Geriatric multidimensional assessment for elderly patients with acute respiratory diseases

•Comorbidity, disability and frailty aren't synonymous but overlap in elderly.•Delirium is a frequent atypical symptom of elder's acute respiratory diseases.•Comprehensive geriatric assessment is the way to assess frail elder's complexity.

The case of an 87-year-old woman who falls at home and is admitted to the Emergency Department of an acute hospital with delirium exemplify a common situation that physicians face in their everyday clinical practice. We describe the typical context of frailty in which acute illnesses frequently present in frail elderly patients and, in particular, the relationship between comorbidity, disability and frailty. We also report the current knowledge about frailty theories and we focus on the “atypical” presentation of many acute illnesses. Major attention is devoted on delirium and on mobility impairment, two of the most common atypical symptoms of elderly frail subjects. Finally we describe the evidence on the comprehensive geriatric assessment, i.e., the method that is required to identify and understand the ultimate needs of elderly complex subjects.