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Americans are living longer and healthier lives. Even so, many older adults will eventually develop one or more of a group of related medical problems called geriatric syndromes.

Vision and hearing problems, bladder problems, dizziness, falls, delirium (a kind of temporary confusion) and dementia (an illness characterized by persistent confusion and memory loss, such as Alzheimer's disease) are examples of geriatric syndromes. These syndromes can limit older adults' abilities to carry out basic daily activities; threaten their independence; and lower their quality of life.

Geriatric syndromes usually have more than one cause, and involve several different body systems. In addition, one geriatric syndrome often contributes to another. A bladder problem, for example, may lead to a bladder infection, which may, in turn, cause delirium. For these reasons, providing medical care for older people with geriatric syndromes can be complicated. Geriatricians -- doctors who have advanced training in the care of older adults -- and other geriatrics healthcare providers can play an important role in diagnosing and managing these syndromes.

Here is the first part of a two-part series on geriatric syndromes and what you should know about them:

Bladder control problems | Delirium | Dementia | Difficulty swallowing | Malnutrition | Sleep Problems

Difficulty swallowing Age-related physical changes, medication side-effects, dementia and certain other illnesses can make swallowing more difficult. This can contribute to malnutrition and related problems, and to choking and aspiration (the inhalation of food or liquid into the lungs, where it can cause pneumonia).
What you should do: If you have difficulty swallowing, tell your healthcare provider. Treatment varies with the underlying cause or causes of the swallowing problem.

Malnutrition Due to age-related physical changes, to chronic illnesses that are common among older adults, and to side effects of medications they may take, older people have different nutritional needs than younger people. Older adults usually need fewer calories than younger adults, but need more of certain nutrients, such as calcium and vitamins D and B12. Older people who don't exercise; have dementia, difficulty functioning, chronic illness, tooth or mouth pain, or depression; drink excessive alcohol or use drugs or are isolated or have limited incomes run a higher risk of malnutrition. Malnutrition can lead to underweight, or, if an older person eats too many calories, to overweight. These problems can lead to other problems, such as weakness and falls, and bone disorders.
What you should do: Your healthcare provider should weigh you when you visit and check for weight gain or loss. Tell your healthcare provider if you're feeling tired or weak or achy, since this may be a sign that you're not getting the nutrients you need. Your provider can investigate possible causes and recommend remedies.

Sleep Problems Sleep problems lower quality of life and can contribute to falls, injuries and other health problems. Stress, anxiety, depression, delirium, dementia, certain drugs, alcohol, and medical problems such as painful arthritis, nerve problems, breathing difficulty, heartburn, and frequent urination at night can cause sleep problems.
What you should do: If you have trouble sleeping or feel sleepy during the day, tell your healthcare provider. He or she will ask you questions that can help identify the type of sleep problem you have. If you often snore or your partner says you stop breathing while asleep (a sign of a sleep disorder called "sleep apnea"), or that you often move your legs and arms while sleeping (a sign of a problem called "periodic limb movements during sleep") your healthcare provider may recommend tests at a sleep lab.

Bladder control problems Many things can cause bladder control problems, or "urinary incontinence," including an overactive bladder muscle, a weak bladder sphincter, urinary tract infection, constipation, delirium, heart disease, diabetes, dementia, medication side effects, and difficulty getting to the toilet. Often, a number of these contribute. Urinary incontinence can lead to problems such as falls, depression, and isolation.
What you should do: In most cases, incontinence can be cured or greatly improved with treatment, so tell your healthcare provider if you have bladder control problems. The treatment your healthcare provider recommends will depend on the underlying causes.

Delirium A significant number of older adults who seek Emergency Room care or are hospitalized have delirium -- a state of confusion that can last days, weeks or even months. Drug side effects, dehydration, thyroid problems, poorly controlled pain, urinary and other infections, poor vision or hearing, strokes, bleeding, and heart and breathing problems can lead to delirium. If delirium isn't recognized and treated quickly it can cause serious and life-threatening complications and loss of function.
What you should do: If you or a loved one suddenly has difficulty paying attention, remembering things or speaking, or is confused, a healthcare provider should be consulted. If you have delirium you should get special care from a team of healthcare providers that includes physicians and nurses. Older adults who are hospitalized should also get special care designed to prevent delirium.

Dementia Alzheimer's disease and "vascular dementia," which is caused by a series of small strokes, are two common forms of dementia. People with Parkinson's disease may also develop dementia. While some healthy older people find it harder to remember things or carry out certain mental activities, this doesn't necessarily mean they have dementia. Dementia gets worse over time and can severely limit ability to function.
What you should do: If memory or thinking problems are making it harder for you to function, tell your healthcare provider. Various tests can help determine whether dementia may be present. If so, there are treatments that can improve functioning and slow progression of the disease.

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Here is the second part of a two-part series on geriatric syndromes and what you should know about them:

Difficulty walking | Dizziness | Fainting | Falls Hearing problems | Pressure Ulcers | "Thinning bones" | Vision problems

Vision problems Among older people, common vision problems include nearsightedness, presbyopia, (age-related changes in the eye that make it hard to see close-up), glaucoma, cataracts, diabetic eye disease, and macular degeneration (damage to the center of the eye that can result in a loss of central vision). Among other things, vision problems can lead to falls.
What you should do: Get a comprehensive eye exam every one to two years. Vision problems can be treated and the earlier treatment begins, the better.

Hearing problems Hearing loss is the most common sensory problem in later life.
What you should do: Ask for a screening hearing test once a year, and tell your healthcare provider if you're having trouble hearing. Treatment improves both hearing and quality of life.

Dizziness Dizziness -- feelings of spinning, near fainting, falling, or lightheadedness -- can make walking more difficult, increase risks of falls, and lessen quality of life. Many things, including low blood pressure, vision problems, inner ear problems, anxiety, and medication side effects can contribute to dizziness. There often is more than one cause.
What you should do: If you often feel dizzy, tell your healthcare provider. There are many treatments for dizziness; treatment depends on the underlying cause or causes.

Fainting Like dizziness, fainting is increasingly common with age and leads to falls. There are many possible causes, including low blood pressure or low blood sugar levels and irregular heartbeat. In older people there are often multiple causes.
What you should do: If you've fainted, tell your healthcare provider immediately. He or she can investigate possible causes and recommend treatment tailored to these causes.

Difficulty walking or "gait impairment" is usually due to a combination of age-related heath problems such as arthritis, bone and muscle problems, disorders such as Parkinson's disease, poor circulation, dizziness, changes due to stroke, vision problems, loss of strength, and even fear of falling.
What you should do: There are many treatments -- ranging from exercise to surgery - that can improve gait and walking considerably. So tell your healthcare provider if you are finding it more difficult to walk.

Falls Injuries from falls are a leading cause of death in older people. Among other things, hazards in the home, medication side effects, walking and vision problems, dizziness, arthritis, weakness, and malnutrition can boost risks of falls. Like other geriatric syndromes, falls usually have more than one cause.
What you should do: Tell your healthcare provider immediately if you've fallen. He or she will investigate what caused the fall and recommend steps to prevent future falls.

"Thinning bones" Osteoporosis, or "thinning bones," is a common health problem among older people, particularly women and men older than 80. It can lead to life-threatening fractures. A diet that doesn't include enough calcium and vitamin D, too little exercise, smoking, too much alcohol, certain medications, and certain bone, thyroid and other health problems can increase risks of osteoporosis. Another bone disorder, osteomalacia, can also lead to fractures, pain and muscle weakness. A lack of vitamin D, certain medications, and kidney, and liver and problems can lead to osteomalacia.
What you should do: Women who are 65 and older, and other people who run an increased risk of osteoporosis, should get a bone mass density (BMD) test for osteoporosis. Increased calcium and vitamin D intake, strength training exercises and weight-bearing exercise (such as walking) can boost BMD. Your healthcare provider may also recommend medications or other treatments. Vitamin D is used to treat osteomalacia.

Pressure Ulcers Also known as "bed sores," pressure ulcers are skin and tissue damage caused by uninterrupted pressure on skin and the "soft tissue" underneath it. Older adults who are unable to move for long periods of time (because they're in bed, or a wheel chair) run an increased risk of pressure ulcers. These can be painful and lead to life-threatening infections. Smoking, underweight, malnutrition, low blood pressure, diabetes, heart disease, kidney failure, and bladder problems can raise risks of pressure ulcers.
What you should do: If you or a loved one is confined to a bed or a wheelchair, healthcare providers should evaluate the risk of pressure ulcers periodically. There are many things healthcare staff can do to help prevent pressure ulcers, including treating malnutrition; providing appropriate skin care and pressure reducing bedding and cushions; repositioning you or the loved one often; and encouraging appropriate exercise.