Reflecting the challenges aforementioned, the term ‘geriatric giants’ was first coined in 1965 by British geriatrician Professor Bernard Isaacs. His syndrome cluster described four clinical issues:1
The four descriptive syndrome clusters above were proposed to enable clinicians to describe the actual ‘illness’ presentation – a descriptive pragmatic tool to facilitate a mutual understanding between health professionals and patients. Isaacs originally suggested that if appropriate assessments were in place, all common problems in older people would relate to one or other of these four descriptive terms.
By 2017, the nomenclature had evolved and four new geriatric syndromes were proposed:2
- Frailty (refer to Part A. Frailty)
- Anorexia of ageing
- Cognitive impairment.
A notable absence from the new proposed list of geriatric syndromes was iatrogenic illness.
None of the proposed syndrome types reflect the traditional disease model of care; however, they have significant implications in terms of individual morbidity and mortality, and, indeed, healthcare costs.
GPs’ understanding of illness presentation in the older population will continue to evolve, and the nomenclature used will undoubtedly change.
In the current context, GPs are pragmatic and need logical tools to enable optimum patient management. The 5M tool provides a framework that reflects the evolving geriatric giant concept (refer to Table 1):3
- Matters most.
Geriatric 5Ms and focus areas