Geriatric syndromes: medical misnomer or progress in geriatrics?

Abstract

Both in geriatric and internal medicine journals, and in medical textbooks certain (aggregates of) symptoms are labelled as 'geriatric syndromes'. In frail elderly patients a large number of diseases present with well-known and highly prevalent atypical symptoms (e.g. immobility, instability, impaired cognition and incontinence), which are referred to as geriatric syndromes. While classically the term syndrome is used for grouping together multiple symptoms with a single pathogenetic pathway, geriatric syndrome primarily refers to one symptom or a complex of symptoms with high prevalence in geriatrics, resulting from multiple diseases and multiple risk factors. The geriatric workup should therefore consist of both a search for and treatment of the aetiologically related diseases and a risk factor assessment and reduction. Effectiveness and efficiency of this specific geriatric syndrome workup has been demonstrated predominantly for combinations of geriatric syndromes that often serve as targeting criteria for geriatric interventions, and for some specific geriatric syndromes. Therefore, we argue that the concept of geriatric syndromes is valuable as a theoretical frame, a directive for diagnostic analysis and as an educational tool in teaching geriatrics to medical students and trainees. Added to this, explaining the heterogeneous way 'syndrome' is used in current clinical practice, as opposed to 'disease', will also substantially improve clinical reasoning both in geriatrics and general internal medicine.