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# 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

## Key points

- Domains: clinical, functional, mental (cognitive and affective) and social.
- Basic activities of daily living (bathing, dressing, eating, toileting): Barthel or Katz index. Instrumental (money, medicines, shopping, phone): Lawton-Brody scale.
- Cognition: MMSE, Mini-Cog or Pfeiffer; mood: Yesavage Geriatric Depression Scale.
- Falls (CDC STEADI): fallen in the past year? feel unsteady? worried about falling? A Timed Up and Go of 12 seconds or more indicates risk.
- Delirium: acute onset and fluctuating course with inattention, plus disorganised thinking or altered consciousness (CAM).
- All medicines are reviewed for polypharmacy and inappropriate drugs.

## 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.'

## Memory aid

In the older adult ask what they have, what they can do, what they remember, how they feel and who is with them.

## 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.

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## Related

- [Mental status: orientation, attention and screening tests](https://durgical.com/en/clinical-exam/mental-status-orientation-attention-and-screening-tests/)
- [Inspection of gait and posture (orthopedic)](https://durgical.com/en/clinical-exam/inspection-of-gait-and-posture/)
- [Medicines, allergies and habits: tobacco, alcohol and other substances](https://durgical.com/en/clinical-exam/medicines-allergies-and-habits-tobacco-alcohol-and-other-substances/)
- [Nursing assessment: head-to-toe and focused assessment](https://durgical.com/en/clinical-exam/nursing-assessment-head-to-toe-and-focused-assessment/)

## Related conditions

- [Delirium](https://durgical.com/en/conditions/delirium/)
- [Dementia (major neurocognitive disorder)](https://durgical.com/en/conditions/dementia/)
- [Falls in older adults](https://durgical.com/en/conditions/falls-in-older-adults/)
- [Frailty syndrome](https://durgical.com/en/conditions/frailty-syndrome/)
- [Polypharmacy and potentially inappropriate medications in older adults](https://durgical.com/en/conditions/polypharmacy-and-potentially-inappropriate-medications-in-older-adults/)
- [Urinary incontinence in older adults (urge, overflow, functional)](https://durgical.com/en/conditions/urinary-incontinence-in-older-adults/)

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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](https://www.cdc.gov/steadi/index.html) (Centers for Disease Control and Prevention, 2024); [12.2 Types of Assessment - Fundamentals of Nursing | OpenStax](https://openstax.org/books/fundamentals-nursing/pages/12-2-types-of-assessment) (OpenStax, Rice University, 2024).

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Representative model, for educational purposes only.

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