Disease Presentation

The most common form of atypical disease presentation is with one or several of the geriatric giants listed above. It is important to recognize that one of the geriatric giants may be the presenting complaint but often many coexist. The key to recognizing the geriatric giants as a presentation of disease is to understand that a new appearance of a geriatric giant in an older individual is often a sign of a new illness. Likewise, a worsening of any of these giants equally signifies a problem worthy of assessment. Therefore, it is important to understand how an older person was functioning when they were well in order to notice the new onset of a geriatric giant or worsening of one.

Understanding an individual's level of function is key to understanding the importance of the geriatric giants for picking up disease in older adults. An older person may have difficulties getting around inside and outside their home due to underlying diseases such as osteoarthritis and require a walker. This may be their normal level of function. However, if this same individual is now unable to get up from bed and stand this should indicate that something is wrong and should be considered an atypical presentation of some disease (immobility).

Likewise, when an individual begins to fall (instability) for no apparent reason, the body may be saying that it is sick and this may be the way in which an acute illness is presenting. A new onset of incontinence (either urinary or fecal) is often a marker of an underlying recent illness that also deserves attention.

Acute confusion in an older person is nearly always associated with a new underlying illness. An illness presenting this way would be presenting as one of the geriatric giants-intellectual impairment. In medical terminology this is referred to as delirium, which is an acute change in cognition often associated with inattention. Dementia is also a cause for intellectual impairment but is chronic in nature and slowly progressive. Those with an underlying diagnosis of dementia are at increased risk of developing delirium if ill for any reason.

Any change in an individual's normal level of function requires consideration in order to rule out any possible new illness that may be contributing to the problem. It was found in one study that delirium was the most common form of an atypical disease presentation, being the presenting symptom in 50 percent of those presenting atypically. Falls and immobility combined accounted for 21 percent of the atypical presentations and nonspecific functional decline for another 20 percent.