Atypical Presentation of Disease with Aging

In frail older patients, an atypical disease presentation such as a sudden mobility problem or hyperactivity in delirium is often the only signal that a new disease episode occurred. Classical signals of disease may be lacking completely. In fact, atypical symptoms are the most typical characteristics of geriatric patients and urge for a comprehensive geriatric assessment (CGA) to find the causes. Frailty causes close interactions between organs with decreased physiological reserve. The atypical symptoms originate from the individual patient’s most frail organ, which is closely linked to the ill or stressed organ at which the disease episode started. Atypical symptoms mostly have a multifactorial causality with a recent precipitating factor, also called acute geriatric syndromes or geriatric giants. Similarly, more chronic atypical presentations may result in chronic geriatric syndromes, such as malnutrition or cognitive decline. The chapter closes with general guidelines on how to apply evidence-based medicine (EBM) and shared decision-making (SDM) to frail older adults with their complex multicausality and varying treatment wishes.