Geriatric Assessment, Function, and Disability
Domains and hierarchy
Comprehensive geriatric assessment (CGA) is multidimensional: medical, functional, cognitive, psychological, social, environmental, nutritional, and advance care planning. Function is measured by ADLs (Katz: bathing, dressing, toileting, transferring, continence, feeding) and IADLs (Lawton: telephone, shopping, food preparation, housekeeping, laundry, transportation, medications, finances). IADLs typically decline before ADLs; ADL dependence signals need for hands-on care and predicts mortality, hospitalization, and nursing home placement.
Screen with brief tools: Mini-Cog or MoCA for cognition, PHQ-2/9 or GDS for mood, Timed Up and Go and gait speed for mobility, and a caregiver/social history. The SPICES framework (Sleep, Problems with eating, Incontinence, Confusion, Evidence of falls, Skin breakdown) is a rapid inpatient screen.
Traps: attributing IADL loss (missed bills, medication errors) to 'normal aging' when it may be early dementia; documenting 'independent' without specifying ADL versus IADL; missing caregiver strain; and confusing delirium with dementia.
Worked example: an 82-year-old man still bathes and dresses himself but has stopped paying bills and mismanages insulin. He has IADL impairment with preserved ADLs-screen cognition, review medications and vision, and assess finances and safety. Do not label this normal aging.
Rule of thumb: ask about IADLs first; new ADL loss usually means an acute medical problem or advanced disease.