Guide — Geriatrics
Geriatric Assessment Fundamentals
Older adults are the majority of hospitalized patients, and the standard adult assessment misses what matters most in this population. This guide covers what changes — and the framework that catches real disease early.
9 min read · Geriatrics
Educational use only. Assessment findings in older adults are interpreted against individual baseline and escalated for provider evaluation. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Overview
Geriatric assessment differs from standard adult assessment in three ways. First, the goalposts move: normal findings shift with age, so you need to know what aging does to each system. Second, presentations blunt: fever, pain, and tachycardia are quieter, and the first sign of nearly any acute illness may be a change in cognition or function. Third, context dominates: medications, mobility, sensory function, and social support shape every finding.
The practical shift is this — in younger adults you assess for disease; in older adults you assess for disease, function, and reserve at the same time. A pneumonia that costs a 40-year-old a week costs an 85-year-old their independence if function is not protected during treatment.
Key Concepts
Function is the fifth vital sign
Ask what the patient could do two weeks ago versus today — bathing, dressing, toileting, transferring, feeding (ADLs) and shopping, cooking, managing medications and money (IADLs). Acute functional decline is a symptom with a cause.
Baseline beats textbook
A heart rate of 88 may be tachycardia for this patient; mild confusion may be brand new. Family, caregivers, and prior records are assessment tools — use them deliberately.
Sensory deficits corrupt every other finding
A patient who cannot hear your questions scores as confused; one who cannot see cannot cooperate. Glasses on, hearing aids in, before you assess cognition.
Medications are part of the exam
Every geriatric assessment includes a medication review — new symptoms are assumed medication-related until reviewed, because so often they are.
Assessment Adjustments by Domain
| Domain | What Changes | Nursing Approach |
|---|---|---|
| Cognition | Delirium risk high; dementia may mask acute change | Screen attention (CAM concepts); compare to baseline, not to “oriented ×4” |
| Mobility | Gait speed predicts outcomes; falls are multifactorial | Observe an actual transfer and a few steps — do not rely on self-report |
| Skin | Thin, dry, slow-healing; pressure risk elevated | Full visual inspection including heels and sacrum; Braden scoring |
| Nutrition | Decreased thirst, taste, dentition issues | Weight trend, meal observation, swallowing screen when indicated |
| Pain | Underreported; may present as agitation or withdrawal | Ask directly with multiple words (aching, soreness); use behavioral scales when needed |
| Vitals | Blunted fever and tachycardia; orthostatic risk | Orthostatic measurements; treat small deviations from baseline as meaningful |
Therapeutic Communication Considerations
Slow the pace, lower your pitch, face the patient in good light, and allow genuine pauses — processing speed slows with normal aging, and rushed questions produce inaccurate answers that look like confusion.
Address the patient directly even when family answers for them, and never use elderspeak (“sweetie,” exaggerated slow talk) — it is disrespectful and correlates with resistance to care.
Patient Education
Teach to the patient’s sensory reality: large print, contrast, hearing aids in, one concept at a time, teach-back to confirm. Include the care partner with the patient’s permission.
Anchor new routines to existing habits (medications with breakfast, walk after lunch) — habit-linked teaching survives discharge far better than instruction sheets.
NCLEX Pearls
- ✦New confusion, new falls, new incontinence, or new functional decline = acute illness until proven otherwise.
- ✦Orthostatic vitals before first ambulation in any older adult — especially with new medications.
- ✦Assess attention, not just orientation: inattention is the hallmark of delirium.
- ✦Always pair the assessment with the medication list — the cause is on it more often than anywhere else.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with American Geriatrics Society (AGS) · AGS Beers Criteria. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →