Patient Assessment, Monitoring, and Care Transitions
Comprehensive Assessment
A geriatric assessment spans function (ADLs/IADLs), cognition, mood, mobility and falls, nutrition and weight, continence, sensory function, pain, social support, and goals of care. Screening tools should be brief and validated. Falls assessment includes orthostatic vitals, vision, footwear, home hazards, gait and balance testing, and medication review - especially sedatives, antihypertensives, and anticholinergics.
Monitoring
Monitoring should match the drug and the patient: renal function and potassium for ACE inhibitors, ARBs, and diuretics; INR for warfarin; sodium for SSRIs and thiazides; glucose for insulin and sulfonylureas; and blood pressure for antihypertensives. Older adults may need more frequent monitoring early after a change because of reduced reserve.
Care Transitions
Transitions between hospital, skilled nursing facility, and home are high-risk for medication errors. Key practices: medication reconciliation at every transition, a clear discharge medication list with indications, patient and caregiver education using teach-back, timely follow-up appointments, and communication with the next provider. Watch for duplicate therapy, omitted home medications, and discharge prescriptions that conflict with prior regimens. The "brown bag" review and pharmacist-led reconciliation reduce discrepancies.
Traps
Stems may describe a patient discharged on a new anticoagulant without follow-up labs or a duplicate antihypertensive after transition. Another trap is assuming the patient understands instructions without teach-back.
Rule of Thumb
At every transition, reconcile the list, confirm indications, and schedule follow-up within days for high-risk drugs. Use teach-back to verify understanding rather than asking "do you have questions?"