Older adults frequently live with multiple chronic conditions. Geriatric medicine emphasizes function, quality of life, and coordinated management of multimorbidity rather than disease-centered silos.

Common geriatric conditions include cardiovascular disease, arthritis, osteoporosis, dementia, and sensory impairments. Source: Unsplash.

Hypertension

Hypertension affects 70% of adults over 65. Systolic hypertension (isolated systolic hypertension) is the most common form, reflecting arterial stiffness. The SPRINT trial demonstrated benefit of intensive blood pressure targets (<120 mmHg systolic) in older adults, with reduced cardiovascular events and mortality, but increased risk of hypotension, syncope, and acute kidney injury. For frail older adults, less aggressive targets are appropriate. First-line medications: thiazide diuretics, calcium channel blockers, ACE inhibitors, ARBs. Monitor for orthostatic hypotension (blood pressure drop on standing), which increases fall risk.

Diabetes Mellitus

Type 2 diabetes affects 30% of adults over 65. Glycemic targets should be individualized based on health status: for healthy older adults with long life expectancy, HbA1c <7.0–7.5%; for those with multiple comorbidities, <8.0%; for those with limited life expectancy or advanced frailty, <8.5%. Avoiding hypoglycemia is paramount — hypoglycemia causes falls, cognitive impairment, and cardiovascular events. Metformin is first-line (monitor renal function). SGLT2 inhibitors and GLP-1 receptor agonists have cardiovascular and renal benefits. Sulfonylureas and insulin carry higher hypoglycemia risk.

Osteoarthritis

OA affects 50% of older adults — most commonly the knees, hips, hands, and spine. Pain management: weight loss (5–10% reduces knee OA pain by 50%), exercise (strengthening, aerobic, aquatic), and topical NSAIDs. Acetaminophen and oral NSAIDs (with gastroprotection) are second-line. Intra-articular corticosteroids for flares. Total joint arthroplasty is definitive for end-stage disease. Opioids should be avoided.

Heart Failure

HF affects 10% of adults over 70. HF with preserved ejection fraction (HFpEF, EF >50%) is the most common form in older adults, reflecting hypertensive heart disease, aging-related diastolic dysfunction, and comorbidities (obesity, diabetes, atrial fibrillation). HF with reduced ejection fraction (HFrEF, EF <40%) is managed with guideline-directed medical therapy (beta-blockers, ACE/ARB, aldosterone antagonists, SGLT2 inhibitors). Careful diuresis balances volume management with renal function and orthostatic blood pressure.

Osteoporosis

Osteoporosis affects 50% of women and 25% of men over 50. Screening with DXA starting at age 65 (women) and 70 (men), or earlier with risk factors. Bisphosphonates are first-line therapy. Denosumab is an alternative. Adequate calcium (1200 mg/day) and vitamin D (800 IU/day) are foundational. Fall prevention is essential.

Dementia

Dementia affects 10% of adults over 65 and 35% of those over 90. Alzheimer disease is the most common cause (60–80%). See article 03 for full discussion.

Urinary Incontinence

UI affects 30–50% of older adults. Types: stress incontinence (leakage with cough, sneeze, exertion), urge incontinence (overactive bladder — sudden, strong urge), and overflow incontinence (from outlet obstruction or detrusor underactivity). Management: behavioral therapy (pelvic floor exercises, bladder training, scheduled voiding), medications (anticholinergics, beta-3 agonists such as mirabegron), and, for severe cases, sacral nerve stimulation or sling procedures. Avoid bladder irritants (caffeine, alcohol).

⚠ Clinical Correlation

Geriatric syndromes are multifactorial health conditions that occur when age-related changes in multiple organ systems converge, often precipitated by minor insults. They include falls, delirium, incontinence, pressure ulcers, frailty, dizziness, syncope, and failure to thrive. These syndromes do not fit neatly into single-disease diagnostic categories. Management requires assessment of contributing factors across multiple domains (medical, functional, environmental, social). Comprehensive geriatric assessment (CGA) — a multidisciplinary evaluation addressing medical, psychological, functional, and social domains — is the gold standard approach and improves outcomes (reduced hospitalization, improved function, reduced mortality).

Polypharmacy

Polypharmacy is the use of multiple medications, typically defined as 5+ or 10+ medications. It affects 40% of older adults. Consequences: adverse drug reactions, drug-drug interactions, medication non-adherence, cognitive impairment, falls, and increased healthcare utilization. The Beers Criteria (AGS) identifies potentially inappropriate medications in older adults. Screening Tool of Older Persons Potentially Inappropriate Prescriptions (STOPP) and Screening Tool to Alert to Right Treatment (START) guide deprescribing. Regular medication review with deprescribing of unnecessary medications is essential.

Summary

Common geriatric conditions require an integrated, patient-centered approach prioritizing function and quality of life. Hypertension and diabetes management should be individualized with emphasis on avoiding hypoglycemia and orthostasis. Osteoarthritis, heart failure, osteoporosis, dementia, and incontinence each have specific management considerations. Polypharmacy is prevalent and harmful — regular medication review and deprescribing are essential. Comprehensive geriatric assessment is the gold standard approach for complex older patients.