Back To Search Results

Geriatric Care Special Needs Assessment

Editor: Ranjan Dahal Updated: 2/20/2023 8:39:54 PM


The elderly population (age >65 years) is increasing throughout the world, leading to increased hospitalization. There was a 16.7% increase in elderly hospitalization from 2003-2009 in the United States. This rising hospitalization has impacted healthcare services delivery.[1] With the aging population comes a multitude of chronic conditions. It is estimated that 9 out of 10 Americans have at least one chronic condition by age 80.[2] 

Due to multiple comorbidities and frailty, the elderly are at increased risk of adverse outcomes with each clinical insult.[1] Besides the common comorbidities such as diabetes and hypertension, older patients can present with atypical presentation too. For example, a patient with sepsis may present without fever, or a patient with Urinary Tract Infection (UTI) may present with confusion. The elderly population varies in cognitive, physical, and social functioning and thus requires different levels of care based on individual needs and functional status.[3][4] 

Geriatric assessment, thus, includes a coordinated approach for the physical, functional, and psychosocial assessment of the elderly and formulate an integrated plan of care.[1]

Issues of Concern

Register For Free And Read The Full Article
Get the answers you need instantly with the StatPearls Clinical Decision Support tool. StatPearls spent the last decade developing the largest and most updated Point-of Care resource ever developed. Earn CME/CE by searching and reading articles.
  • Dropdown arrow Search engine and full access to all medical articles
  • Dropdown arrow 10 free questions in your specialty
  • Dropdown arrow Free CME/CE Activities
  • Dropdown arrow Free daily question in your email
  • Dropdown arrow Save favorite articles to your dashboard
  • Dropdown arrow Emails offering discounts

Learn more about a Subscription to StatPearls Point-of-Care

Issues of Concern

Issues of concern in geriatric assessment can be broadly divided into the following 4 classes:

  1. Functional Status
  2. Physical Health
    • Vision impairment
    • Hearing loss
    • Nutrition status
    • Fall prevention
    • Urinary Incontinence
    • Osteoporosis and arthritis
  3. Polypharmacy and Medication Reconciliation
  4. Cognitive Assessment
    • Dementia
    • Sleep and insomnia
    • Mood disorder

1. Functional Status

Evaluation of one's ability to perform activities required to live independently comprises functional status assessment. It can be broadly divided into 2 levels - basic activities of daily living (BADL), which includes activities of self-care such as feeding, dressing, bathing, toileting, grooming, controlling bladder and bowel movements, etc. and instrumental activities of daily living (IADL) which includes activities to live independently such as taking medications, shopping, preparing meals, driving/using public transport, handling finances, doing household works, using telephone, etc. Commonly used indices to assess such activities are the Katz index for BADL and the Lawton scale for IADL. Information about functional status can also be achieved by asking open-ended questions about their daily activities. Functional status is directly affected by physical health, so any change in functional status should prompt further evaluation. There are various validated tools to measure functional ability, such as the Vulnerable Elders Scale-13 or Clinical Frailty Scale.[5][6] Recently, gait speed has also been proposed as a screening tool for functional status.[7] One pooled analysis showed gait speed is associated with better survival for every 0.1 m/s increments.[8]

2. Physical Health

Geriatric assessment should include detailed medical history and physical examination, with particular focus on problems specific to the elderly such as vision, hearing, nutrition, fall prevention, urinary incontinence, osteoporosis, and preventative health.

Preventative Health

Preventative health includes screening for diseases such as diabetes mellitus, hypertension, cancer, etc. Early identification and treatment may be beneficial in diabetes, hypertension as well as in certain malignancies. However, the American Geriatric Society recommended that such screenings be based on patient's preferences, life expectancy, and co-morbid conditions rather than solely on age-based criteria. Older patients may have many co-morbid conditions that can shorten their life, hence the potential benefits of such screening tests and patient's preference for further evaluation and invasive procedure if screened positive should be taken into account before the screening. For the same reason, screening should be focused on treatable conditions which can provide immediate benefit to their quality of life rather than on asymptomatic diseases.[9] Similarly, vaccine-preventable infections such as influenza, pneumonia, herpes zoster, etc., represent major causes of morbidity and mortality in older patients. Hence, most societies recommend following vaccines routinely for older patients: influenza vaccine, pneumococcal vaccine, herpes zoster vaccine and tetanus, Diptheria, and acellular pertussis vaccine. Depending on specific co-morbidities, an older patient may qualify for other vaccines as well.[10][11]


Visual impairment affects older patients' functional status, especially functions such as driving, preparing meals, managing money, etc. are significantly affected. It is also associated with falls, cognitive decline, and depression in the elderly.[12] Older patients are at increased risk of visual impairment due to age-related decline as well as co-morbid conditions. Common causes of visual impairment in the elderly are cataracts, glaucoma, presbyopia, macular degeneration, diabetic retinopathy, and hypertensive retinopathy.[13] Although studies show an increased association of visual impairment with functional decline, one meta-analysis of 5 randomized controlled trials failed to show any evidence of decreased visual impairment with visual screening in the elderly.[12][14] The U.S. Preventive Services Task Force (USPSTF) did not find sufficient evidence to recommend routine visual screening in older patients. However, any decline in functional capacity, cognition, or falls should prompt a visual assessment. This can be done with a Snellen chart, questionnaires, or direct fundoscopic examination. In contrast to USPSTF, the American Academy of Ophthalmology recommends comprehensive eye examinations every 1 to 2 years for adults 65 years and older.[15]


Hearing loss is, in fact, the third most common condition in older patients. Like visual impairment, hearing loss is associated with functional decline, poor cognition, and dementia, social isolation, and depression.[16][17] USPSTF does not recommend routine screening for hearing loss in older patients due to insufficient evidence. However, the decline in cognition, functional capacity, or mood should lead to hearing loss screening. Rapid test such as whispered voice test has shown to be highly sensitive and specific for screening.[18] Providers should be aware of difficulties in communication due to hearing loss and avoid misdiagnosing it as cognitive decline or stroke. Patients who fail the screening test should be referred to an otolaryngologist for possible need of a hearing aid.[19][16]


Up to 15% of the community-dwelling elderly population is affected by malnutrition, which is associated with a decline in physical health, such as poor wound healing, anemia, immune dysfunction, etc. Poor cognition, functional decline, and an overall increase in mortality.[20][21] Besides organic causes (chronic medical conditions, malignancy, poor dentition, etc.), various psychosocial causes (depression, alcoholism, isolation, bereavement, etc.) also lead to malnutrition in the elderly.[22] Although there is no single laboratory screening test for this condition, clinical assessment, serial weights on clinic visits, and various validated tools such as Mini Nutritional Assessment (MNA) or Geriatric Nutrition Risk Index (GNRI) can be used for nutritional assessment in older patients.[23][24] The elderly population at-risk as determined by one of these screening strategies should undergo further evaluation to determine the cause and initiate treatment such as optimizing chronic medical conditions, proper dentition, adequate assistance for physically or mentally disabled patients, and oral supplementation or enteral feeding as needed.[22][25]


About 28% of older adults report falling at least once in the last year, as per a recent cross-sectional study in the United States.[26] Besides obvious health hazards such as hip fractures and trauma, falls also cause limitations in physical and social activities directly and due to fear of falling indirectly, further leading to functional decline.[27][28] In the US, the toll on health care cost due to falls is around $50 billion.[29] Therefore, the American Geriatric Society recommends all adults above 65 be screened for falls and instability annually.[30] One meta-analysis of 33 studies evaluating 26 tools for fall risk assessment did not find a single tool to have both high sensitivity and specificity to assess fall risk.[31] 

A systematic review of 18 studies reported fall to be multifactorial with the following risk factors - history of falls, gait or balance impairment, orthostatic hypotension, visual impairment, cognitive impairment, impairment in activities of daily living, and medications such as benzodiazepines, antidepressants, diuretics, etc. Of these, the two most predictive risk factors were history of falls and gait or balance impairment. When adjusted for other variables, age was not as important as the aforementioned two risk factors in predicting falls. Hence, a simple approach could be to ask for a history of falls and any abnormality in gait and balance. The patient will be at high risk if he/she answers "yes" to any one of these questions.[32] Due to multifactorial causes, high-risk patients benefit more from a multidisciplinary approach formulating individualized fall prevention strategies, some of which can include exercise programs, optimizing medical conditions, discontinuing medications such as benzodiazepine, environmental safety, and use of assistive devices.[33][34]

Urinary Incontinence

Most studies show the prevalence of urinary incontinence (UI) in the range of 25-45% and rise further with aging.[35] However, UI is not a normal or inevitable consequence of aging. Older patients suffering from UI cannot participate in social activities leading to isolation, increased risk of depression, and functional disability. It can also increase the risk of falls, fractures, affects sexual health, and causes an overall reduction in quality of life. UI can be classified into 5 types - stress, urge, overflow, mixed and functional. Stress incontinence is leakage of urine due to activities that increase abdominal pressure. Urge incontinence is characterized by leakage of urine after a sudden urge to void. Overflow incontinence manifests as frequent small volume leaks, usually due to bladder outlet obstruction or neurological disorders. Functional incontinence refers to incontinence resulting from an inability to use the toilet independently due to functional disability such as cognitive impairment or limited mobility. Mixed incontinence is the combination of 2 or more types of incontinence.[36][37] 

Initial evaluation of incontinence should comprise a non-invasive approach, including detailed medical history, fluid intake assessment, self-voiding diary, etc.; however, complicated cases may necessitate urodynamic studies. A simple and reproducible validated tool to differentiate stress and urge incontinence is 3 Incontinence Questions which comprises questions about urinary leaks.[38] Conservative treatments such as behavioral modification, dietary modification, pelvic floor muscle training, timed voiding, and weight loss should be tried first. Various pharmacological therapies are available for urge incontinence. A systematic review of 13 trials showed anticholinergics as the only pharmacological therapy that decreased urinary leakage in urge incontinence.[39] Devices such as pessaries can be used for incontinence associated with pelvic organ prolapse. Similarly, surgical options such as sling procedures and neuromodulation can be offered to carefully selected patients with incontinence.[36]

Osteoporosis and Arthritis

Osteoporosis and osteopenia are common in the elderly and can lead to fractures even with mild trauma. Increased bone loss due to aging and menopause in women puts older patients and post-menopausal women at high risk of osteoporosis.[40] Screening and diagnosis should be with dual-energy X-ray absorptiometry of the hip and/or spine. Due to their increased risk, USPSTF recommends routine screening of women older than 65 for osteoporosis.[4] Preventive measures in the elderly should include early diagnosis, nutritional supplements with calcium and vitamin D, and fall prevention.[40]  

Osteoarthritis (OA) is a major cause of disability and pain in older patients. About 50% of people will have OA changes in knees by age 65, and almost everyone will have at least 1 joint affected with OA by age 75. Evaluation should include ruling out infectious process, rheumatoid arthritis, polymyalgia rheumatic, gout, and pseudogout. A careful history, physical examination, arthrocentesis, laboratory tests, and radiographic imaging may be necessary to come to a diagnosis. Medication such as NSAIDs and acetaminophen are used primarily to manage symptoms as no pharmacological cure is available for OA. Despite early enthusiasm, glucosamine and chondroitin sulfate have not shown to decrease pain in a recent clinical trial. Joint replacement surgery for carefully selected older patients may provide maximum benefit in improving the quality of life.[41]

3. Polypharmacy

Patients older than 65 use more than 30% of all prescribed medication in the U.S.[42] Polypharmacy in the elderly is multifactorial - multiple comorbidities, multiple specialties on board, multiple hospitalization and transition of care, self-medication, prescription cascade, and cognitive decline in the elderly contribute to polypharmacy.[43][44] 

Taking multiple medications can cause serious adverse effects due to the drug itself, drug-drug interaction, and drug-disease interaction.[42] Besides, there are also increased chances of iatrogenic illness due to overprescribing, poor compliance due to multiple medications, increased falls, overall poor quality of life, increased hospitalization, and even death.[44] Commonly prescribed drugs such as aspirin, warfarin, oral hypoglycemic agents, insulin, and digoxin are responsible for most hospitalizations due to adverse drug effects. The medication list should be scrutinized to see if any new signs and symptoms in the elderly are due to the prescribed medication. It is, thus, important to do a comprehensive medication reconciliation at least annually and after each transition of care to check if the medication in use is really necessary.[42][43] Physicians can refer to the American Geriatric Society's Beers criteria which lists the potentially inappropriate medication that should be avoided in the elderly.[45] 

4. Cognitive Assessment

Prevalence of mild cognitive impairment (MCI) and dementia increases with age. The prevalence of dementia is around 5% to 7%, and that of MCI is about 4 times that of dementia.[46][47] Due to their age, multiple comorbidities, and above-described factors, older patients are at increased risk of MCI and dementia. Many of these older patients present to primary care providers with complaints of memory problems. Early detection of such conditions can help determine the reversible causes, initiate appropriate pharmacological interventions early and help patients and caregivers plan for the future.[48] Hence, providers should have a low threshold to screen for cognitive decline in elderly patients. There are various validated tools to screen for cognitive declines, such as Mini-Mental State Exam (MMSE), Montreal Cognitive Assessment (MoCA) test, and Mini-Cog.[48][49] Mini-Cog, due to its simplicity and minimal language interpretation, can be used in multi-lingual patients.[50]


Insomnia is one of the common presenting problems of older patients. Poor sleep is associated with increased fatigue, falls, nursing home placement, poor quality of life, and overall mortality. Quality of sleep decreases with aging. Sleep disorders could be primary such as insomnia, restless leg syndrome, obstructive sleep apnea, or secondary to comorbid medical, psychiatric, behavioral, environmental, or medication side effects. Assessment of sleep disorder should include evaluation for secondary causes if any. Due to increased side-effects of hypnotics used in the treatment of insomnia, non-pharmacological interventions such as cognitive behavioral therapy, education about sleep hygiene and expected changes with aging, stimulus control, decreased daytime sleep and dietary modifications are the first line of treatment for insomnia.[51][52]


Almost half of the cases of depression have their onset at 60 or older. Depression is associated with decreased cognition, physical and social functioning, self-care, and independence. Older patients with depression die at a higher rate; a portion of that death rate results from the highest suicide rate among older adults.[53] Options for treatment, when diagnosed early, include psychotherapy and antidepressant medications. USPSTF recommends screening for depression in all adults.[54] Patient Health Questionnaire (PHQ) 2 is a validated screening tool for depression screening, which, if positive, should be followed by PHQ 9 to diagnose depression in the elderly.[55]

Clinical Significance

Due to the aging process, even a well-functioning older patient can deteriorate rapidly due to any 1 or a combination of issues. The development of any new signs or symptoms in the elderly can be due to the adverse effects of medication. Hence, medication reconciliation and avoidance of polypharmacy are important in every visit or each transition of care.[43] Similarly, falls are one of the major causes of disability and morbidity in the elderly. It is important to assess for falls and discuss ways to prevent them during each visit.[28][30]

Sensory issues such as vision and hearing impairment can also lead to functional decline and masquerade as mood changes and cognitive impairment. So, patients with suspicion of such symptoms should be assessed for vision and hearing impairment. Urinary incontinence (UI), osteoporosis, and arthritis can all lead to functional decline by limiting older patients' mobility. It is important to get detailed history to diagnose the type of UI and provide appropriate treatment based on UI type. Appropriate nutrition and preventative health, use of safe medication, and surgical options like knee replacement can significantly improve the health of patients who have osteoporosis and arthritis. Early recognition of cognitive decline, including dementia, insomnia, and mood disorder, could provide an opportunity to begin behavioral and medical therapy early in the course of the disease with the possibility to reverse or at least arrest the disease progression.[48] 

Older patients make the largest share of health care consumers at present. However, due to multiple issues, it can be overwhelming for providers to address all of these. The use of various standardized tools can help alleviate confusion and discrepancy in assessing older patients. It is important to address such issues on a rollover basis during each clinic visit to improve outcomes for this vulnerable population.[4]

Other Issues

Some of the Other Issues of Concern Include

Safety assessment

  • Home safety
  • Driving safety
  • Elder mistreatment

Goals of care and advanced directives 

Safety Assessment

Home safety: About 57,000 adults above age 65 died of unintentional injuries in 2018 as per the Centers for Disease Control and Prevention (CDC), more than half of which is estimated to be due to falls. Decline in overall health at old age along with isolation leads to a higher risk of accidents at home. Clinicians should discuss common ways to prevent falls at home, such as lights, handrails, and walking assistance devices. CDC has published a checklist for home fall prevention for older adults, which can be found at

Driving: Driving is a complex task and is affected by the decline in visual, motor, and cognitive ability in old age. However, it is also one of the important IADLs that help older patients maintain mobility and engage socially. Therefore, the prospect of "retiring from driving" is highly stressful for the elderly, and such recommendations should be made based on individualized assessment. Besides testing for visual acuity, neck mobility, and reaction time, a multidisciplinary approach including an ophthalmologist, a psychiatrist, a pharmacist, a physical therapist, and an occupational therapist can help assess and improve driving function. If the risk of driving is high, options for alternative forms of transportation and mobility should be discussed with patients and caregivers.[56]

Mistreatment: Elder mistreatment includes abuse and neglect. Various studies show the prevalence of elder mistreatment ranging from 2 to 36%. In the U.S., the prevalence is around 9.5%. Still, the reported prevalence is low as elder abuse tends to be underreported.[57] Some of the signs of mistreatment could be bruising in unusual places, burns, bite marks, genital trauma, pressure ulcers, BMI<17.5 kg/m2, frequent emergency room visits, etc. Such patients should be screened for mistreatment and may need further evaluation by a social worker.[58]

Goals of Care and Advanced Directives

Clinicians should discuss goals of care and advance directives primarily in ambulatory settings, well in advance of facing health crises. Effective communication allows the patient to cope with the serious illness and empowers them to direct their treatment. Goals of care discussion should be individualized as different patients would have different short or long-term goals. Similarly, advanced directives discussion allows the providers to know about the patient's wishes, prevents confusion at the end of life, and minimizes healthcare costs by deferring unwanted medical procedures. Such discussions do not increase depression, anxiety, or hopelessness in patients rather improve their quality of life and even survival by up to 25%. It also decreases stress, anxiety, and depression among family members and improves family satisfaction.[59][60][61]

Enhancing Healthcare Team Outcomes

Life expectancy has improved over the last few decades due to advancements in medical science. Due to this, the population of older patients has also increased significantly. United States Census Bureau estimates around 49 million people in the US are 65 years or over in 2016. Impairment in multiple domains in the aging population inversely affects health outcomes and quality of life. Hence, a comprehensive assessment in this population is imperative for early diagnosis and treatment of a wide variety of issues in the older population.[62]

Due to the multitude of comorbidities, geriatric assessment and care require coordination between all members of the interprofessional healthcare team, including clinicians of different specialties like primary care, hospitalist, geriatrician, psychiatrist, podiatrist, dentist, to name a few, as well as nurse, social worker, and other allied health care workers such as a physical therapist, occupational therapist, nutritionist, pharmacist, psychologist, audiologist and optician. A systematic review of 29 randomized controlled trials has shown that hospitalized older patients who receive this kind of assessment have more chances of surviving and living at home than in nursing homes.[1] [Level I]



Ellis G,Gardner M,Tsiachristas A,Langhorne P,Burke O,Harwood RH,Conroy SP,Kircher T,Somme D,Saltvedt I,Wald H,O'Neill D,Robinson D,Shepperd S, Comprehensive geriatric assessment for older adults admitted to hospital. The Cochrane database of systematic reviews. 2017 Sep 12;     [PubMed PMID: 28898390]

Level 1 (high-level) evidence


Sucher JF,Mangram AJ,Dzandu JK, Utilization of Geriatric Consultation and Team-Based Care. Clinics in geriatric medicine. 2019 Feb;     [PubMed PMID: 30390981]


Mooijaart SP, Improving the care for older emergency department patients: the Acutely Presenting Older Patient study. Zeitschrift fur Gerontologie und Geriatrie. 2021 Mar;     [PubMed PMID: 33693970]


Elsawy B,Higgins KE, The geriatric assessment. American family physician. 2011 Jan 1;     [PubMed PMID: 21888128]


Min L,Yoon W,Mariano J,Wenger NS,Elliott MN,Kamberg C,Saliba D, The vulnerable elders-13 survey predicts 5-year functional decline and mortality outcomes in older ambulatory care patients. Journal of the American Geriatrics Society. 2009 Nov;     [PubMed PMID: 19793154]

Level 3 (low-level) evidence


Rockwood K,Song X,MacKnight C,Bergman H,Hogan DB,McDowell I,Mitnitski A, A global clinical measure of fitness and frailty in elderly people. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne. 2005 Aug 30;     [PubMed PMID: 16129869]


Cesari M, Role of gait speed in the assessment of older patients. JAMA. 2011 Jan 5;     [PubMed PMID: 21205972]


Studenski S,Perera S,Patel K,Rosano C,Faulkner K,Inzitari M,Brach J,Chandler J,Cawthon P,Connor EB,Nevitt M,Visser M,Kritchevsky S,Badinelli S,Harris T,Newman AB,Cauley J,Ferrucci L,Guralnik J, Gait speed and survival in older adults. JAMA. 2011 Jan 5;     [PubMed PMID: 21205966]

Level 2 (mid-level) evidence


American Geriatrics Society Ethics Committee., Health screening decisions for older adults: AGS position paper. Journal of the American Geriatrics Society. 2003 Feb;     [PubMed PMID: 12558727]


Triglav TK,Poljak M, Vaccination indications and limits in the elderly. Acta dermatovenerologica Alpina, Pannonica, et Adriatica. 2013 Sep;     [PubMed PMID: 24089135]


Koldaş ZL, [Vaccination in the elderly population]. Turk Kardiyoloji Dernegi arsivi : Turk Kardiyoloji Derneginin yayin organidir. 2017 Sep;     [PubMed PMID: 28976399]


Sloan FA,Ostermann J,Brown DS,Lee PP, Effects of changes in self-reported vision on cognitive, affective, and functional status and living arrangements among the elderly. American journal of ophthalmology. 2005 Oct;     [PubMed PMID: 16226514]


Miller KE,Zylstra RG,Standridge JB, The geriatric patient: a systematic approach to maintaining health. American family physician. 2000 Feb 15;     [PubMed PMID: 10706161]

Level 1 (high-level) evidence


Clarke EL,Evans JR,Smeeth L, Community screening for visual impairment in older people. The Cochrane database of systematic reviews. 2018 Feb 20;     [PubMed PMID: 29460275]

Level 1 (high-level) evidence


Feder RS,Olsen TW,Prum BE Jr,Summers CG,Olson RJ,Williams RD,Musch DC, Comprehensive Adult Medical Eye Evaluation Preferred Practice Pattern(®) Guidelines. Ophthalmology. 2016 Jan;     [PubMed PMID: 26581558]


Cosh S,Helmer C,Delcourt C,Robins TG,Tully PJ, Depression in elderly patients with hearing loss: current perspectives. Clinical interventions in aging. 2019;     [PubMed PMID: 31616138]

Level 3 (low-level) evidence


Ford AH,Hankey GJ,Yeap BB,Golledge J,Flicker L,Almeida OP, Hearing loss and the risk of dementia in later life. Maturitas. 2018 Jun;     [PubMed PMID: 29704910]


Pirozzo S,Papinczak T,Glasziou P, Whispered voice test for screening for hearing impairment in adults and children: systematic review. BMJ (Clinical research ed.). 2003 Oct 25;     [PubMed PMID: 14576249]

Level 1 (high-level) evidence


Yueh B,Shapiro N,MacLean CH,Shekelle PG, Screening and management of adult hearing loss in primary care: scientific review. JAMA. 2003 Apr 16;     [PubMed PMID: 12697801]


Verdery RB, Failure to thrive in the elderly. Clinics in geriatric medicine. 1995 Nov;     [PubMed PMID: 8556693]


Chapman IM, Nutritional disorders in the elderly. The Medical clinics of North America. 2006 Sep;     [PubMed PMID: 16962848]

Level 2 (mid-level) evidence


Ahmed T,Haboubi N, Assessment and management of nutrition in older people and its importance to health. Clinical interventions in aging. 2010 Aug 9;     [PubMed PMID: 20711440]


Vellas B,Guigoz Y,Garry PJ,Nourhashemi F,Bennahum D,Lauque S,Albarede JL, The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition (Burbank, Los Angeles County, Calif.). 1999 Feb;     [PubMed PMID: 9990575]


Abd Aziz NAS,Mohd Fahmi Teng NI,Kamarul Zaman M, Geriatric Nutrition Risk Index is comparable to the mini nutritional assessment for assessing nutritional status in elderly hospitalized patients. Clinical nutrition ESPEN. 2019 Feb;     [PubMed PMID: 30661705]


Bourdel-Marchasson I,Barateau M,Rondeau V,Dequae-Merchadou L,Salles-Montaudon N,Emeriau JP,Manciet G,Dartigues JF, A multi-center trial of the effects of oral nutritional supplementation in critically ill older inpatients. GAGE Group. Groupe Aquitain Geriatrique d'Evaluation. Nutrition (Burbank, Los Angeles County, Calif.). 2000 Jan;     [PubMed PMID: 10674226]

Level 1 (high-level) evidence


Moreland B,Kakara R,Henry A, Trends in Nonfatal Falls and Fall-Related Injuries Among Adults Aged ≥65 Years - United States, 2012-2018. MMWR. Morbidity and mortality weekly report. 2020 Jul 10;     [PubMed PMID: 32644982]


Tinetti ME,Williams CS, The effect of falls and fall injuries on functioning in community-dwelling older persons. The journals of gerontology. Series A, Biological sciences and medical sciences. 1998 Mar;     [PubMed PMID: 9520917]


Tinetti ME,Mendes de Leon CF,Doucette JT,Baker DI, Fear of falling and fall-related efficacy in relationship to functioning among community-living elders. Journal of gerontology. 1994 May;     [PubMed PMID: 8169336]

Level 2 (mid-level) evidence


Florence CS,Bergen G,Atherly A,Burns E,Stevens J,Drake C, Medical Costs of Fatal and Nonfatal Falls in Older Adults. Journal of the American Geriatrics Society. 2018 Apr;     [PubMed PMID: 29512120]


Berková M,Berka Z, Falls: a significant cause of morbidity and mortality in elderly people. Vnitrni lekarstvi. Winter 2018;     [PubMed PMID: 30606025]


Park SH, Tools for assessing fall risk in the elderly: a systematic review and meta-analysis. Aging clinical and experimental research. 2018 Jan;     [PubMed PMID: 28374345]

Level 1 (high-level) evidence


Ganz DA,Bao Y,Shekelle PG,Rubenstein LZ, Will my patient fall? JAMA. 2007 Jan 3;     [PubMed PMID: 17200478]


Rubenstein LZ, Falls in older people: epidemiology, risk factors and strategies for prevention. Age and ageing. 2006 Sep;     [PubMed PMID: 16926202]


Kruschke C,Butcher HK, Evidence-Based Practice Guideline: Fall Prevention for Older Adults. Journal of gerontological nursing. 2017 Nov 1;     [PubMed PMID: 29065212]

Level 1 (high-level) evidence


Milsom I,Gyhagen M, The prevalence of urinary incontinence. Climacteric : the journal of the International Menopause Society. 2019 Jun;     [PubMed PMID: 30572737]


Griebling TL, Urinary incontinence in the elderly. Clinics in geriatric medicine. 2009 Aug;     [PubMed PMID: 19765492]


Khandelwal C,Kistler C, Diagnosis of urinary incontinence. American family physician. 2013 Apr 15;     [PubMed PMID: 23668444]


Brown JS,Bradley CS,Subak LL,Richter HE,Kraus SR,Brubaker L,Lin F,Vittinghoff E,Grady D,Diagnostic Aspects of Incontinence Study (DAISy) Research Group., The sensitivity and specificity of a simple test to distinguish between urge and stress urinary incontinence. Annals of internal medicine. 2006 May 16;     [PubMed PMID: 16702587]


Samuelsson E,Odeberg J,Stenzelius K,Molander U,Hammarström M,Franzen K,Andersson G,Midlöv P, Effect of pharmacological treatment for urinary incontinence in the elderly and frail elderly: A systematic review. Geriatrics     [PubMed PMID: 25656412]

Level 1 (high-level) evidence


Dontas IA,Yiannakopoulos CK, Risk factors and prevention of osteoporosis-related fractures. Journal of musculoskeletal     [PubMed PMID: 17947811]

Level 3 (low-level) evidence


Tutuncu Z,Kavanaugh A, Rheumatic disease in the elderly: rheumatoid arthritis. Rheumatic diseases clinics of North America. 2007 Feb;     [PubMed PMID: 17367692]


Willlams CM, Using medications appropriately in older adults. American family physician. 2002 Nov 15;     [PubMed PMID: 12469968]


Antimisiaris D,Cutler T, Managing Polypharmacy in the 15-Minute Office Visit. Primary care. 2017 Sep;     [PubMed PMID: 28797369]


Mortazavi SS,Shati M,Keshtkar A,Malakouti SK,Bazargan M,Assari S, Defining polypharmacy in the elderly: a systematic review protocol. BMJ open. 2016 Mar 24;     [PubMed PMID: 27013600]

Level 1 (high-level) evidence


By the 2019 American Geriatrics Society Beers Criteria® Update Expert Panel., American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults. Journal of the American Geriatrics Society. 2019 Apr;     [PubMed PMID: 30693946]


Eshkoor SA,Hamid TA,Mun CY,Ng CK, Mild cognitive impairment and its management in older people. Clinical interventions in aging. 2015;     [PubMed PMID: 25914527]


Lopez OL,Kuller LH, Epidemiology of aging and associated cognitive disorders: Prevalence and incidence of Alzheimer's disease and other dementias. Handbook of clinical neurology. 2019;     [PubMed PMID: 31753130]


Yang L,Yan J,Jin X,Jin Y,Yu W,Xu S,Wu H, Screening for Dementia in Older Adults: Comparison of Mini-Mental State Examination, Mini-Cog, Clock Drawing Test and AD8. PloS one. 2016;     [PubMed PMID: 28006822]


Ciesielska N,Sokołowski R,Mazur E,Podhorecka M,Polak-Szabela A,Kędziora-Kornatowska K, Is the Montreal Cognitive Assessment (MoCA) test better suited than the Mini-Mental State Examination (MMSE) in mild cognitive impairment (MCI) detection among people aged over 60? Meta-analysis. Psychiatria polska. 2016 Oct 31;     [PubMed PMID: 27992895]

Level 1 (high-level) evidence


Borson S,Scanlan J,Brush M,Vitaliano P,Dokmak A, The mini-cog: a cognitive 'vital signs' measure for dementia screening in multi-lingual elderly. International journal of geriatric psychiatry. 2000 Nov;     [PubMed PMID: 11113982]


Zdanys KF,Steffens DC, Sleep Disturbances in the Elderly. The Psychiatric clinics of North America. 2015 Dec;     [PubMed PMID: 26600105]


Yaremchuk K, Sleep Disorders in the Elderly. Clinics in geriatric medicine. 2018 May;     [PubMed PMID: 29661333]


Balsamo M,Cataldi F,Carlucci L,Padulo C,Fairfield B, Assessment of late-life depression via self-report measures: a review. Clinical interventions in aging. 2018;     [PubMed PMID: 30410319]


U.S. Preventive Services Task Force., Screening for depression: recommendations and rationale. Annals of internal medicine. 2002 May 21;     [PubMed PMID: 12020145]

Level 1 (high-level) evidence


Levis B,Sun Y,He C,Wu Y,Krishnan A,Bhandari PM,Neupane D,Imran M,Brehaut E,Negeri Z,Fischer FH,Benedetti A,Thombs BD,Depression Screening Data (DEPRESSD) PHQ Collaboration.,Che L,Levis A,Riehm K,Saadat N,Azar M,Rice D,Boruff J,Kloda L,Cuijpers P,Gilbody S,Ioannidis J,McMillan D,Patten S,Shrier I,Ziegelstein R,Moore A,Akena D,Amtmann D,Arroll B,Ayalon L,Baradaran H,Beraldi A,Bernstein C,Bhana A,Bombardier C,Buji RI,Butterworth P,Carter G,Chagas M,Chan J,Chan LF,Chibanda D,Cholera R,Clover K,Conway A,Conwell Y,Daray F,de Man-van Ginkel J,Delgadillo J,Diez-Quevedo C,Fann J,Field S,Fisher J,Fung D,Garman E,Gelaye B,Gholizadeh L,Gibson L,Goodyear-Smith F,Green E,Greeno C,Hall B,Hampel P,Hantsoo L,Haroz E,Harter M,Hegerl U,Hides L,Hobfoll S,Honikman S,Hudson M,Hyphantis T,Inagaki M,Ismail K,Jeon HJ,Jetté N,Khamseh M,Kiely K,Kohler S,Kohrt B,Kwan Y,Lamers F,Asunción Lara M,Levin-Aspenson H,Lino V,Liu SI,Lotrakul M,Loureiro S,Löwe B,Luitel N,Lund C,Marrie RA,Marsh L,Marx B,McGuire A,Mohd Sidik S,Munhoz T,Muramatsu K,Nakku J,Navarrete L,Osório F,Patel V,Pence B,Persoons P,Petersen I,Picardi A,Pugh S,Quinn T,Rancans E,Rathod S,Reuter K,Roch S,Rooney A,Rowe H,Santos I,Schram M,Shaaban J,Shinn E,Sidebottom A,Simning A,Spangenberg L,Stafford L,Sung S,Suzuki K,Swartz R,Tan PLL,Taylor-Rowan M,Tran T,Turner A,van der Feltz-Cornelis C,van Heyningen T,van Weert H,Wagner L,Li Wang J,White J,Winkley K,Wynter K,Yamada M,Zhi Zeng Q,Zhang Y, Accuracy of the PHQ-2 Alone and in Combination With the PHQ-9 for Screening to Detect Major Depression: Systematic Review and Meta-analysis. JAMA. 2020 Jun 9;     [PubMed PMID: 32515813]

Level 1 (high-level) evidence


Falkenstein M,Karthaus M,Brüne-Cohrs U, Age-Related Diseases and Driving Safety. Geriatrics (Basel, Switzerland). 2020 Oct 19;     [PubMed PMID: 33086572]


Pillemer K,Burnes D,Riffin C,Lachs MS, Elder Abuse: Global Situation, Risk Factors, and Prevention Strategies. The Gerontologist. 2016 Apr;     [PubMed PMID: 26994260]


Gnanadesigan N,Fung CH, Quality indicators for screening and prevention in vulnerable elders. Journal of the American Geriatrics Society. 2007 Oct;     [PubMed PMID: 17910565]

Level 2 (mid-level) evidence


Dang MT,Ahmed Z,Betcher JM,Kadakia S,Wisniewski SJ,Sealey JW, Do Not Let it Be the Last: End-of-Life Care Decisions in the Primary Care Clinic. Spartan medical research journal. 2019 Jul 1;     [PubMed PMID: 33655164]


Detering KM,Hancock AD,Reade MC,Silvester W, The impact of advance care planning on end of life care in elderly patients: randomised controlled trial. BMJ (Clinical research ed.). 2010 Mar 23;     [PubMed PMID: 20332506]

Level 1 (high-level) evidence


Bernacki RE,Block SD,American College of Physicians High Value Care Task Force., Communication about serious illness care goals: a review and synthesis of best practices. JAMA internal medicine. 2014 Dec;     [PubMed PMID: 25330167]


Pilotto A,Cella A,Pilotto A,Daragjati J,Veronese N,Musacchio C,Mello AM,Logroscino G,Padovani A,Prete C,Panza F, Three Decades of Comprehensive Geriatric Assessment: Evidence Coming From Different Healthcare Settings and Specific Clinical Conditions. Journal of the American Medical Directors Association. 2017 Feb 1;     [PubMed PMID: 28049616]

Level 3 (low-level) evidence