Geriatrics High-Yield: What the FNP Boards Test About Older Adults

Clinical High-Yield · 9 min read · April 20, 2026

Why Geriatrics Is Increasingly Tested

The US population is aging. Older adults make up a growing proportion of primary care visits — and a growing proportion of FNP board questions. Understanding the unique aspects of geriatric care is essential.

Polypharmacy and the Beers Criteria

Polypharmacy: Use of ≥5 medications simultaneously; associated with adverse drug events, falls, cognitive impairment, non-adherence

Beers Criteria: List of medications potentially inappropriate in older adults (≥65 years). High-yield examples:

• Avoid: Benzodiazepines (fall risk, cognitive impairment), anticholinergics (confusion, urinary retention), NSAIDs (GI bleeding, renal impairment), first-generation antihistamines (diphenhydramine — sedation, anticholinergic effects)
• Use with caution: Warfarin (bleeding risk), opioids (fall risk), antipsychotics (increased mortality in dementia)

Board pearl: When an older adult presents with new confusion, falls, or urinary retention — review the medication list first.

Falls in Older Adults

Risk factors: Previous falls, gait/balance problems, muscle weakness, vision impairment, polypharmacy, cognitive impairment, environmental hazards

Assessment: Timed Up and Go (TUG) test — >12 seconds indicates fall risk

Prevention:

• Exercise (balance and strength training)
• Medication review (reduce fall-risk medications)
• Vision correction
• Home safety assessment
• Vitamin D supplementation if deficient

Dementia

Types:

• Alzheimer's disease: Most common (60–80%); gradual onset, memory loss first
• Vascular dementia: Second most common; stepwise decline, associated with vascular risk factors
• Lewy body dementia: Visual hallucinations, Parkinsonism, REM sleep behavior disorder
• Frontotemporal dementia: Personality/behavior changes, language problems; younger onset

Screening tools: Mini-Cog (3-item recall + clock drawing), MMSE, MoCA

Treatment:

• Cholinesterase inhibitors (donepezil, rivastigmine, galantamine): Mild-moderate Alzheimer's
• Memantine: Moderate-severe Alzheimer's; can combine with cholinesterase inhibitor
• No cure; focus on symptom management and caregiver support

Board pearl: Delirium vs. dementia — delirium is acute onset, fluctuating, with identifiable cause; dementia is gradual onset, progressive. Delirium can be superimposed on dementia.

Urinary Incontinence

Types:

• Stress: Leakage with coughing, sneezing, exercise; weak pelvic floor
• Urge: Sudden strong urge, can't make it to bathroom; overactive bladder
• Overflow: Incomplete emptying, dribbling; BPH, neurogenic bladder
• Mixed: Combination of stress and urge

Treatment:

• Stress: Pelvic floor exercises (Kegel), pessary, surgery
• Urge: Bladder training, anticholinergics (oxybutynin — use with caution in elderly), beta-3 agonists (mirabegron — preferred in elderly)
• Overflow: Treat underlying cause; catheterization if necessary