Geriatric Assessment: An Office-Based Approach for Family Physicians

Family physicians should be proficient in geriatric assessment because, as society ages, older adults will constitute an increasing proportion of patients. Since 2013, every day 10,000 baby boomers turn 65 years of age and enter Medicare. By 2030, the population older than 65 years will double to 72 million (20% of the total U.S. population). Individuals are living longer, with multiple chronic illnesses, making them vulnerable to disability and diminished quality of life. Although 95% of older patients with complex needs have regular access to care, 58% struggle to navigate the system, and 62% are stressed about their ability to afford housing, utilities, or meals.

The Scope of Geriatric Assessment

Geriatric assessment evaluates medical, social, and environmental factors that influence overall well-being, and addresses functional status, fall risk, medication review, nutrition, vision, hearing, cognition, mood, and toileting. Geriatric assessment, which evaluates medical problems; cognitive, affective, and functional abilities; and social and environmental factors, can identify these unrecognized needs to improve the well-being of older adults.

Comprehensive geriatric assessment is a systematic evaluation of frail older persons by a team of health professionals and consists of six core components: data gathering, team discussion, development of a treatment plan, and implementation of a treatment plan, with monitoring and revision as needed. Comprehensive geriatric assessment can lead to early recognition of problems that impair quality of life by identifying areas for focused intervention, but a rolling geriatric assessment over several visits can also effectively identify subtle or hidden problems.

Clinical Implementation and Efficiency

Assessment should be tailored to patient goals of care and life expectancy. The Medicare Annual Wellness Visit includes the key elements of geriatric assessment performed by family physicians. By asking patients and families to self-assess risks using precompleted forms, and by using trained office staff to complete validated assessment tools, family physicians can maximize efficiency by focusing on identified problems.

Key Screening Elements

• Fall Risk: Fall risk can be assessed with a single screening question: “Have you fallen in the past year?”
• Medication Review: The Beers, STOPP (screening tool of older persons' prescriptions), and START (screening tool to alert doctors to right treatment) criteria are helpful resources for reviewing the appropriateness of medications in older adults.
• Mental Health: Screening for depression is recommended when depression care supports are available; this can be performed with a brief two-item screen, the Patient Health Questionnaire-2.
• Nutrition: Older adults should be screened for unintentional weight loss and malnutrition.
• Cognition: The U.S. Preventive Services Task Force advises clinicians to assess cognition when there is suspicion of impairment.
• Toileting: Urinary incontinence can impair patients' quality of life, and it can be assessed with a two-question screening tool.
• Preventive Care: Immunizations and advance care planning are also important components of the geriatric assessment.

Evidence-Based Recommendations

The following table summarizes key clinical recommendations for geriatric assessment based on current evidence: