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Nursing the older adult: functional assessment and geriatric syndromes

  • Assessment

The nurse checks what the older person can do day to day and looks for the common problems of old age, which are not normal ageing.

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What it is

Caring for an older adult starts with a baseline: what the person can do on their own, how they think, eat, sleep, move and feel. In Colombia a person aged 60 or over is generally considered an older person, and the national policy on ageing (2022–2031) aims at healthy, autonomous and independent ageing. Functional assessment asks about basic activities of daily living (washing, dressing, eating, using the toilet, moving) and instrumental activities (shopping, cooking, handling money and medicines, using the phone or transport). The geriatric syndromes are common, multi-cause problems that threaten independence: falls, delirium, incontinence, polypharmacy, frailty, pressure injuries and malnutrition. Confusion, pain or a new loss of function are never «just age»: they are reported and investigated.

Reference values

  • Older person in Colombia: generally 60 years or over.
  • Expected baseline: the person's own usual level of function, thinking and mood, recorded on admission so that changes can be seen.
  • Basic activities of daily living: bathing, dressing, eating, continence, using the toilet, moving from bed to chair, walking.
  • Instrumental activities of daily living: using the phone, shopping, preparing food, housework, transport, managing medicines and money.
  • Memory loss and confusion are not normal ageing.

What you need

  • A quiet, well-lit room, the person's glasses, hearing aid and dentures in place.
  • Time: older adults may need longer to answer and to complete tasks.
  • The functional scales the institution uses (for example Barthel and Lawton), applied as trained.
  • A family member or carer, with the person's permission, to confirm the usual baseline.
  • The complete medicine list, including non-prescription products and herbal remedies.

How to measure it (and why)

  1. Introduce yourself and make sure glasses and hearing aids are in place: sensory loss can look like confusion.
  2. Ask what the person does alone, with help or not at all each day: this sets the baseline for basic activities.
  3. Ask about shopping, cooking, money, medicines, phone and transport: these show whether living alone is safe.
  4. Apply the institutional functional scales as trained and record the result: a number lets the team see change over time.
  5. Ask about falls in the last year and observe gait and balance: a previous fall is a strong warning sign.
  6. Screen for the other syndromes: new confusion, incontinence, skin breakdown, weight loss and poor appetite.
  7. Review all medicines with the team (medication reconciliation): many medicines raise the risk of falls and confusion.
  8. Ask about mood, loneliness, support at home and signs of neglect or abuse: they change the care plan.
  9. Agree goals with the person and plan referrals (physiotherapy, nutrition, social work): the aim is to keep independence.

How to read it

  • A sudden drop in function compared with the baseline points to an acute problem (infection, delirium, a fall injury), not to ageing.
  • Dependence in instrumental activities with preserved self-care suggests the person needs support at home or supervision with medicines.
  • Several syndromes often appear together: for example, poor intake, weakness, a fall and then a pressure injury.
  • Frailty means less reserve: a minor illness can lead to a large loss of function.

Next step: when to call for help

  • Call at once: new or fluctuating confusion, drowsiness or agitation (possible delirium) or a sudden change in neurological status.
  • Report the same shift: a fall, even without visible injury; a new inability to walk or bear weight.
  • Report: new incontinence or urinary retention, new skin breakdown, marked weight loss or refusal to eat.
  • Report: new medicines that raise the risk of falls or confusion, or signs of neglect, abuse or financial exploitation.

Test yourself

Think of the answer, then tap the question to see it.

What is the difference between basic and instrumental activities of daily living?

Basic activities are self-care tasks such as bathing, dressing, eating and using the toilet. Instrumental activities are those needed to live independently, such as shopping, cooking, managing money and medicines.

What do the Barthel index and the Lawton scale assess?

In general terms, both assess how independent the person is in activities of daily living; a change in the result over time shows a gain or loss of function.

Which are the main geriatric syndromes?

Falls, delirium, incontinence, polypharmacy, frailty, pressure injuries and malnutrition.

An older patient is suddenly confused this morning. Is this normal ageing?

No. New or fluctuating confusion is a change from baseline that may be delirium. It is reported at once so the cause can be found.

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Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: Nursing Fundamentals, 19.3: Care of the older adult, applying the nursing process (Open RN, Wisconsin Technical College System (CC BY 4.0), LibreTexts, 2021); Ageing and health (fact sheet) (World Health Organization (WHO), 2024); Envejecimiento y vejez (Ministerio de Salud y Protección Social de Colombia, 2022); Factores asociados a la capacidad funcional de adultos mayores en Bucaramanga-Colombia: estudio ARENA (MedUNAB, Universidad Autónoma de Bucaramanga, 2024).

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Representative model, for educational purposes only.