Table 3.

Areas of assessment included in a geriatric evaluation and approaches to management.

Area of assessment	Approach to assessment	Management
General	-Obtain the medical history with a focus on conditions common to older adults -Obtain collateral history when appropriate and with consent -Focus on physical health, function, cognitive and affective health - Comprehensive review of both basic and instrumental activities of daily living -Review of social, psychological and environmental determinants of health	-Approach is multidisciplinary and includes allied health involvement including nursing staff, pharmacists, social work, physical and occupational therapy -Due to multifactorial nature of problems in geriatrics, treatment is usually directed at the underlying causes -All treatment recommendations ideally will take into consideration individual patient abilities, preferences and goals
Cognition	-Thorough history from both the patient as well as a family member or friend -Comprehensive physical examination with a focus on the neurological examination, including mental status, as well as objective cognitive testing -Consideration of factors that influence cognition and cognitive testing including age, education and sociocultural and linguistic background -Investigations including blood work and imaging when indicated	-Home care support -Social work support -Referral to day programs -Referral to Alzheimer's Society -Medical therapy when indicated
Depression and anxiety	-Comprehensive history and physical examination -Investigations as needed to rule out other conditions which may mimic depression and/or anxiety -Assessment of patient safety and social supports available	-Referral to counseling and psychiatry services as indicated -Consideration of antidepressant and/or, anxiolytic with consideration of pharmacodynamics and pharmacokinetic changes associated with aging
Malnutrition and weight loss	-Comprehensive history and physical exam to elucidate concerns related to reduced intake, increased energy demands, reduced absorption and/or impaired motility -Screen for food insecurity including a safe, accessible and affordable food supply -Screen for depression -Evaluation for red flags related to malnutrition and weight loss which way may warrant targeted investigations	-Referral to dietician when indicated -Referral to Gastroenterology when indicated -Home care, formal/paid care and family supports -Further investigations when indicated based on the history and physical exam
Urinary incontinence and constipation	-Comprehensive history and physical examination -Review of mobility (ability to access toilet), cognition (ability to recognize need to toilet) -Medication and dietary review searching for contributing factors -Cognitive evaluation as needed -Assessment for lower urinary tract symptoms in men -Evaluation for co-existing neurological symptoms	-Scheduled, prompted and assisted toileting where mobility and cognition are deemed to be contributors -Nonpharmacological and pharmacological management targeted to culprit conditions -Urology/gynecology/ Gastroenterologist evaluation as needed -Urodynamic studies, cystoscopy, endoscopy/ colonoscopy, prostate evaluation (PSA) as indicated -Deprescribing of culprit medications
Balance/gait and falls	-Comprehensive history of impaired gait and falls -Comprehensive physical exam and gait evaluation -Bone health assessment -Laboratory investigations, imaging and further testing (i.e., nerve conduction studies) where indicated	-Physiotherapy -Occupational therapy-mobility aids, reducing environmental fall risks in the home -vitamin D supplementation and encouragement of calcium from the diet (or supplement) -Osteoporosis treatment (e.g., bisphosphonates) if indicated -Referral to specialized care (i.e., orthopedic and spinal surgery) where indicated
Polypharmacy	-Thorough review of dose, duration, timing and indications for each medication -Search for indicated medications that have been omitted in prescribing (to avoid under-prescribing) -Review of over the counter and infrequently used medications -Assessment of cannabis product use, as well as frequency and route -Pharmacist review, assessment of medication, dose, correct usage by patient	-Education -Tapering and stopping medications no longer indicated -Re-consideration of prescriptions in which there are drug-drug and/or drug-disease interactions -Adjusting dosages based on renal and hepatic function -Prescribing indicated medications that were previously omitted -Blister packs/dosettes -Medication assistance or oversight when impaired cognition is present
Visual and hearing impairment	-Bedside hearing and vision assessment -Audiologist assessment -Optometrist and/or ophthalmologist assessment for glaucoma, cataracts, vitreous opacities (associated with ATTR)	-Hearing aids and amplifiers -Vision aids -Medications and surgery when indicated
Sleep disorder	-Comprehensive history and review of past medical history -Consideration of co-existing medical comorbidities such as obstructive sleep apnea and cognitive disorders, such as Lewy Body Dementia which may present with sleep disorders -Screen for depression/anxiety	-Patient education around changes in sleep with aging -Sleep hygiene -Exercise prescribing -Minimize caffeine -Referral to Cognitive Behavioral Therapy -Referral for sleep study if indicated

ATTR, transthyretin amyloidosis; PSA, prostate specific antigen.