Worked Examples
Example 1: Cockcroft-Gault Calculation
80-year-old female, 60 kg, SCr 1.2:
CrCl = [(140โ80) ร 60] / (72 ร 1.2) ร 0.85 = (60 ร 60) / 86.4 ร 0.85 = 3600/86.4 ร 0.85 = 35.4 mL/min โ renal dose adjustment required for many drugs.
Example 2: Delirium vs Dementia Assessment
Patient A: acute confusion overnight, fluctuating attention, recent UTI โ delirium (reversible). Patient B: 2-year progressive memory decline, MMSE 18, CT shows atrophy โ Alzheimer's. Patient C: low mood, effortful testing, "I don't know" responses โ pseudodementia (depression).
Example 3: Falls Risk Assessment
75-year-old: orthostatic BP drop (150/80 supine โ 120/70 standing), on lorazepam and oxybutynin (anticholinergic), no grab bars, poor lighting, vitamin D 18 ng/mL. Interventions: deprescribe, home modifications, vitamin D 2000 IU, exercise program, vision check.
Practice Problems
Problem 1: Calculate CrCl for a 75-year-old male, 80 kg, SCr 1.5.
Answer: CrCl = [(140โ75) ร 80] / (72 ร 1.5) = 5200/108 = 48.1 mL/min โ moderate renal impairment
Problem 2: What are the five Fried frailty criteria?
Answer: (1) Unintentional weight loss (>10 lbs in past year), (2) Self-reported exhaustion, (3) Low physical activity, (4) Slow walking speed, (5) Weak grip strength. โฅ3 = frail; 1-2 = pre-frail; 0 = robust.
Problem 3: Differentiate delirium from dementia.
Answer: Delirium: acute onset, fluctuating course, inattention, altered consciousness, reversible. Dementia: chronic progressive decline, memory loss, stable deficits, irreversible. Delirium superimposed on dementia is common and medical emergency.
Problem 4: What is the Beers Criteria?
Answer: A list of potentially inappropriate medications for adults โฅ65 years. Includes benzodiazepines, anticholinergics, NSAIDs, Z-drugs, first-generation antihistamines, digoxin >0.125 mg, sliding-scale insulin. Updated regularly by AGS.
Problem 5: Name three types of elder abuse.
Answer: Physical (hitting, pushing, inappropriate restraint), Emotional/psychological (humiliation, threats, isolation), Financial (theft, coercion, misuse of power of attorney). Also: sexual abuse, neglect (active/passive), abandonment.