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:
social and family support
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.
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.