Multimorbidity and non-specific presentations in older patients
Why older people present with falls, confusion or "off legs" instead of textbook symptoms, how multimorbidity and frailty change the work-up, comprehensive geriatric assessment, the minimum criteria for treating UTI in residential care, and deciding which tests and treatments will change anything.
Tier 1Topic overview
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Multimorbidity is two or more long-term conditions in one person. About half of Australians aged 65 and over live with two or more chronic conditions, and the proportion climbs with age (AIHW).
- Older people often present with non-specific syndromes: delirium, falls, reduced mobility ("off legs"), new incontinence, anorexia or functional decline. The organ that fails is the weakest one, not necessarily the one that is diseased.
- Fever, pain and leucocytosis are blunted. A normal temperature doesn't exclude sepsis.
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Sources
- Comprehensive geriatric assessment for older adults admitted to hospital (Ellis G et al. Cochrane Database Syst Rev 2017;9:CD006211)Cochrane, 2017
- Multimorbidity: clinical assessment and management (NG56)National Institute for Health and Care Excellence, 2016
- Choosing Wisely Australia recommendations, Australian and New Zealand Society for Geriatric MedicineAU/NZChoosing Wisely Australia (now held by the Australian Commission on Safety and Quality in Health Care), 2016
- Statement on transitioning of NPS MedicineWise programs and services (Choosing Wisely Australia to ACSQHC from 1 December 2022)AU/NZNPS MedicineWise, 2022
- Delirium Clinical Care Standard (revised 2021)AU/NZAustralian Commission on Safety and Quality in Health Care, 2021
- Development of minimum criteria for the initiation of antibiotics in residents of long-term-care facilities (Loeb M et al. Infect Control Hosp Epidemiol 2001;22:120-4)Infection Control and Hospital Epidemiology, 2001
- Clinical practice guideline for the evaluation of fever and infection in older adult residents of long-term care facilities: 2008 update by the IDSA (High KP et al. Clin Infect Dis 2009;48:149-71)Infectious Diseases Society of America, 2008
- Clinical practice guideline for the management of asymptomatic bacteriuria: 2019 update by the IDSA (Nicolle LE et al. Clin Infect Dis 2019;68:e83-110)Infectious Diseases Society of America, 2019
- Prevalence of chest pain-free presentation in acute MI, National Registry of Myocardial Infarction (Canto JG et al. JAMA 2000;283:3223-9)JAMA, 2000
- Chronic conditions and multimorbidityAU/NZAustralian Institute of Health and Welfare, 2024
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Personal emails, About story and Australian-style copy