Rotation Prep


Published April 3, 2020

Geriatric Assessment

Elderly patients often do not present with typical signs and symptoms associated with their medical conditions. Given that impediments to detecting those conditions can have detrimental consequences, a geriatric assessment is important for older patients.

The geriatric assessment should involve a detailed history of the patient and the development of a treatment plan, with the ultimate aims of managing the patient’s identified health problems and optimizing his or her health and functional independence. Patients who merit referral for a geriatric assessment include those with known medical comorbidities, dementia, depression, and recent hospitalization.

A comprehensive geriatric assessment is important for evaluating underlying disease processes. The assessment should be multidisciplinary, focusing on:

  • physical health

  • functional capacity

  • nutritional status

  • mood

  • cognition

  • social and family support

  • living situation

A number of screening tools and questionnaires can help in assessing these domains, including the Vulnerable Elders Survey (VES-13), the Katz Index of Independence in Activities of Daily Living, and SF-12.

A geriatric assessment can occur in a variety of settings, including the patient’s home, an outpatient clinic, or a nursing home or hospital. Studies have shown that home geriatric assessments are associated with reduced mortality and improvements in patients’ functional status. In contrast, the clinical-outcomes data on geriatric assessments conducted in hospitals, outpatient clinics, and nursing homes are mixed.

When an older adult is hospitalized, the hospitalization itself signifies a marker of insult that can precipitate disability. This insult can have a lasting effect on the patient’s functional independence to engage in activities of daily living. A comprehensive geriatric assessment that starts in the hospital can help to make care less fragmented and streamline care transitions.

Hospital-Based Geriatric Assessment

A hospital-based geriatric assessment includes:

  • identification of the patient’s understanding of his or her illness, priorities, and goals

  • a timely and thorough discharge summary, including specification of follow-up testing and appointments

  • measurement of cognitive and functional ability or disability

  • safe discharge-medication reconciliation, with deprescribing to limit polypharmacy (see Medication Management in this rotation guide)

  • appropriate education of patient and family regarding the treatment plan and what to do if a problem arises

  • assessment of the patient’s and family’s understanding of this plan

Learn more about the components of geriatric assessment.

NEJM Knowledge+