Senile Surveillance (Geriatric Surveillance / Geriatric Assessment)

"Senile surveillance" is another way of referring to geriatric surveillance or comprehensive geriatric assessment (CGA) - the systematic monitoring and evaluation of older adults to identify conditions that impair quality of life, independence, and survival, many of which go undetected in standard medical consultations.

Goals of Geriatric Surveillance

The fundamental goal is to improve quality of life, independence, and longevity in elderly patients by:

Identifying conditions that are often undetected but can be ameliorated
Informing prognosis and patients' values/preferences
Guiding management decisions across multiple domains
Goldman-Cecil Medicine, p. 237

The Four Core Components of Comprehensive Geriatric Assessment

1. Functional Assessment

Decline in every organ system occurs at roughly 1% per year after age 30. The assessment covers three tiers of function:

Level	Examples	Clinical Significance
ADLs (Activities of Daily Living)	Feeding, continence, toileting, transferring, bathing, dressing	Impaired in ~10% of community-dwelling adults ≥75 years
Instrumental ADLs	Meal prep, housework, shopping, driving, handling medications/finances	Impaired in ~20% of community-dwelling adults ≥75 years; early sign of undiagnosed dementia
Advanced ADLs	Playing an instrument, social/community roles	Loss may indicate mild cognitive impairment

ADL and instrumental ADL dependency are strong predictors of long-term institutionalization and death.

2. Cognition and Competency

Dementia incidence rises from <1%/year at age 65 to 5%/year at age 85
The Mini-Cog test has high sensitivity and specificity for cognitive impairment
Disorientation to year is ~85% sensitive and ~95% specific for cognitive impairment
Decision-making capacity requires the patient to: (a) make and express personal preferences, (b) comprehend risks/benefits, (c) comprehend decision implications, and (d) give rational reasons for their choice
Note: treating hypertension to a systolic target of 120 mmHg is the only intervention demonstrated to reduce the incidence of dementia and mild cognitive impairment
Goldman-Cecil Medicine, p. 240

3. Mood and Affective Disorders

Depression is common and underdiagnosed in the elderly
Screening tools: Geriatric Depression Scale (GDS) and Mini-Mental State Examination (MMSE) or MoCA
Depression often presents as weight loss, cognitive slowing, or social withdrawal rather than sad mood

4. Geriatric Syndromes and Frailty

Frailty is defined by the presence of 3 or more of:

Unintentional weight loss ≥10 lbs in the past year
Self-reported exhaustion
Low physical activity
Weak grip strength
Slow walking speed

Frailty predicts a 5-fold increase in mortality, plus hip fractures, cognitive decline, and adverse surgical/hospital outcomes.

Goldman-Cecil Medicine, p. 243

Other Key Domains Monitored

Hearing and Vision

Screening especially important in the elderly - untreated hearing loss worsens cognitive outcomes
Impaired vision increases fall risk

Nutrition

Assess with the Mini Nutritional Assessment (MNA) - available at www.mna-elderly.com
Look for involuntary weight loss (≥5% in 6 months), BMI <21, and reduced food intake

Medications (Polypharmacy)

Ask the patient and caregiver to bring all prescribed and over-the-counter medications to every visit
Assess for drug-drug interactions and drugs whose harms exceed benefits
Deprescribing - withdrawing medications one at a time - is a key intervention

Falls

Foot exam: improper footwear and foot deformities are a major cause of falls
Home safety assessment (CDC STEADI program) to reduce fall hazards

Sexuality

Nearly 80% of adults aged 66-75 in good health remain sexually active
Every elderly patient should be asked about sexual activity; screen for STIs as needed

Self-neglect and Elder Abuse

Over 10% of older people suffer mistreatment (emotional, financial, physical, sexual abuse, or neglect)
Screening questions:
- "Are you afraid of anyone?"
- "Has anybody hurt you?"
- "Is anyone taking your money without your permission?"
Most states require clinicians to report reasonable suspicion of abuse to adult protective services
Goldman-Cecil Medicine, p. 244

The Built and Social Environment

Surveillance also includes:

Built environment: Is the home safe given the patient's cognitive/functional abilities? Can they access community services?
Social support: Who helps with daily activities? Who holds durable power of attorney?
Financial assessment: Enough money for food, housing, medications, and emergencies? Eligibility for Medicare/Medicaid/veterans' benefits?

Prognosis Estimation

Life expectancy is estimated using tools like the ePrognosis calculator (eprognosis.ucsfc.edu), which incorporates age, sex, functional status, and comorbidities. This guides decisions about preventive services and the appropriateness of aggressive interventions.

Practical Screening Questions (Geriatric Review of Systems)

From Harrison's Principles of Internal Medicine, a brief "geriatric review of systems" during any visit should screen for:

Functional decline (ADLs/iADLs)
Cognitive changes
Depression/mood
Hearing and vision changes
Falls and mobility problems
Nutritional status
Social support and safety at home

Positive responses should trigger further assessment with validated tools.

Harrison's Principles of Internal Medicine 22e, p. 2079

In summary, senile surveillance / geriatric assessment is a multi-domain clinical process - not a single test - covering function, cognition, mood, frailty, medications, environment, and social context. It is best conducted by a multidisciplinary team and has been shown to improve survival, independent living, and quality of life, especially in older adults with serious diseases.

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