?

There are four functional domains or risk factors identified that are thought to contribute to geriatric syndromes.

These risk factors include:

  1. Older age
  2. Cognitive impairment
  3. Functional impairment
  4. Impaired mobility

1. Older age

Adults aged 65 years or older are at risk for these impairments, increasing the risk of developing geriatric syndromes.

2. Cognitive Impairment

Cognitive impairments, such as delirium and dementia, are common among the aging population but are not normal parts of aging.

Mild cognitive impairment (MCI) is defined as an early stage of memory loss causing slight impairments in cognition, such as slowed thinking and reaction time, impaired decision-making, and visual/spatial perception.

MCI is the step between the normal cognitive decline expected with aging and a more severe decline, also known as dementia.

Some of those diagnosed with MCI will develop dementia, and others will not.

Over 20% of adults 65 or older are diagnosed with MCI without dementia in the US.

While patients with MCI still have most of their independence, those with dementia do not.

Dementia is a loss of cognitive functioning to the extent that it interferes with daily life.

There are many different types of dementia, with the most common being Alzheimer’s Disease.

Your doctor can use various screening tools such as the Folstein mini-mental state examination (MMSE) or the Montreal Cognitive Assessment (MoCA) to verify if you have dementia.

It is important to note that geriatric assessment tools like this are only one aspect of your doctor’s overall health assessment.

While dementia is a slow and progressive change in cognition, delirium is an acute change in cognition that occurs in up to 40% of hospitalized older adults.

In a study published in JAMA, patients who experienced delirium had a 40% acceleration in the rate of cognitive decline out to six years following their hospitalization.

During hospitalization, specific protocols are followed to prevent the development of delirium.

If you or a loved one develops delirium, most episodes resolve within a few days as long as the underlying cause is identified and treated.

However, delirium may persist long after acute hospitalizations in some cases.

3. Functional Impairment

Functional impairment is another risk factor that can lead to geriatric syndromes.

As we age, our body doesn’t work as well as it used to in our youth.

Many age-associated changes occur in our bodies, such as the gastrointestinal (GI), cardiovascular, nervous, musculoskeletal, renal, genitourinary, pulmonary, and immune systems.

These changes cause the body to be more susceptible to certain diseases and chronic illnesses, which increases the risk of geriatric syndromes.

4. Impaired Mobility

Impaired mobility is the fourth and final functional domain of geriatric syndromes.

The body also undergoes physiologic changes as we age, such as decreased muscle mass, reduced ligament and tendon strength, and bone loss.

These physiologic changes affect mobility, leading to balance impairment, falls, osteoporosis, and pressure ulcers from lack of movement.

Is Dementia A Geriatric Syndrome?

Yes, dementia is considered a geriatric syndrome. As individuals age, the likelihood of developing dementia increases. Research has shown how dementia affects mortality, with a higher risk of death for those diagnosed with the condition. It is important for geriatric care to address the challenges associated with dementia.

Geriatric syndromes and important implications for older adult safety

The older adult population faces many challenges due to these age-associated conditions.

As we age, it becomes harder to do all the activities we used to do.

This, in turn, leads to a higher prevalence of geriatric syndromes.

Activities of daily living (ADLs) are skills required to care for oneself independently, including mobility, feeding, dressing, personal hygiene, and going to the bathroom.

ADLs are an indication of a person’s functional status.

As these essential life skills and physical activity become more challenging, it may lead to poor quality of life and unsafe conditions.

In a study published in the Journal of the American Geriatrics Society, daytime drowsiness has been associated with harmful outcomes, including heart disease, falls, and death.

Many geriatric syndromes can lead to falls, which can cause painful injuries, disability, and death.

According to the CDC, one out of four older people fall each year, and one out of five falls causes a severe injury such as a broken bone or head injury.

This may cause a fear of falling, causing individuals to cut down on their everyday activities.

Once older individuals begin giving up their daily activities, they become weaker, increasing their risk of falling.

The same concept is true with bladder control problems; this is embarrassing; therefore, many avoid doing the things they would typically do. This again leads to weakness and an increased risk of falling.

According to the CDC, less than half of older adults who fall tell their doctor.

It’s essential to have these conversations with a healthcare provider to determine what is causing the geriatric syndromes and how best to manage or prevent further episodes.

How to manage geriatric syndromes

Several underlying factors involve multiple organ systems that contribute to geriatric syndromes that are not fully understood.

Identifying the underlying cause of these syndromes through a comprehensive geriatric assessment can effectively provide providers with a roadmap to reducing the risk factors associated with geriatric syndromes.

Falls can be potentially life-threatening occurrences.

Immediately after a fall, see a healthcare provider to ensure injuries, underlying acute illnesses, and chronic conditions are identified and treated.

There are multiple non-medication options to prevent further falls, such as exercise and physical therapy to improve balance and movement, the use of assistive devices such as canes and walkers, and the removal of tripping hazards in the home (i.e., floor mats, cords, etc.).

A healthcare provider such as a pharmacist should review your medications to ensure that inappropriate medications are not contributing to the falls.

The pharmacist may be able to recommend removal or changes in medications to decrease your risk of falls.

Inappropriate prescribing and overmedication is the 5th leading cause of death among older adults in the U.S.!

I discuss this topic in detail in my 2023 AGS Updated Beers Criteria of Inappropriate Medications and polypharmacy articles.

Urinary incontinence is undesirable and can cause avoidance of normal activities, resulting in a poor quality of life.

It is essential to know while urinary incontinence is common among the aging population, it is not a normal consequence of aging.

Multiple treatment options include special devices, exercise, medications, and surgery.

Talk to a healthcare provider to determine the cause and best course of action for you or your loved one.

Other chronic health conditions can cause sleep problems; however, it is also a normal part of aging.

According to the Journal of the American Geriatrics Society, as many as 50% of older adults report trouble sleeping.

Talk to a healthcare provider to identify the cause and best management strategy to improve sleep.

I write in detail about insomnia in older adults here.

Delirium is considered a medical emergency. It is essential to seek medical attention immediately at the first sign of sudden changes in mental functioning.

Dementia has a slower and progressive onset of changes in cognitive functioning compared to delirium.

Talk to a healthcare provider to receive testing to determine if and what kind of dementia you or a loved one is experiencing.

There are many treatments available to slow down the disease and improve functioning.

Osteoporosis is a common part of aging, and older adults should be screened using a bone mass density (BMD) test.

Increasing calcium and vitamin D intake through diet, weight-bearing, and strength training exercises will help to keep bones strong and healthy.

If you or a loved one is diagnosed with osteoporosis, there are prescription medications to treat the loss of bone mass.

If you are concerned about thinning bones, talk to a healthcare provider about a bone density test.


“Geriatric Syndromes” is a term used to characterize common health conditions in older adults affecting functionality and quality of life that do not fit into specific disease categories.

The most common geriatric syndromes include falls, urinary incontinence or overactive bladder, sleep problems, cognitive problems such as delirium and dementia, and osteoporosis.

Studies have shown that these geriatric syndromes are associated with poor outcomes such as decreased quality of life, disability, and reduced life expectancy.

It is essential to recognize these changes in yourself or a loved one and talk to a healthcare provider to determine how to manage them best.


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