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Geriatrics - Geriatric Assessment - Fast Facts | NEJM Resident 360

Older adults 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 tailored treatment plan, with the ultimate aim of managing identified health problems and optimizing 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 the following domains:

• biomedical

• mobility and function

• cognition

• psychosocial

• what matters most

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, Geriatric Depression Scale, UCLA Loneliness Scale, and SF-12.

A geriatric assessment can occur in a variety of settings, including the patient’s home, an outpatient clinic (including via telehealth or phone), 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

• 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.

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