A Function-First Approach
Geriatric assessment looks at the whole person, and centers on function — what the older adult can actually do. Function is treated almost like a vital sign because it predicts independence and outcomes.
- Function over a single diagnosis — the goal is maintaining independence and quality of life, not just treating one disease.
- Expect complexity — multiple chronic conditions, polypharmacy, and sensory/cognitive changes all interact.
- Track change — a new decline in function is often the earliest sign that something is wrong.
When an older adult "isn't doing what they used to," that's clinically meaningful. Always ask what they can do now versus a few weeks ago — a change in function is a signal to investigate.
Every key point in this guide fits on one free printable page. Jump to the free cheatsheet PDF →
Atypical Presentation
Atypical presentation is the high-yield trap: in older adults, serious illness often shows up without the classic symptoms.
- Infection
- New confusion, a fall, or incontinence — often with little or no fever — instead of obvious infection signs (UTI and pneumonia are common culprits).
- Heart attack
- May be "silent" or present as shortness of breath, fatigue, or weakness rather than crushing chest pain.
- Many illnesses
- Show up first as functional decline, decreased appetite, falling, or "just not acting right."
Treat new confusion, a new fall, or sudden functional decline as a possible sign of acute illness and assess for a cause — don't attribute it to aging. (More in Normal Age-Related Changes.)
ADLs vs IADLs
Functional assessment splits into basic self-care (ADLs) and the more complex skills of independent living (IADLs).
ADLs — basic self-care (Katz)
Bathing
Dressing
Toileting
Transferring (bed to chair)
Continence
Feeding (eating)
IADLs — independent living (Lawton)
Shopping
Managing finances
Managing medications
Using the telephone
Preparing meals & housekeeping
Laundry & transportation
The complex tasks (finances, medications, cooking) tend to slip before basic self-care does. So trouble managing money or pills can be an early warning of cognitive or functional decline — worth a closer look.
? Is "managing medications" an ADL or an IADL — and why does the distinction matter?
Cognitive & Mood Screening
Because confusion and depression are common — and often missed — older-adult assessment routinely screens cognition, delirium, and mood.
- CognitionMMSE / MoCA
- Screens overall thinking and memory; helps detect and track dementia.
- DeliriumCAM
- The Confusion Assessment Method — quick bedside screen for acute, fluctuating confusion. (See the 3 D's.)
- MoodGDS
- The Geriatric Depression Scale — a simple yes/no tool built for older adults.
Key Screening Tools
A quick map of the tools you'll see — each targets a specific high-risk area in older adults. Match the tool to what it screens.
- Katz Index
- Basic ADLs (self-care).
- Lawton Scale
- IADLs (independent-living skills).
- MMSE / MoCA
- Cognition / dementia screening.
- CAM
- Delirium (acute confusion).
- Geriatric Depression Scale
- Depression / mood.
- Braden Scale
- Pressure-injury risk.
- Morse Fall Scale / Hendrich II
- Fall risk. (See Falls.)
- Mini Nutritional Assessment
- Nutrition / malnutrition risk.
Communication Tips
Good assessment depends on good communication — and aging vision, hearing, and processing speed all need accommodating.
- Allow extra time and don't rush; give the person time to process and answer.
- Reduce barriers — ensure glasses and hearing aids are in, face the patient, and lower your pitch rather than shouting.
- Minimize distractions — a quiet, well-lit room.
- Speak respectfully — address adults by name, never "sweetie"; avoid "elderspeak" (baby talk).
- Ask about goals and values — what matters to the patient guides the plan.
Age-related hearing loss affects high-frequency sounds first, so shouting (which raises pitch) often doesn't help. Face the patient, speak clearly at a lower pitch, and reduce background noise.
Frequently Asked Questions
Common student questions on this topic.
What makes geriatric assessment different from assessing a younger adult?
What is the difference between ADLs and IADLs?
What is atypical presentation in older adults?
What screening tools are commonly used with older adults?
Why is functional status so important in older adults?
Quick-Reference Cheatsheet
Every key point from this guide on a single printable page.
Geriatric Assessment Cheatsheet
Free, printable PDF · no spam · returning visitors skip the email step.