What is an example of a comprehensive geriatric assessment?

Comprehensive Geriatric Assessment: A Practical Example

A comprehensive geriatric assessment systematically evaluates older adults across five core domains—the "Geriatric 5Ms" framework (Mind, Mobility, Medications, What Matters Most, and Multicomplexity)—using validated screening tools and multidisciplinary input to identify vulnerabilities and guide treatment planning. 1, 2, 3

The Geriatric 5Ms Framework in Practice

Mind: Cognitive and Psychological Assessment

• Screen for cognitive impairment using the Mini-Cog test, which includes 3-word recall (1 point each) and clock drawing (2 points if normal, 0 if abnormal), with scores 0-2 indicating high likelihood of cognitive impairment 1
• Assess for depression and anxiety as these commonly co-occur with cognitive decline and affect treatment adherence 1, 2
• Evaluate decision-making capacity and identify healthcare proxy information if the patient lacks capacity 1
• Screen for delirium in acute settings, as this represents acute cognitive impairment often precipitated by illness or medications 4

Mobility: Falls and Functional Status

• Conduct fall risk assessment including detailed history of age >65, location and cause of falls, difficulty with gait/balance, falls in previous months, time spent on floor, loss of consciousness, near-syncope/orthostasis, and visual or neurological impairments 1
• Perform the "Get Up and Go" test where patients must rise from bed, turn, and steadily ambulate—inability to do so requires reassessment before discharge 1
• Measure orthostatic blood pressure to identify orthostatic hypotension 1
• Assess both basic activities of daily living (dressing, eating, ambulating/transferring, toileting, bathing) and instrumental activities of daily living (shopping, meal preparation, household cleaning, medication and finance management, communication via technology, transportation arrangement) 1
• Evaluate proximal motor strength and presence of peripheral neuropathies during neurologic examination 1

Medications: Polypharmacy Review

• Perform comprehensive medication reconciliation with special attention to vasodilators, diuretics, antipsychotics, sedative/hypnotics, and other high-risk medications that increase fall risk 1, 2
• Identify potentially inappropriate medications using validated criteria and consider deprescribing 2
• Check measurable medication levels when appropriate (e.g., digoxin, anticonvulsants) 1

What Matters Most: Goals of Care

• Elicit patient's meaningful health outcome goals and care preferences through direct conversation 1, 2
• Discuss advance care planning including healthcare proxy designation, particularly before cognitive decline progresses 2
• Involve family members and caregivers in care planning discussions, especially if cognitive impairment or mood disorders are present 2, 3
• Assess patient's self-perception of health as part of screening tools like the G-8 1

Multicomplexity: Medical and Social Context

• Document all chronic medical conditions including specific comorbidities such as dementia, Parkinson's disease, stroke, diabetes, hip fracture, and depression 1
• Assess nutritional status including food intake, unintended weight loss (>5% in 6 months or >10% beyond 6 months), and body mass index 1, 4
• Evaluate social determinants of health including economic security (one-third of older patients are net worth poor), living conditions, caregiver presence, transportation access, and social isolation 1, 4
• Screen for hearing and vision impairment and ensure patients are wearing hearing aids or glasses if indicated 1
• Assess alcohol use as part of fall risk evaluation 1

Additional Screening Tools

• Use the G-8 screening tool (8 items covering food intake, weight loss, mobility, neuropsychological problems, BMI, prescription drugs, self-perception of health, and age) with scores 0-14 recommending a full geriatric assessment 1
• Apply the CARG toxicity tool (11 items including sociodemographics, tumor/treatment variables, laboratory results, and geriatric assessment variables) for patients receiving cancer treatment, with scores 6-9 indicating intermediate risk and 10-23 indicating high risk for chemotherapy toxicity 1
• Obtain laboratory tests including complete blood count, standard electrolyte panel, hemoglobin, and creatinine clearance when evaluating fall risk or treatment tolerance 1
• Order EKG when cardiac causes of falls are suspected 1

Multidisciplinary Team Involvement

The assessment ideally involves physicians, nurses, social workers, physical therapists, occupational therapists, pharmacists, dietitians, audiologists, and speech-language pathologists, though the core team typically includes the physician, family members/caregivers, and a social worker. 3

Setting and Duration

• Conduct the assessment as an in-person outpatient visit either in a clinical setting or the patient's home 3
• Allocate 45-90 minutes for a comprehensive evaluation 5
• Consider home safety assessment for patients at fall risk, evaluating rubber/nonskid floor surfaces, even floor surfaces, handrails, aisle lighting, bedside commodes, grab bars in restrooms, properly positioned bedrails, and appropriate clothing that minimizes fall risk 1

Common Pitfalls to Avoid

• Never attribute symptoms to "old age" without investigation—all symptoms require evaluation 4
• Do not miss atypical presentations—elderly patients often lack typical symptoms of serious conditions 4
• Avoid overlooking medication burden—systematically review all medications for appropriateness and deprescribing opportunities 2, 4
• Do not ignore cognitive status—cognitive impairment affects informed consent, medication adherence, and self-care abilities 4
• Never fail to assess frailty—frailty predicts outcomes better than chronological age alone and affects approximately 25% of persons aged ≥85 years 4