Practical Geriatric Assessment

The Mini-Cog test, MMSE and MoCA are all well-known cognitive screens. We recommend the Mini-Cog test for its rapidity and assessment of executive function, as well as a lack of education or language bias. We recommend the MoCA for a more thorough cognitive assessment given its excellent sensitivity for even mild cognitive impairment.
MMSE: Mini-Mental Status Examination; MoCA: Montreal Cognitive Assessment

The above medications are listed on both the Beers Criteria and the STOPP criteria as medications to avoid in older adults.
^†Patients may be taking NSAIDs without a prescription; and particular care should be given to inquiring about the use of these medications.
STOPP: Screening tool of older people's potentially inappropriate prescriptions.
Data taken from [61,63,64].

Authors and Disclosures

Tia Kostas^{* 1, 2}, Allison Paquin³ & James L Rudolph<sup>1, 2

1</sup>VA Boston Healthcare System, Geriatrics Research, Education & Clinical Center, 150 South Huntington Avenue, Jamaica Plain, MA 02130, USA
²Brigham & Women's Hospital, Division of Aging, 75 Francis Street, Boston, MA 02115, USA
³VA Boston Healthcare System, Department of Pharmacy (119), 150 South Huntington Avenue, Boston, MA 02130, USA

Financial & competing interests disclosure
T Kostas, AM Paquin and JL Rudolph are all US government employees. JL Rudolph is supported by a VA Rehabiliation Research Career Development Award. T Kostas, AM Paquin and JL Rudolph are supported by a VA Transformational grant to develop noninstitutional alternatives to long-term care – the PILL Project. T Kostas is supported by the John A Hartford Foundation Center of Excellence Award. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.
No writing assistance was utilized in the production of this manuscript.

*Author for correspondence
Tel.: +1 857 364 4153 kostas.tia@gmail.com

Sidebar

Executive Summary

Background

• Geriatric assessment should focus on functional status and how various comorbidities impact patients' function.

• Geriatric assessment should be tailored to each individual patient, using validated screening and assessment instruments when possible.

• Geriatric assessment should include physical, cognitive, psychological and social domains.

Physical Domain

• Providers should systematically assess mobility, falls, vision, hearing, pain and urinary incontinence.

Cognitive Domain

• Elderly patients should be screened for cognitive impairment and delirium.

Psychological Domain

• Depression and alcohol abuse should be evaluated in older adults.

Social Domain

• Providers should conduct an assessment of patients' social support networks and home safety to maximize function.

Key Areas of Functional Decline Related to Multiple Domains

• The healthcare provider should assess medication management, nutrition and driving, as these are complex entities that are often affected by various medical and functional impairments.