The geriatric assessment—known internationally as the Comprehensive Geriatric Assessment (CGA)—is a comprehensive geriatric examination—a multidimensional diagnostic procedure developed specifically for older patients with complex health problems—particularly for multimorbid patients who suffer from multiple conditions simultaneously.
The key difference from a standard medical examination is that:
- It does not focus on a single condition, but rather on the interplay of all conditions, medications, functional limitations, and social factors.
- It uses standardized tests—not subjective assessments, but measurable results with specific thresholds.
- The results are used to create an individualized treatment plan that addresses all problem areas.
In geriatrics, the assessment is not an add-on—it is the foundation of every treatment. Without an assessment, we cannot determine what a patient needs, what they can tolerate, and what goals are realistic.
A geriatric assessment covers seven key areas. For each area, there is a specific, scientifically validated testing tool:
1. Activities of Daily Living — Barthel Index
The Barthel Index is the most widely used tool in geriatrics. It measures how independently you can perform ten basic activities of daily living: eating, washing, dressing, using the toilet, bathing, getting out of bed, walking, climbing stairs, and bladder and bowel control.
The result is on a scale from 0 to 100: 100 points indicate complete independence. A score below 60 points indicates an increased need for assistance—and early geriatric rehabilitation may be indicated.
2. Mobility and Risk of Falling — Tinetti Test and Timed Up and Go
The Tinetti Test assesses balance and gait in real-life situations: standing up, standing with eyes closed, turning, and sitting down. Maximum score: 28 points. A score below 19 indicates a significantly increased risk of falling.
The Timed Up and Go (TUG) test is even simpler: You stand up from a chair, walk three meters, turn around, and sit back down. The entire process is timed. A time under 14 seconds is considered normal. A time over 20 seconds indicates an increased risk of falling.
This simple test takes less than a minute—and tells you more about your risk of falling than many elaborate examinations.
3. Cognition — Mini-Mental State Examination (MMSE) and MoCA
The Mini-Mental State Examination (MMSE) assesses orientation, memory, attention, language, and spatial reasoning in just a few minutes. The maximum score is 30 points. A score below 24 suggests cognitive impairment—in which case further evaluation is warranted.
The Montreal Cognitive Assessment (MoCA) is more sensitive to mild cognitive impairments and is increasingly used as an alternative, especially when early-stage dementia is suspected.
→ You can find more information on dementia diagnostics—from the clock drawing test to biomarker analysis—in our article on dementia diagnostics.
4. Mood — Geriatric Depression Scale (GDS)
The Geriatric Depression Scale consists of 15 simple yes/no questions designed specifically for older adults. A score of 6 or higher indicates possible depression in older adults. This is important because depression in older adults is one of the most commonly overlooked diagnoses—it is often dismissed as a “sign of aging.” To help distinguish between the two, we also recommend the page “Dementia or Depression?”
→ To learn why depression in older adults is so often overlooked—and what can be done about it—read our article on depression in older adults.
5. Nutrition — Mini Nutritional Assessment (MNA)
The Mini Nutritional Assessment assesses nutritional status, weight trends, appetite, and eating habits. A score below 17 points indicates overt malnutrition in older adults—a problem that affects 25 to 30 percent of all hospitalized seniors and significantly impacts surgical risk, wound healing, and susceptibility to infection.
6. Medication Review
In geriatrics, we systematically review all medications for interactions, duplicate prescriptions, and potentially inappropriate active ingredients. To do this, we use the PRISCUS list—a negative list of medications developed specifically for Germany that should be avoided in older adults—as well as the FORTA classification, which evaluates medications based on their suitability for older patients.
→ For detailed information on polypharmacy and deprescribing, see our articles on Polypharmacy in Older Adults and Reducing Medications (Deprescribing).
7. Social Situation
Who lives with you? Who supports you in your daily life? Do you have a power of attorney for healthcare or a living will? Is your home accessible? These questions are not trivial—they determine whether a patient can return home after a hospital stay or whether alternative care must be arranged.
Every finding has a consequence—nothing is simply filed away. That is the key difference of the geriatric assessment: It produces not just data, but a concrete treatment plan.
Examples:
- Barthel score below 60: Early geriatric rehabilitation may be indicated to restore activities of daily living.
- Tinetti score below 19 or TUG time over 20 seconds: Targeted fall prevention program, review of medication for fall-promoting ingredients, physical therapy balance training.
- MMSE score below 24: Further dementia diagnostics, cognitive stimulation, and medication adjustment.
- GDS score of 6 or higher: Suspected depression in older adults—further evaluation and, if necessary, initiation of treatment.
- MNA below 17: Nutritional intervention, liquid nutrition, dietary counseling for malnutrition in older adults.
- PRISCUS hits: Switch or discontinue medication—initiate deprescribing, explore alternatives.
The overall picture of all results forms the basis for an individualized geriatric treatment plan—and that is precisely what distinguishes geriatrics from other medical specialties: not treating a diagnosis, but treating the whole patient.
→ To learn how geriatric early rehabilitation builds on the assessment results, read our article on Geriatric Early Rehabilitation.
One of the most important applications of geriatric assessment is determining whether an older patient can tolerate a planned surgery.
Before joint replacement, heart surgery, or any other major procedure, older patients always ask themselves: “Am I fit enough for this surgery?” The answer comes not just from the surgeon—but from a geriatric assessment.
We evaluate:
- Frailty status: How resilient is the patient overall? Learn more about frailty syndrome.
- Risk of delirium: How likely is the patient to experience postoperative confusion? Learn more about delirium in older adults and delirium prevention.
- Nutritional status: Malnutrition significantly increases the risk of complications.
- Cognition: Can the patient understand and follow the postoperative rehabilitation instructions?
- Medication: Are there any drug interactions that increase surgical risk? Keyword: polypharmacy in older adults.
The results are factored into the shared decision: Is surgery advisable? Does the patient need to be brought to optimal health beforehand? Or do the risks outweigh the benefits?
→ For more details: Surgical Risk in Older Adults — How Doctors Assess a Patient’s Resilience Before Surgery.
→ Specifically on hip replacement: Total hip replacement (THR) for patients aged 80 and older—how geriatric co-management reduces the risk.
Use this checklist to assess yourself or a loved one:
If you recognize yourself or a loved one in two or more of these points, talk to your primary care physician about a geriatric assessment. They can arrange a referral to a geriatric outpatient clinic (GIA), day clinic, or hospital.
This geriatric evaluation can take place in various settings:
- In an acute care hospital: As part of early geriatric rehabilitation or as a consultation for inpatients.
- At a geriatric day clinic: On an outpatient basis over one or more days.
- At a geriatric outpatient clinic (GIA): As an outpatient evaluation.
- At home: In special cases, as an assessment ordered by a primary care physician.
The assessment typically lasts 45 to 90 minutes. It is not a single doctor’s appointment but a team effort: geriatricians, physical therapists, occupational therapists, and nursing staff work together to build a comprehensive picture.
The effectiveness of the geriatric assessment is supported by high-quality studies:
- 2017 Cochrane Review (Ellis et al.): 29 randomized trials involving 13,766 patients showed that older patients who received a CGA were significantly more likely to be alive and living in their own homes (RR 1.06). The probability of admission to a nursing home was reduced by 20 percent (RR 0.80)—with a high level of evidence certainty.
- Umbrella Review 2022 (Veronese et al., Age & Ageing): 31 systematic reviews involving a total of 279,744 patients confirmed that CGA reduces falls by 49 percent, pressure ulcers by 54 percent, and delirium following hip fractures by 29 percent—in each case with high certainty of evidence.
- Meta-analysis 2025 (Hayes et al., JAGS): 22 studies involving 7,219 patients showed that even home-based CGA improves daily functioning, quality of life, and patient satisfaction.
To put it simply: A geriatric assessment can determine whether you return home after an illness—or are admitted to a nursing home. It is one of the few interventions in medicine that has been proven to protect the independence of older adults.
