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Comprehensive geriatric assessment
Comprehensive geriatric assessment is a multidimensional evaluation of the older patient — medical, functional, cognitive, emotional, nutritional and social — that ends with a shared care plan and follow-up, not just a list of diagnoses.
Why it matters in the exam
Many geriatrics exam questions test whether the candidate knows which tool measures what: Katz for basic activities of daily living (ADL), Lawton for instrumental activities (IADL), MMSE or MoCA for cognition, GDS for depression, MNA for nutrition and the Timed Up and Go for gait and fall risk. Another question is who benefits most: a frail older person or one at risk of functional decline, not a fully healthy older adult or a patient at the end of life.
Candidates are also asked about the evidence: comprehensive assessment delivered in a dedicated geriatric unit in hospital increases the chance that the patient is alive and at home a year later compared with usual care. The key point is that the assessment leads to action and follow-up — an assessment without a plan does not help.
In practice the assessment is carried out by a team: a geriatrician, a nurse, a physiotherapist, an occupational therapist, a social worker and a dietitian, each contributing their own domain to a single plan. The exam likes to ask about the difference between an "assessment" and a "consultation": in comprehensive assessment the team also carries out the recommendations and follows them up. Candidates are also asked about including the patient's goals — what matters to them, where they want to live and what treatment they are willing to accept — as part of the assessment rather than as a separate topic, and about repeating the assessment after an admission, a fall or a new decline in function.
Key points
- A multidimensional assessment that ends with a plan and follow-up.
- Katz/Barthel for ADL; Lawton for IADL; IADL is affected first.
- MoCA below 26, MMSE 24 or less, GDS-15 of 5 or more — suspicious findings.
- TUG of 12 seconds or more or gait speed below 0.8 m/s — fall risk.
- Greatest benefit in the frail older adult; in a dedicated unit — more patients alive and at home.
Summary table
| Domain | Common tool | Cut-off / note |
|---|---|---|
| Basic function (ADL) | Katz or Barthel | Bathing, dressing, toileting, transfers, continence, feeding |
| Instrumental function (IADL) | Lawton | Telephone, shopping, cooking, medications, money — affected first in early dementia |
| Cognition | MMSE, MoCA, Mini-Cog | MoCA below 26 or MMSE 24 or less — suspected impairment |
| Mood | GDS-15 | 5 or more — suspected depression |
| Nutrition | MNA | Weight loss of 5% or more in 6 months — warning sign |
| Gait and falls | Timed Up and Go, gait speed | TUG of 12 seconds or more or gait speed below 0.8 m/s — increased risk |
In the full version for subscribers
- A simple algorithm
- Memory aid
- Exam traps
- 5 review cards
- Enough for IMLE
The full version is open to subscribers of: Geriatrics, Medical licensing exam (IMLE), Internal medicine, Family medicine, Physical medicine and rehabilitation.
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Sources
- Geriatrics Review Syllabus (American Geriatrics Society), 11th edition (2022) — Assessment of the older adult
- Brocklehurst's Textbook of Geriatric Medicine and Gerontology, 8th edition (2017) — Comprehensive geriatric assessment
- Cochrane review — Comprehensive geriatric assessment for older adults admitted to hospital, 2017 update — Main results
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.