Clinical exam · History taking and the interview
Comprehensive geriatric assessment: function, cognition, falls !
- History
In an older person diseases are not enough: what they can do alone, memory, mood, nutrition and fall risk are assessed too.
Updated 2026-11-01
What it is
The comprehensive geriatric assessment examines the older person in four domains: clinical, functional, mental (cognitive and affective) and social. It uses short scales to measure what the patient can do alone, memory, mood, nutrition and fall risk. It picks up problems the usual history misses, such as delirium, polypharmacy or frailty, and guides a plan aimed at keeping independence.
What it must include
- Diagnoses, medicines (with a polypharmacy review), vision, hearing, continence and nutrition.
- Function: basic and instrumental activities of daily living.
- Cognition and mood with validated scales; information from the carer.
- Gait, balance and previous falls with their circumstances.
- Support network, housing, home hazards and carer burden.
- Advance directives and the patient's goals of care.
How to ask
- 'Can you bathe, dress, eat and use the toilet without help?'
- 'Do you manage your own money, medicines and shopping? Do you use the phone?'
- 'Have you fallen in the past year? Do you feel unsteady when walking? Are you afraid of falling?'
- 'Have you noticed you forget things more than before?' and ask the relative as well.
- 'In the past weeks have you felt down or lost interest in things you used to enjoy?'
- 'Have you lost weight or appetite? Do you see and hear well? Do you leak urine?'
- 'Who do you live with? Who helps you if you need it?'
- 'Please show me all the medicines you take, including herbal ones.'
Test yourself
Think of the answer, then tap the question to see it.
Which scales assess basic and instrumental activities of daily living?
Basic activities with the Barthel or Katz index; instrumental ones (money, medicines, shopping, phone) with the Lawton-Brody scale.
Which three fall-screening questions does STEADI propose?
Whether the person has fallen in the past year, feels unsteady when standing or walking, and worries about falling.
Which CAM criteria define delirium?
Acute onset with fluctuating course and inattention, plus either disorganised thinking or an altered level of consciousness.
Why is the older patient asked to bring all their medicines?
To detect polypharmacy, duplications, interactions and inappropriate drugs that cause falls, confusion and hospital admissions.
Related
- Mental status: orientation, attention and screening tests
- Inspection of gait and posture (orthopedic)
- Medicines, allergies and habits: tobacco, alcohol and other substances
- Nursing assessment: head-to-toe and focused assessment
Related conditions
- Delirium
- Dementia (major neurocognitive disorder)
- Falls in older adults
- Frailty syndrome
- Polypharmacy and potentially inappropriate medications in older adults
- Urinary incontinence in older adults (urge, overflow, functional)
Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis.
Sources: STEADI - Older Adult Fall Prevention | CDC (Centers for Disease Control and Prevention, 2024); 12.2 Types of Assessment - Fundamentals of Nursing | OpenStax (OpenStax, Rice University, 2024).
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Representative model, for educational purposes only.