What questions should be asked during an initial geriatric consult outpatient visit to gather information about a new patient's medical history, current health status, and social support?

Essential Questions for Initial Geriatric Outpatient Consultation

Structure your initial geriatric consultation using the Geriatric 5Ms framework (Mind, Mobility, Medications, What Matters Most, Multicomplexity), which provides a systematic approach to identifying medical, psychosocial, cognitive, physical, and functional needs that directly impact morbidity, mortality, and quality of life. 1

Demographics and Basic Information

• Age, sex, race/ethnicity, birthplace, primary language, years of education, occupation, literacy level 1
• Living situation: type of residence, level of independence, marital status, handedness 1
• Contact person and emergency contacts 1
• Informant identification: relationship to patient, type and amount of contact, living arrangement with patient 1

Mind: Cognitive and Psychological Assessment

Begin with cognitive and psychological evaluation, as this domain influences how all other assessments are conducted and managed. 1

Cognitive Function

• "Do you have serious problems with your memory?" 1
• Subjective cognitive symptoms: onset, progression, impact on daily activities 1
• History of dementia diagnosis or cognitive decline 1, 2
• Delirium history: acute confusion episodes, precipitating factors 2

Psychological Health

• Depression screening: "Over the past 2 weeks, have you felt down, depressed, or hopeless?" and "Have you had little interest or pleasure in doing things?"** 3
• Anxiety symptoms and their impact on function 1
• Coping mechanisms: "How have you been coping?" and "What kinds of support have you been receiving?"** 1
• History of psychiatric conditions and prior treatments 1

Mobility and Fall Risk

• "Have you fallen in the past year?" 3
• Gait problems, balance issues, tremor 1
• Use of assistive devices: cane, walker, wheelchair 1
• History of fractures 1
• Disability assessment: physical limitations affecting mobility 1

Medications

Medication reconciliation is critical, as older adults account for >700,000 emergency visits annually for adverse drug events. 2

• Complete medication list: prescription drugs, over-the-counter medications, herbal supplements, dietary supplements 1
• "Do you take more than 3 medications daily?" 1
• Medication-taking behavior: adherence, rationing of medications or medical equipment 1
• Medication intolerance or side effects 1
• Drug allergies and hypersensitivity reactions 1
• Pharmacy used and medication affordability concerns 1

Functional Status

Basic Activities of Daily Living (ADLs)

Ask specifically about ability to perform each task independently: 1

• Dressing, eating, ambulating/transferring, toileting, bathing 1
• "Do you need help getting in/out of bed, dressing, or bathing/showering?" 1

Instrumental Activities of Daily Living (IADLs)

Assess higher-level functioning: 1

• Shopping, meal preparation, household cleaning 1
• Medication management, finance management 1
• Communication via technology, transportation arrangement 1
• "Before this illness, did you need someone to help you on a regular basis?" 1
• "Since this illness, have you needed more help than usual?" 1

Medical History

Current Health Status

• Cardiovascular disease: myocardial infarction, arrhythmia/atrial fibrillation, heart failure, angina, peripheral artery disease 1
• Cerebrovascular disease: stroke (hemorrhagic/ischemic), transient ischemic attack 1
• "Have you been hospitalized for one or more nights in the past six months?" 1
• Comorbidities: diabetes, hypertension, hyperlipidemia, chronic kidney disease, liver disease, sleep disorders 1
• Autoimmune diseases and chronic infections 1
• History of surgeries and any cognitive difficulties arising post-surgery 1
• Malignancy history 1

Geriatric Syndromes

• Urinary incontinence: "In the last year, have you ever lost your urine and gotten wet?" and "Do you lose urine at least 6 separate days?"** 3
• Swallowing difficulties 1
• Pseudobulbar affect 1

Sensory Function

• Vision: "In general, do you see well?" 1
• Visual impairment affecting daily activities 1
• Last dilated eye examination 1
• Hearing impairment and interference with communication 1
• Last dental visit and dentition status 1

Nutrition and Weight

• "Have you lost weight in the past 3 months?" 1
• Unintended weight loss >5% in 6 months or >10% beyond 6 months 2
• Eating patterns and dietary habits 1
• Difficulty with food intake due to dentition, swallowing, or functional impairments 1

Family History

Family history has become more important as HIV-infected patients live longer and geriatric patients face age-specific conditions. 1

• First-degree relatives with: stroke, cardiovascular disease, dementia, neurological diseases 1
• Myocardial infarction in first-degree relatives before age 55 (males) or 65 (females) 1
• Hypertension, diabetes, hyperlipidemia 1
• Malignancies 1
• Age at death and age of disease onset in relatives 1

Social History and Support

Substance Use

• Tobacco use (current and past) 1
• Alcohol consumption 1
• Recreational drug use 1

Social Support Network

• "Who can you count on for help?" (instrumental support) 1
• "Who can you count on to listen when you need to talk?" (emotional support) 1
• Family structure and relationships 1
• Caregiver presence and adequacy 1
• Who patient can contact in emergencies 1

Social Determinants of Health

Multicomplexity encompasses social determinants that fundamentally alter care management. 1, 2

• Food security: access to adequate nutrition 1
• Housing stability and homelessness risk 1
• Transportation access 1
• Financial security and economic concerns 1
• Community safety 1
• Employment status 1
• Health care access and insurance coverage 1
• Social isolation status 2

What Matters Most: Goals of Care

Autonomy and quality of life are the primary goals of geriatric medicine, not disease cure. 2

• Patient's understanding of their health conditions 1
• Personal values and priorities for care 4
• Goals: maintaining functional status, staying at home, symptom management 1
• Advance care planning: health care proxy documentation, living will, POLST/DNR status 1
• Surrogate decision maker identification 1
• Prognosis understanding and treatment preferences 1

Immunization Status

• Pneumococcal vaccine, influenza vaccine, COVID-19 vaccine 1
• Tetanus toxoid, hepatitis A and B vaccines 1
• Shingles vaccine 1

Daily Routine and Environment

• Daily schedule and routines 1
• Sleep behaviors and sleep disorders 1
• Physical activity level 1
• Home environment safety assessment 1
• Ability to engage in self-management 1

Critical Pitfalls to Avoid

• Never attribute symptoms to "old age" without investigation 2
• Do not miss atypical presentations—elderly patients often lack typical symptoms 2
• Always systematically review medications for appropriateness and deprescribing opportunities 2
• Never overlook cognitive status, as it affects informed consent, medication adherence, and self-care 2
• Always assess frailty, as it predicts outcomes better than chronological age alone 2
• Recognize that reduced capacity for rehabilitation means many patients cannot return to baseline function 2