Volume 55, Issue 5 p. 780-791

Geriatric Syndromes: Clinical, Research, and Policy Implications of a Core Geriatric Concept

(See Editorial Comments by Dr. William Hazzard on pp 794–796)

Sharon K. Inouye MD, MPH

Sharon K. Inouye MD, MPH

From the; * Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania § Department of Veterans Affairs Pittsburgh Geriatric Research, Education and Clinical Center, Pittsburgh, Pennsylvania Department of Internal Medicine and Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut Center on Aging, University of Connecticut Health Center, Farmington, Connecticut.

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Stephanie Studenski MD

Stephanie Studenski MD

From the; * Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania § Department of Veterans Affairs Pittsburgh Geriatric Research, Education and Clinical Center, Pittsburgh, Pennsylvania Department of Internal Medicine and Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut Center on Aging, University of Connecticut Health Center, Farmington, Connecticut.

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Mary E. Tinetti MD

Mary E. Tinetti MD

From the; * Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania § Department of Veterans Affairs Pittsburgh Geriatric Research, Education and Clinical Center, Pittsburgh, Pennsylvania Department of Internal Medicine and Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut Center on Aging, University of Connecticut Health Center, Farmington, Connecticut.

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George A. Kuchel MD

George A. Kuchel MD

From the; * Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania § Department of Veterans Affairs Pittsburgh Geriatric Research, Education and Clinical Center, Pittsburgh, Pennsylvania Department of Internal Medicine and Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut Center on Aging, University of Connecticut Health Center, Farmington, Connecticut.

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First published: 11 April 2007
Citations: 1,219
Address correspondence to Sharon K. Inouye, MD, MPH, Aging Brain Center, Hebrew SeniorLife, 1200 Centre Street, Boston, MA 02131.

Abstract

Geriatricians have embraced the term “geriatric syndrome,” using it extensively to highlight the unique features of common health conditions in older people. Geriatric syndromes, such as delirium, falls, incontinence, and frailty, are highly prevalent, multifactorial, and associated with substantial morbidity and poor outcomes. Nevertheless, this central geriatric concept has remained poorly defined. This article reviews criteria for defining geriatric syndromes and proposes a balanced approach of developing preliminary criteria based on peer-reviewed evidence. Based on a review of the literature, four shared risk factors—older age, baseline cognitive impairment, baseline functional impairment, and impaired mobility—were identified across five common geriatric syndromes (pressure ulcers, incontinence, falls, functional decline, and delirium). Understanding basic mechanisms involved in geriatric syndromes will be critical to advancing research and developing targeted therapeutic options, although given the complexity of these multifactorial conditions, attempts to define relevant mechanisms will need to incorporate more-complex models, including a focus on synergistic interactions between different risk factors. Finally, major barriers have been identified in translating research advances, such as preventive strategies of proven effectiveness for delirium and falls, into clinical practice and policy initiatives. National strategic initiatives are required to overcome barriers and to achieve clinical, research, and policy advances that will improve quality of life for older persons.