Older Adults

Older adults medicine is a high-yield AKT topic because the ageing population makes up a large proportion of GP consultations. Questions often involve complex scenarios with multiple interacting conditions, medications, and social factors.

Frailty is a clinical syndrome characterised by reduced physiological reserve. The electronic Frailty Index (eFI) uses routine GP data to identify frailty. The Clinical Frailty Scale (Rockwood) ranges from 1 (very fit) to 9 (terminally ill). NICE recommends identifying frailty in people aged 65 and over and offering comprehensive geriatric assessment to those who are moderately or severely frail.

Falls are a common and preventable cause of morbidity. NICE guideline CG161 recommends a multifactorial risk assessment for people who have fallen or are at risk. This includes medication review (particularly antihypertensives, sedatives, and anticholinergics), visual assessment, cardiovascular assessment (including lying and standing blood pressure), gait and balance assessment, and home hazard assessment.

Dementia diagnosis in primary care follows the NICE pathway. Initial assessment includes a cognitive screening tool (GPCOG or 6-CIT are recommended for primary care), blood tests to exclude reversible causes (thyroid function, B12, folate, calcium, glucose, renal function), and referral to memory services for formal assessment. Treatment includes acetylcholinesterase inhibitors (donepezil, rivastigmine, galantamine) for mild to moderate Alzheimer's and memantine for moderate to severe. You should know contraindications and monitoring requirements.

Polypharmacy reviews are essential in older adults. The STOPP/START criteria provide evidence-based guidance on potentially inappropriate medications (STOPP) and medications that should be considered (START). Common STOPP examples include long-term NSAIDs in over-65s, benzodiazepines for more than 4 weeks, and anticholinergics in patients with dementia.

Capacity assessment follows the Mental Capacity Act 2005. The two-stage test asks: (1) Does the person have an impairment of or disturbance in the functioning of the mind or brain? (2) If so, does that impairment mean they cannot understand, retain, use or weigh, or communicate the relevant information? Capacity is decision-specific and time-specific.

Care home medicine involves structured medication reviews, advance care planning, and managing the interface between primary care, care home staff, and secondary care.