# Geriatric Medicine and the Physician in the Community for NEET PG Medicine: Frailty, Falls, Beers Criteria, NPHCE, NP-NCD Source: https://tracknation.in/story/geriatric-medicine-and-the-physician-in-the-community-for-neet-pg-medicine-frailty-falls-beers-criteria-nphce-np-ncd (TrackNation β€” free UPSC notes with PYQs) > NEET PG Medicine: ageing physiology, comprehensive geriatric assessment (ADL, IADL), frailty, falls and the Get-Up-and-Go test, drug handling in older adults, Beers Criteria, benzodiazepines, prescribing cascade, immobility complications, elder abuse, NPHCE, NP-NCD screening and PM-JAY 70+, with a diagram, hooks, vignette MCQs and cards. ## Start Here 🎯 **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 mΒ² per decade after 40 while serum creatinine can stay normal β€” 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 β†’ 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 β‰₯ 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 β‰₯ 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. | **Programme** | **What a physician should know** | | NPHCE (2010) | Preventive/promotive care via domiciliary visits; weekly geriatric clinic at PHC; wards at CHC/DH; physiotherapy units; Regional Geriatric Centres with PG courses | | NP-NCD | NCD clinics at CHC and DH (opportunistic screening); population-based screening (from 2016) of everyone β‰₯ 30 y for hypertension, diabetes and oral, breast, cervical cancer; CBAC checklist | | AB PM-JAY | Health cover for all citizens aged β‰₯ 70 years irrespective of income | | Legal | Maintenance & Welfare of Parents & Senior Citizens Act 2007 (basis for NPHCE) | ## 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 β†’ 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** β€” ADLs - 🧠 **IADL = 'SHAFT': Shopping/errands, Housework, Accounts, Food (meals), Telephone β€” plus medications** β€” IADLs - 🧠 **Get-Up-and-Go: 'Up, 3 metres, turn, back, down'** β€” falls test - 🧠 **Prescribing cascade: 'pill for a pill'** β€” cascade - 🧠 **India's elderly: 'NPHCE 2010, NP-NCD 30+, PM-JAY 70+'** β€” programmes ## Rapid-Revision Cards - ↓ muscle, water; ↑ fat; creatinine falsely normal. - ~8 mL/min/1.73 mΒ² per decade after 40. - Longer (fat ↑ Vd). - Eat, dress, bathe, transfer, toilet, continence. - Meals, housework, meds, errands, money, phone. - Geriatrician, nurse, social worker, pharmacist. - Loss of reserve; prevent with exercise, diet. - Leading injury death β‰₯ 65. - Rise, walk 3 m, turn, return, sit. - Postural hypotension, delirium, dementia, stroke, drugs. - Reduce hip fracture. - Inappropriate drugs β‰₯ 65 y. - Falls, fractures, delirium. - Low albumin β†’ more free drug. - Side effect treated as new disease. - Start lowest, go slow. - Pressure sores, DVT, retention, delirium. - Physical, psychological, neglect, financial. - 2010; weekly PHC clinic; RGCs; physio units. - Screen β‰₯ 30 y; NCD clinics at CHC/DH. - All β‰₯ 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 β€” Merck & Co. (MSD Manuals), reviewed 2025–26 (link) - National Programme for Health Care of the Elderly (NPHCE) β€” National Health Mission, MoHFW, page accessed 2026 (link) - NP-NCD Operational Guidelines β€” Ministry of Health and Family Welfare, 2023 (link) - Cabinet approves health coverage to all senior citizens aged 70 and above under AB PM-JAY β€” Prime Minister's Office, 2024 (link) - Competency Based Undergraduate Curriculum, General Medicine (GM 25, GM 29) β€” 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, βˆ’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 **Answer: (a)** β€” Estimate creatinine clearance. **Q2.** After age 40, GFR declines on average by about - (a) 8 mL/min/1.73 mΒ² per decade - (b) 30 mL/min per decade - (c) 1 mL/min per decade - (d) nothing **Answer: (a)** β€” Variable between individuals. **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 **Answer: (c)** β€” Explains drug-level changes and dehydration risk. **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 **Answer: (c)** β€” Highly lipophilic. **Q5.** Which is an instrumental activity of daily living (IADL)? - (a) eating - (b) bathing - (c) toileting - (d) managing finances **Answer: (d)** β€” IADLs enable independent living. **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 **Answer: (b)** β€” IADLs are higher-level tasks. **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) **Answer: (d)** β€” Usually outpatient. **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 **Answer: (a)** β€” Weakness, slowness, weight loss, falls. **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 **Answer: (b)** β€” Regular aerobic activity also helps longevity. **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 **Answer: (a)** β€” Assess fall risk routinely. **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 **Answer: (d)** β€” Detects weakness, imbalance, unsteady gait. **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 **Answer: (a)** β€” Also postprandial hypotension, drugs. **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 **Answer: (c)** β€” Plus exercise and education. **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 **Answer: (c)** β€” With fall-prevention education. **Q15.** The tool most commonly used to identify potentially inappropriate medicines in adults β‰₯ 65 is - (a) the AGS Beers Criteria - (b) the CHA2DS2-VASc score - (c) the CURB-65 score - (d) the Glasgow score **Answer: (a)** β€” Not for hospice/end-of-life care. **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 **Answer: (c)** β€” Z-drugs carry similar risks. **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 **Answer: (c)** β€” Listed with benzodiazepines. **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 **Answer: (b)** β€” Also wider distribution (lipid-soluble). **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 **Answer: (b)** β€” Side effect mistaken for a new disease. **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 **Answer: (c)** β€” Responses vary widely. **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 **Answer: (a)** β€” Review regularly. **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 **Answer: (c)** β€” Iatrogenic complications. **Q23.** Elder abuse includes all EXCEPT - (a) financial exploitation - (b) routine prescription of indicated medicines - (c) neglect - (d) psychological mistreatment **Answer: (b)** β€” And physical abuse. **Q24.** The National Programme for Health Care of the Elderly (NPHCE) was launched in - (a) 2005 - (b) 2020 - (c) 1990 - (d) 2010 **Answer: (d)** β€” Based on the National Policy on Older Persons and the 2007 Act. **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 **Answer: (a)** β€” Wards at CHC/DH; Regional Geriatric Centres. **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 **Answer: (c)** β€” Therapeutic exercise and ADL training. **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 **Answer: (d)** β€” And the National Policy on Older Persons. **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 **Answer: (a)** β€” Launched in 2016. **Q29.** Under NP-NCD, opportunistic screening at district hospitals and CHCs happens through - (a) NCD clinics - (b) IDSP units - (c) ICTCs - (d) DOTS centres **Answer: (a)** β€” Population screening extends it to the community. **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 **Answer: (d)** β€” Approved by the Cabinet in 2024. ### 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.