Geriatric Medicine and the Physician in the Community for NEET PG Medicine: Frailty, Falls, Beers Criteria, NPHCE, NP-NCD

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🎯 Exam priority: Medium. Expect: body composition changes with age, why creatinine misleads, ADL vs IADL, frailty definition, falls as leading injury death, the Get-Up-and-Go test, Beers Criteria, benzodiazepine harms, prescribing cascade, start-low dosing, immobility complications, elder abuse types, NPHCE components, NP-NCD screening age and PM-JAY 70+.

CBME mapping: GM 25.1–25.22 (geriatrics) and GM 29 (physician in the community). Programme details are in Community Medicine; drug handling in Pharmacology; dementia and delirium in article 24.

Ageing, frailty, falls, medicines and programmes in India. Drawn by TrackNation.

Ageing, Assessment and Frailty

• Ageing: less lean and muscle mass, less creatinine production, less total body water, more fat; presbyopia; dehydration-prone. GFR falls ~8 mL/min/1.73 m² per decade after 40 while serum creatinine can stay normal — estimate creatinine clearance (e.g. Cockcroft–Gault).

• Comprehensive geriatric assessment by an interdisciplinary team (geriatrician, nurse, social worker, pharmacist). ADLs: eating, dressing, bathing, transferring, toileting, continence. IADLs: meals, housework, medications, errands, finances, telephone. Also vision, hearing, continence, gait and balance, cognition and mood.

• Frailty: loss of physiological reserve → disability after minor stress; weakness, slowness, weight loss, sarcopenia, falls, immobility, incontinence. Exercise and a healthy diet prevent or reduce it.

• Falls: the leading cause of injury-related death at ≥ 65 years. Causes include orthostatic and postprandial hypotension, delirium, dementia, stroke, arthritis, drugs. Get-Up-and-Go test: rise from an armchair, walk 3 m, turn, return and sit. Prevent with leg-strength and balance exercise, fall education; hip protectors reduce hip fracture.

• Elder abuse: physical or psychological mistreatment, neglect, financial exploitation.

Medicines and Hospital Care

• More body fat prolongs lipophilic drugs (e.g. diazepam); lower albumin means more free drug (e.g. NSAIDs); reduced renal clearance.

• Beers Criteria (AGS) list potentially inappropriate medicines for adults ≥ 65. Benzodiazepines and Z-drugs raise the risk of cognitive impairment, delirium, falls and fractures; paroxetine is sedating and anticholinergic.

• Prescribing cascade: a side effect is read as a new disease and treated with another drug. Start medicines at the lowest dose; a drug is inappropriate when harm outweighs benefit.

• Immobilised or demented inpatients are prone to pressure sores, DVT, urinary retention and delirium.

Traps the Examiner Sets

• Normal creatinine in an elderly person does not mean normal GFR.

• Using the telephone or managing money is an IADL, not an ADL.

• New symptom after a new drug → think prescribing cascade.

• NP-NCD screening starts at 30 years; PM-JAY covers all aged 70+.

Memory Hooks & Shortcuts

Shortcuts to lock in this article's numbers and lists. Each one only re-packages facts proven above.

• 🧠 ADL = 'DEATH': Dressing, Eating, Ambulating/transfer, Toileting, Hygiene — ADLs

• 🧠 IADL = 'SHAFT': Shopping/errands, Housework, Accounts, Food (meals), Telephone — plus medications — IADLs

• 🧠 Get-Up-and-Go: 'Up, 3 metres, turn, back, down' — falls test

• 🧠 Prescribing cascade: 'pill for a pill' — cascade

• 🧠 India's elderly: 'NPHCE 2010, NP-NCD 30+, PM-JAY 70+' — programmes

Rapid-Revision Cards

• Ageing body

  ↓ muscle, water; ↑ fat; creatinine falsely normal.

• GFR decline

  ~8 mL/min/1.73 m² per decade after 40.

• Diazepam in elderly

  Longer (fat ↑ Vd).

• ADLs

  Eat, dress, bathe, transfer, toilet, continence.

• IADLs

  Meals, housework, meds, errands, money, phone.

• CGA team

  Geriatrician, nurse, social worker, pharmacist.

• Frailty

  Loss of reserve; prevent with exercise, diet.

• Falls

  Leading injury death ≥ 65.

• Get-Up-and-Go

  Rise, walk 3 m, turn, return, sit.

• Fall causes

  Postural hypotension, delirium, dementia, stroke, drugs.

• Hip protectors

  Reduce hip fracture.

• Beers Criteria

  Inappropriate drugs ≥ 65 y.

• Benzodiazepines/Z-drugs

  Falls, fractures, delirium.

• NSAIDs elderly

  Low albumin → more free drug.

• Prescribing cascade

  Side effect treated as new disease.

• Dosing

  Start lowest, go slow.

• Immobility

  Pressure sores, DVT, retention, delirium.

• Elder abuse

  Physical, psychological, neglect, financial.

• NPHCE

  2010; weekly PHC clinic; RGCs; physio units.

• NP-NCD

  Screen ≥ 30 y; NCD clinics at CHC/DH.

• PM-JAY 70+

  All ≥ 70, any income.

Sources

Facts in this article were checked against these documents.

• MSD Manual Professional: Physical Changes With Aging; Comprehensive Geriatric Assessment; Prevention of Frailty; Falls in Older Adults; Pharmacokinetics in Older Adults; Drug Categories of Concern; Medication-Related Problems; Prevention of Iatrogenic Complications; Elder Abuse — Merck & Co. (MSD Manuals), reviewed 2025–26 (link)

• National Programme for Health Care of the Elderly (NPHCE) — National Health Mission, MoHFW, page accessed 2026 (link)

• NP-NCD Operational Guidelines — Ministry of Health and Family Welfare, 2023 (link)

• Cabinet approves health coverage to all senior citizens aged 70 and above under AB PM-JAY — Prime Minister's Office, 2024 (link)

• Competency Based Undergraduate Curriculum, General Medicine (GM 25, GM 29) — National Medical Commission, 2024

Test Yourself: Practice Questions

Thirty questions in NEET PG style, most of them clinical vignettes.

Practice Questions (NEET PG pattern)

Original questions written in the style of the exam: +4 for a correct answer, −1 for a wrong one. Every answer was checked against the sources listed above. NEET PG papers are not published by NBEMS, so these are not past-paper questions.

Q1. An 80-year-old has a serum creatinine of 1.0 mg/dL. The correct interpretation is

• (a) GFR may still be reduced because muscle mass and creatinine production fall with age

• (b) GFR is increased

• (c) creatinine is irrelevant

• (d) renal function is certainly normal

Q2. After age 40, GFR declines on average by about

• (a) 8 mL/min/1.73 m² per decade

• (b) 30 mL/min per decade

• (c) 1 mL/min per decade

• (d) nothing

Q3. With ageing, body composition changes include

• (a) no change

• (b) more muscle and water

• (c) less lean mass and total body water, more fat

• (d) less fat

Q4. Diazepam lasts longer in older adults mainly because

• (a) absorption falls

• (b) albumin rises

• (c) increased body fat enlarges its volume of distribution

• (d) it is renally cleared faster

Q5. Which is an instrumental activity of daily living (IADL)?

• (a) eating

• (b) bathing

• (c) toileting

• (d) managing finances

Q6. Basic activities of daily living (ADLs) include

• (a) managing money

• (b) eating, dressing, bathing, transferring, toileting and continence

• (c) using the phone

• (d) shopping and cooking

Q7. Comprehensive geriatric assessment is most successful when performed by

• (a) a single specialist

• (b) a surgeon alone

• (c) family members

• (d) an interdisciplinary team (geriatrician, nurse, social worker, pharmacist)

Q8. Frailty is best defined as

• (a) loss of physiological reserve making a person vulnerable to disability after minor stress

• (b) dementia

• (c) any chronic disease

• (d) old age itself

Q9. The measure recommended to prevent or reduce frailty is

• (a) routine hormone therapy

• (b) exercise and a healthy diet

• (c) benzodiazepines

• (d) bed rest

Q10. In people aged 65 and over, the leading cause of injury-related death is

• (a) falls

• (b) burns

• (c) road traffic accidents

• (d) drowning

Q11. The Get-Up-and-Go test involves

• (a) climbing stairs

• (b) walking 100 m

• (c) standing on one leg for 1 minute

• (d) rising from an armchair, walking 3 m, turning, walking back and sitting

Q12. An older man falls each time he gets up quickly from bed. A likely contributor to look for is

• (a) orthostatic (postural) hypotension

• (b) myopia

• (c) hypertension

• (d) hyperthyroidism

Q13. A device that reduces hip fracture risk during falls is

• (a) knee braces

• (b) cervical collars

• (c) padded hip protectors over the greater trochanter

• (d) walking sticks only

Q14. Exercises that help prevent falls in older adults are those that improve

• (a) breath-holding

• (b) flexibility of fingers

• (c) leg strength and balance

• (d) grip only

Q15. The tool most commonly used to identify potentially inappropriate medicines in adults ≥ 65 is

• (a) the AGS Beers Criteria

• (b) the CHA2DS2-VASc score

• (c) the CURB-65 score

• (d) the Glasgow score

Q16. An 82-year-old taking a benzodiazepine for sleep is at increased risk of

• (a) weight loss only

• (b) better memory

• (c) falls, fractures, delirium and cognitive impairment

• (d) fewer falls

Q17. Z-drug hypnotics such as zolpidem in older adults

• (a) prevent delirium

• (b) improve balance

• (c) carry risks similar to benzodiazepines

• (d) are completely safe

Q18. NSAID adverse effects may be greater in the elderly partly because

• (a) fat decreases

• (b) low plasma protein leaves more free active drug

• (c) they are cleared faster

• (d) absorption is blocked

Q19. An elderly woman develops a new symptom after starting a drug; it is taken as a new disease and another drug is added. This sequence is

• (a) normal ageing

• (b) a prescribing cascade

• (c) heart failure

• (d) drug allergy

Q20. When starting a new medicine in an older adult, the dose should be

• (a) the usual adult maximum

• (b) double the adult dose

• (c) the lowest dose, titrated slowly

• (d) irrelevant

Q21. A medication is considered inappropriate in an older adult when

• (a) its potential for harm exceeds its potential benefit

• (b) it is new

• (c) it is expensive

• (d) it is generic

Q22. An immobilised elderly patient after hip surgery is at high risk of

• (a) hypertension only

• (b) polycythaemia

• (c) pressure sores, DVT, urinary retention and delirium

• (d) hyperthyroidism

Q23. Elder abuse includes all EXCEPT

• (a) financial exploitation

• (b) routine prescription of indicated medicines

• (c) neglect

• (d) psychological mistreatment

Q24. The National Programme for Health Care of the Elderly (NPHCE) was launched in

• (a) 2005

• (b) 2020

• (c) 1990

• (d) 2010

Q25. Under NPHCE, regular monitoring of older people is organised through

• (a) a weekly geriatric clinic at PHCs and domiciliary visits by health workers

• (b) private clinics

• (c) only tertiary hospitals

• (d) annual camps only

Q26. NPHCE provides medical rehabilitation through

• (a) only home visits

• (b) private gyms

• (c) physiotherapy units at CHC, district hospital and Regional Geriatric Centres

• (d) none

Q27. The legal basis cited for NPHCE includes

• (a) the MTP Act

• (b) the Mental Healthcare Act 2017

• (c) the PCPNDT Act

• (d) the Maintenance & Welfare of Parents & Senior Citizens Act 2007

Q28. Under NP-NCD, population-based screening for hypertension, diabetes and three common cancers covers

• (a) everyone aged 30 years and above

• (b) only women

• (c) only symptomatic people

• (d) only those over 60

Q29. Under NP-NCD, opportunistic screening at district hospitals and CHCs happens through

• (a) NCD clinics

• (b) IDSP units

• (c) ICTCs

• (d) DOTS centres

Q30. Under AB PM-JAY, health coverage is extended to

• (a) only women over 70

• (b) only BPL families over 60

• (c) only government pensioners

• (d) all senior citizens aged 70 and above, irrespective of income

Active Recall

From memory: describe body changes with ageing and their effect on creatinine and drugs, list ADLs and IADLs, define frailty, explain falls and the Get-Up-and-Go test, the Beers Criteria, benzodiazepine harms and the prescribing cascade, immobility complications and elder abuse, and the elderly-related features of NPHCE, NP-NCD and PM-JAY.