Table 1.

Title core elements for geriatric assessment in and following ICU: the 6M's

Core domain	Site	Agent of care	Timing	Example of intervention
Mobility
Mobilization Passive/active Posturing	ICU/ Step down	ICU Nursing staff/ Physiotherapist	Post admission Stable patient	Positioning in & out of bed; Passive range of movements
			Post admission Stable patient /awake/ cooperative	Active Range of movements/Transfers/ Strength exercise/Balance/ Dynamic/static/coordination
Mind
Cognitive assessment Delirium Assessment	ICU	ICU Nursing staff	Post admission/ Awake/ or RASS > -2	Delirium (hypo / hyperactive) CAM
	Step down	GNP	Awake	CGA
Cognition/orientation	ICU	ICU Nursing staff	Post admission Communicating	Follow up
	Step down	GNP		CGA
Psychological Status/mood/sleep	ICU	ICU Nursing staff	Post admission/ Communicating/ No delirium	Follow up
	Step down	GNP		CGA
Competency/capacity	ICU	GNP/ Geriatrician/ Psychiatrist	Post admission/ Communicating/ No delirium/ No narcotics/ sedatives	Kitchen Picture Test [39]
	Step down/ General ward
Communication	ICU	Speech Therapist/ Nursing staff	Post admission/ Communicating/ No delirium/ No narcotics/ sedatives
	Step down/ General ward
Sensory Integrity/Assistive sensory aids	ICU	Ophthalmologist Otolaryngologist	Post admission	Family and patient interview/Past Medical History/Physical assessment/ ENT/ophthalmologist
	Step down/ General Ward
Pain/nausea	ICU	ICU Nursing staff/ Pain clinic consultants/ GNP for delirious patients	From day one of admission	BPS for sedated patient/ VAS for alert patient
	Step down/ General ward
Medications
Polypharmacy	ICU	Physician/GNP Clinical Pharmacist	Continuous	Assess chronic medications/withholding/reducing/ restarting according to patient's condition
	Step down General Ward		Continuous	Adjusting medications to patient's condition Preparation for stable dosing and long-term treatment
De-prescribing: Psychoactive/Central acting Drugs	ICU	Physician/ GNP	From admission, According to patient's condition. Aim for Minimum dose	BEERS [40] STOPP START [41]
	Step down/ General Ward
Multimorbidity
Sphincter Control/ Autonomic function	ICU/ Step down/ General Ward	Nursing staff follow up	From admission, according to patient's condition
Skin care/pressure sores	ICU/ Step down/ General Ward	Nursing staff follow up	Continuous assessment from admission, according to patient's condition	NORTON scale for risk assessment/ Daily skin assessment [42]
Oral care	ICU/ Step down/ General Ward	ICU Nursing staff	Daily assessment and standard care
Swallowing assessment	ICU/ Step down/ General Ward	Condition dependent Not intubated Awake and cooperative Routing feeding-Nursing Staff	Continuous assessment from admission, according to patient's condition	Staff report swallowing difficulties/ known pathology/ Speech Therapist/ ENT
Nutritional Status	ICU/ Step Down/ General Ward	Dietician	Continuous assessment from admission, according to patient's condition
Frailty/Physiological reserve	ICU	Nursing staff	Assessed on admission	History/Screening tools. CFS [43]
	Step Down/General Ward	Physician/ GNP	Assessed on admission	Diagnostic tools e.g. HANDGRIP/ TUG
What Matters Most
Preferences/goals/ cultural background/Integrity/dignity	ICU/ Step down/ General Ward	Physician/Nursing/ GNP/ Palliative care consultation/ Social Worker (S/W)/ Advanced directives/ Next of Kin (NOK)/ Surrogates	Conscious and competent patients-Assessed on admission or earliest timing possible	Patient preferences/advance directives/surrogates/custodians/family interview
Momentum
Prognostics/Trajectory of critical illness	ICU/ Step Down/ General Ward	Physicians	Updating according to available data	Time-limited trial with short term goals/ monitor biomarkers
Motivation/Compliance/Resilience	Step Down/General Ward	Physician/Nursing/GNP/ Physiotherapists/Social workers/ all staff	Conscious/Competent patient at earliest timing possible
Social support/Family support	ICU/ Step Down/General Ward	S/W	Continuous assessment from admission, background, acute and chronic conditions changes in patient's condition	Family and other caregivers/Barriers to future care/ Finances

BEERS—Beers Criteria for Potentially Inappropriate Medication, BPS—Behavioural Pain Scale, CAM—Confusion Assessment Method, CFS—Clinical Frailty Scale, CGA—Complete Geriatric Assessment, ENT—Ear Nose and Throat, GNP—Geriatric Nurse Practitioner, ICU—Intensive Care Unit, NOK—Next of Kin, RASS—Richmond Agitation and Sedation Scale, STOPP-START—Screening Tool of Older People's Prescriptions (STOPP), Screening Tool to Alert to Right Treatment (START), S/W—Social Worker, TUG—Timed Up and Go, VAS—Visual Analog Scale