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 — in particular for multimorbid patients who suffer from several illnesses at the same time.
The decisive difference from the normal medical examination:
- It looks not at a single illness, but at the interplay of all illnesses, medications, functional limitations and social factors.
- It uses standardized tests — not subjective assessments, but measurable results with concrete threshold values.
- From the results, an individual treatment plan emerges that takes all problem areas into account.
In geriatrics, the assessment is not an add-on — it is the foundation of every treatment. Without an assessment, we cannot judge what a patient needs, what they can tolerate and which goals are realistic.
A geriatric assessment covers seven central areas. For each area there is a specific, scientifically validated test instrument:
1. Everyday competence — Barthel Index
The Barthel Index is the most widely used instrument in geriatrics. It measures how independently you manage ten basic everyday activities: eating, washing, dressing, using the toilet, bathing, getting up, walking, climbing stairs as well as bladder and bowel control.
The result lies on a scale from 0 to 100: 100 points mean complete independence. Below 60 points there is an increased need for help — and a geriatric early rehabilitation may be indicated.
2. Mobility and risk of falls — Tinetti test and Timed Up and Go
The Tinetti test assesses balance and gait in everyday situations: standing up, standing with eyes closed, turning, sitting down. A maximum of 28 points. A value below 19 indicates a markedly increased risk of falls.
The Timed Up and Go test (TUG) is even simpler: you get up from a chair, walk three meters, turn around and sit down again. The whole thing is timed. Below 14 seconds is considered normal. Over 20 seconds indicates an increased risk of falls.
This simple test takes less than a minute — and says more about your risk of falls than many elaborate examinations.
3. Cognition — Mini-Mental State Examination (MMSE) and MoCA
The Mini-Mental State Examination (MMSE) checks orientation, recall, attention, language and spatial thinking within a few minutes. A maximum of 30 points. A value below 24 gives indications of a cognitive impairment — then a further work-up is carried out.
The Montreal Cognitive Assessment (MoCA) is more sensitive to mild cognitive impairments and is increasingly used as an alternative, particularly when there is a suspicion of an early form of dementia.
→ More on dementia diagnostics — from the clock-drawing test to biomarker analysis — can be found in our article on dementia diagnostics.
4. Mood — Geriatric Depression Scale (GDS)
The Geriatric Depression Scale comprises 15 simple yes/no questions developed specifically for older people. A value of 6 or more points gives an indication of a possible depression in old age. This is important, because depression in old age is one of the most frequently overlooked diagnoses — it is often dismissed as a ‘sign of aging’. To distinguish it, the page dementia or depression? is also recommended.
→ Why depression in old age is so often overlooked — and what helps against it — can be found in our article on depression in old age.
5. Nutrition — Mini Nutritional Assessment (MNA)
The Mini Nutritional Assessment records nutritional status, weight history, appetite and eating behavior. A value below 17 points indicates a manifest malnutrition in old age — a problem that exists in 25 to 30 percent of all hospitalized seniors and considerably affects the surgical risk, wound healing and susceptibility to infection.
6. Medication check
In geriatrics, we systematically check all medications for interactions, double prescriptions and potentially unsuitable active substances. In doing so, we use the PRISCUS list — a negative list of medications developed specifically for Germany that should be avoided in older people — as well as the FORTA classification, which rates medications according to their suitability for older patients.
→ Detailed information on the topic of polypharmacy and deprescribing can be found in our articles on polypharmacy in old age and reducing medications (deprescribing).
7. Social situation
Who lives with you? Who supports you in daily life? Do you have a power of attorney or advance directive? Is your home barrier-free? These questions are not a side issue — they decide whether a patient can return home after a hospital stay or whether other care must be organized.
Every value has a consequence — nothing is simply filed away. That is the decisive difference of the geriatric assessment: it produces not just data, but a concrete treatment plan.
Examples:
- Barthel below 60: Geriatric early rehabilitation may be indicated in order to restore everyday competence.
- Tinetti below 19 or TUG over 20 seconds: A targeted fall prevention program, review of the medication for fall-promoting active substances, physiotherapeutic balance training.
- MMSE below 24: Further dementia diagnostics, cognitive stimulation, adjustment of the medication.
- GDS from 6 points: Suspicion of depression in old age — further work-up and, where appropriate, initiation of therapy.
- MNA below 17: Nutritional intervention, oral nutritional supplements, dietary counseling in malnutrition in old age.
- PRISCUS hit: Switch or discontinue the medication — initiate deprescribing, examine alternatives.
From the overall picture of all results, an individual geriatric treatment plan emerges — and that is exactly what distinguishes geriatrics from other specialties: not the treatment of a diagnosis, but the treatment of the whole patient.
→ How geriatric early rehabilitation builds on the assessment results can be found in our article on geriatric early rehabilitation.
One of the most important applications of the geriatric assessment: assessing whether an older patient can tolerate a planned operation.
Before a joint replacement, a heart operation or another major procedure, the question always arises in older patients: ‘Am I fit enough for this operation?’ The answer is not provided by the surgeon alone — but by a geriatric assessment.
We check:
- Frailty status: How resilient is the patient overall? More on the frailty syndrome.
- Risk of delirium: How high is the probability of postoperative confusion? More on delirium in older people and delirium prevention.
- Nutritional status: Malnutrition considerably increases the risk of complications.
- Cognition: Can the patient understand and carry out the rehab measures after the operation?
- Medication: Are there interactions that increase the surgical risk? Keyword polypharmacy in old age.
The results feed into the joint decision: is the operation sensible? Does the patient need to be optimized beforehand? Or do the risks outweigh the benefits?
→ In detail on this: surgical risk in old age — how doctors assess resilience before an operation.
→ Specifically on the topic of hip prosthesis: hip replacement from age 80 — how geriatric co-management lowers the risk.
Check yourself or your relative against this checklist:
- Age over 70 years and the presence of several chronic illnesses
- Recently fallen or afraid of falls in old age
- Increasing forgetfulness or orientation problems — a possible indication of mild cognitive impairment (MCI)
- Unintentional weight loss in the last few months
- Taking five or more medications daily — the risk of polypharmacy
- A planned operation — more on this: surgical risk in old age
- Increasing difficulties in daily life — shopping, cooking, dressing — possible signs of immobility in old age
- Increasing listlessness or social withdrawal
If you recognize yourself or your relative in two or more points, speak to your general practitioner about a geriatric assessment. They can arrange a referral to a geriatric institutional outpatient clinic (GIA), a day clinic or a hospital.
This geriatric examination can take place in various settings:
- In the acute hospital: As part of a geriatric early rehabilitation or as a consultation for inpatients.
- In the geriatric day clinic: On an outpatient basis over one or more days.
- In the geriatric institutional outpatient clinic (GIA): As an outpatient examination.
- At home: In special cases as an assessment arranged by the general practitioner.
The duration is usually 45 to 90 minutes. It is not a single doctor’s appointment, but a team effort: geriatrician, physiotherapy, occupational therapy and nursing work together to create a complete picture.
The effectiveness of the geriatric assessment is proven by high-quality studies:
- Cochrane review 2017 (Ellis et al.): 29 randomised studies with 13,766 patients showed: older patients who received a CGA were significantly more often alive and in their own home (RR 1.06). The probability of admission to a nursing home was reduced by 20 percent (RR 0.80) — and that with a high certainty of evidence.
- Umbrella review 2022 (Veronese et al., Age & Aging): 31 systematic reviews with a total of 279,744 patients confirmed: CGA reduces falls by 49 percent, pressure ulcers by 54 percent and delirium in hip fractures by 29 percent — each with a high certainty of evidence.
- Meta-analysis 2025 (Hayes et al., JAGS): 22 studies with 7,219 patients showed that home-based CGA also improves everyday function, quality of life and patient satisfaction.
In plain words: A geriatric assessment can decide whether you return home after an illness — or are admitted to a nursing home. It is one of the few measures in medicine that demonstrably protects the independence of older people.
