A comprehensive geriatric assessment looks at every part of an older adult’s health that shapes how they live, from medicines and function to cognition, mood, frailty, and support at home, and ends with a plan for each problem found. Copy the free template, see an assessment after two falls and one for memory loss and weight loss, and check what goes in each part.
Blank comprehensive geriatric assessment template
FreeCOMPREHENSIVE GERIATRIC ASSESSMENT Patient: [Name, age, date of birth] Date and setting: [Date; geriatric clinic, primary care, home visit, day hospital, or hospital ward] Present: [Patient, family member or caregiver, interpreter] Sources: [Patient, caregiver, medicine bottles, pharmacy record, previous notes] Clinician and team: [Name, credentials; nurse, pharmacist, therapist, or social worker involved] REASON AND GOALS Referral question: [Who referred, and what they asked] Goals: [What matters most, in the patient's words; the caregiver's main concern] MEDICAL PROBLEMS Active conditions: [Each condition, how well controlled, recent changes] Recent events: [Hospital stays, emergency visits, new symptoms in the past 6 months] Examination: [Lying and standing BP and pulse, weight and height, focused findings] Recent tests: [Bloods, ECG, imaging, with dates and results] MEDICATION REVIEW Every medicine: [Prescription, over-the-counter, and herbal products, with dose; the total] Who manages them: [Self, family, organizer, blister pack; missed doses] Medicines flagged: [Each one, the criteria used, Beers or STOPP, and why] Missing treatment: [Indicated but not prescribed, by START criteria or your judgment] Deprescribing plan: [What stops or tapers, in what order, what to watch for, and when to recheck] FUNCTION AND MOBILITY Basic activities: [Katz ADL score out of 6, and the activities that need help] Instrumental activities: [Lawton IADL score out of 8, who does each task lost, and what the patient managed a year ago] Falls in the past year: [Number, what happened just before, injuries, time on the floor] Timed Up and Go: [Seconds and walking aid; rising, turning, reaching for support; fear of falling] COGNITION AND MOOD Testing conditions: [Glasses and hearing aids in, quiet room, language or interpreter] Cognitive screen: [Mini-Cog out of 5, MoCA out of 30 with years of schooling, or another tool] Delirium: [Sudden change or attention that comes and goes, or none] Mood screen: [GDS-15 out of 15, and what the interview added] Thoughts of death or suicide: [Asked directly; the answer; means at home] NUTRITION, CONTINENCE, VISION AND HEARING Weight change: [Today's weight, an earlier weight with its date, and the percentage change] Intake and teeth: [Meals, who shops and cooks, appetite, alcohol, dentures and their fit] Bladder and bowel: [Urgency, leaks, night trips, pads, constipation, and when each began] Vision: [Acuity with glasses, type of lenses, last eye exam] Hearing: [Whispered voice test or report, hearing aids, ear canals] FRAILTY AND SUPPORT Frailty level: [Clinical Frailty Scale level 1 to 9 on the baseline, or Edmonton Frail Scale total out of 17] Living situation: [Alone or with whom; type of home; stairs] Supports and caregiver: [Family, friends, paid help; the caregiver's help each week, health, and strain] Money and mistreatment: [Money worries; asked alone about neglect or mistreatment] HOME SAFETY AND ADVANCE CARE PLANNING Home: [Lighting, rugs, stairs and rails, bathroom, stove, personal alarm] Driving and firearms: [Drives or not, and any concerns; firearms and how they are stored] Decision-maker: [Name, relationship, and documents on file] Wishes: [Goals of care and treatment wishes discussed, or the date booked] PROBLEM LIST AND PLAN Problems by domain: [Each problem, the domain it came from, the plan, who acts, and by when] Referrals: [Physical therapy, occupational therapy, dietitian, audiology, memory clinic, social work] Shared with: [Patient, caregiver, referring clinician, care team] Follow-up: [Date, and what will be rechecked] Signed: [Clinician name, credentials, date]
Use it for
Each one follows the template. Use them to judge how much detail every part needs.
Geriatric clinic, referral from her family physician, with her son, 90 minutes
82-year-old woman referred by her family physician after two falls in 3 months: “Why does she keep falling, and is it safe for her to live alone?” History from her, her son, her medicine bottles, and the pharmacy record. Her goals: “stay in my own house,” and keep singing in her church choir. Her son’s main worry: a fall when no one is there.
Hypertension for 20 years; a third BP medicine added 14 months ago for high home readings. Osteoporosis, treated since 2023. Bladder leakage for about 14 months. Knee osteoarthritis. No heart disease, stroke, or diabetes. Fall 1, August: stood up from the sofa after supper, the room “went grey,” and she sat down hard; no injury. Fall 2, October, about 3 a.m.: hurrying to the bathroom, felt dizzy in the hall, and fell against the door frame; bruised right shoulder and cheek; no loss of consciousness; got up alone after about 10 minutes. Lying BP after 5 minutes 152/78, pulse 66. Standing at 1 minute 122/70, pulse 84, dizzy, “like before the falls.” At 3 minutes 126/72, pulse 82. Heart sounds normal, no murmur; no focal neurological signs. Bloods last month: hemoglobin, sodium, kidney function, and TSH normal. ECG: sinus rhythm.
9 medicines, from her bottles and the pharmacy record: ramipril 10 mg daily; amlodipine 10 mg daily; doxazosin 4 mg at bedtime, added 14 months ago; oxybutynin 5 mg twice a day, started 10 months ago for leakage; aspirin 81 mg daily, started years ago “for prevention”; atorvastatin 20 mg; alendronate 70 mg weekly; vitamin D 1,000 units daily, bought over the counter; acetaminophen 500 mg as needed for her knees. Fills a weekly organizer herself; no missed doses. Flagged: doxazosin, an alpha-1 blocker used for BP, which the Beers criteria advise against and STOPP flags with a repeated drop on standing; Beers also notes it can worsen leakage in women. Oxybutynin: strongly anticholinergic by Beers, and started for leakage that began after the doxazosin, a likely prescribing cascade. Aspirin with no heart disease or stroke: Beers suggests considering stopping aspirin taken for primary prevention. Missing treatment by START: none.
Katz ADL 6 of 6. Lawton IADL 7 of 8: her son has done the big weekly shop since the second fall. Managed every task before August. Timed Up and Go 16 seconds, no walking aid: slow to rise, steadied herself on the chair arm on the turn. Gait slightly wide, steady on the flat; reaches for furniture at home, by her son’s account. Now gets a lift to choir instead of walking. Afraid of falling at night.
Tested with her hearing aids in. Mini-Cog 5 of 5. Alert and attentive; no signs of delirium. GDS-15 2. No thoughts of death or suicide.
Three meals a day, cooks for herself; own teeth; alcohol at Christmas only. Weight 61 kg, unchanged from a year ago. Bladder: urgency, leaks on the way to the toilet and sometimes when she coughs, up twice a night, wears a pad; began about 14 months ago. Bowels regular. Vision: wears progressive lenses all day, including on the stairs; acuity with glasses 20/50 right, 20/40 left; last eye exam 4 years ago. Hearing: aids in both ears, hears well with them.
Clinical Frailty Scale 4, living with very mild frailty: not dependent on others, but slowed and limited by her falls. Widowed 5 years. Lives alone in a two-storey house; bedroom and bathroom upstairs, along a hall. Son lives 10 minutes away and visits twice a week; her daughter lives in another city and calls daily. Choir and church friends. No money worries. Asked alone about neglect or mistreatment: none.
No night light between bedroom and bathroom; loose rugs in the upstairs hall; no grab bars by the tub or toilet; three garden steps with no rail. No personal alarm. Doesn’t drive. No firearms. Has named her son as her decision-maker in a power of attorney for health; copy requested for the record. Wishes about future treatment not yet discussed; she wants her daughter there for that conversation.
1. Recurrent falls from orthostatic hypotension, with symptoms: doxazosin 2 mg at bedtime for 1 week, then stopped. Stand up in stages, sitting on the edge of the bed first. Home BP sitting and standing twice a day for 2 weeks; nurse visit in 2 weeks for lying and standing BP; amlodipine adjusted by the standing readings. 2. Gait and balance, TUG 16 seconds: physical therapy for strength and balance, then home exercises 3 times a week. 3. Leakage: bladder training and pelvic floor exercises from today; oxybutynin stopped at the 2-week visit, once doxazosin is off; leakage reviewed at 6 weeks. 4. Aspirin for primary prevention: stopped today, after discussion. 5. Vision: eye exam; single-vision distance glasses for stairs and walking outside. 6. Home safety: occupational therapy home visit; her son will fit night lights and lift the hall rugs this week; grab bars and a bath seat as the therapist advises; personal alarm pendant. 7. Advance care planning: conversation booked with her son and daughter at the next visit. Living alone: safe to continue with these changes. Shared with her, her son, and her family physician. Follow-up in 6 weeks; repeat TUG at 3 months.
Geriatric outreach team, home visit, with his daughter
88-year-old man referred by his family physician at his daughter’s request. Her concern: he forgets meals and appointments, and his clothes hang loose. He thinks he is “just getting old.” Seen at his apartment with his daughter. History from both, the pharmacy record, and his physician’s notes. His goals: stay in his apartment, and “not be a burden.” His daughter’s: know what is wrong, and get him help at home.
Type 2 diabetes, hypertension, and high cholesterol. Wife died 14 months ago. Over the past year: missed appointments, two unpaid bills, the stove left on twice, and repeated questions; his daughter noticed the first changes before his wife died, and they’ve been worse since. No sudden change, and no confusion that comes and goes. No trouble swallowing, bleeding, change in bowel habit, cough, or night sweats. BP sitting 128/72, standing 124/70; pulse 72, regular. Loose upper denture. Abdomen soft, no masses. No focal neurological signs; no tremor or rigidity. Bloods 3 months ago: A1C 6.1%; eGFR 52.
5 medicines, from the pharmacy record and the blister pack on the counter: metformin 500 mg twice a day; amlodipine 5 mg daily; atorvastatin 40 mg daily; amitriptyline 25 mg at bedtime, started 6 years ago for sleep; acetaminophen as needed. Doses missed on 9 of the last 28 days, by the blister pack. Flagged: amitriptyline, which the Beers criteria advise against: strongly anticholinergic and sedating, and it can worsen memory. Metformin: A1C 6.1% with poor appetite and weight loss is more treatment than he needs at 88, and metformin can dull appetite and lower B12 over time.
Katz ADL 6 of 6, though he showers less often than before. Lawton IADL 4 of 8: his daughter now does his shopping and laundry and sets up his medicines, and he no longer cooks. Uses the phone, does light housework, and still drives locally. A year ago he managed all of these. Timed Up and Go 11 seconds, no walking aid. No falls.
Tested at his kitchen table, facing him, with a pocket amplifier. Mini-Cog 1 of 5: recalled 1 word; clock abnormal. MoCA 18 of 30, 14 years of schooling; most points lost on delayed recall and the executive tasks. Attention steady through the visit; no signs of delirium. GDS-15 7. In the interview: low mood most days since his wife died, stopped going to his club, sleeps poorly, little interest in food. Asked directly: no thoughts of suicide or of wishing to be dead. A hunting rifle in the hall closet, with ammunition on the same shelf.
Weight 74.0 kg at his physician’s office in May; 69.6 kg today, down 4.4 kg, about 6% in 6 months. Height 1.75 m; BMI 22.7. Eats toast and tea most days; frozen meals in the freezer untouched. The loose denture makes meat hard to chew. No alcohol. Up once a night to pass urine; no leaks; bowels regular. Vision: reading glasses, acuity 20/30 each eye with them; eye exam last year. Hearing: failed the whispered voice test in both ears; no hearing aids; ear canals clear.
Clinical Frailty Scale 5, living with mild frailty: needs help with shopping, meals, medicines, and laundry. Lives alone in a second-floor apartment with an elevator. His daughter, 58, works full time, visits every evening, and does his shopping, laundry, and medicines. She sleeps badly, has missed work, and says, “I can’t keep doing this every night.” His son lives in another city and helps little. No paid help or community services yet. Pension covers his costs. Asked alone about neglect or mistreatment: none.
No automatic stove shut-off. Still drives locally; no crashes, but got lost coming home from the store last month, by his daughter’s account. Rifle and ammunition as above. Wants his daughter to decide for him if he can’t; no power of attorney for health or money. He explained what a power of attorney does and why he chose her.
1. Cognitive impairment, cause not yet known: the Mini-Cog, MoCA, and lost daily tasks suggest dementia, with low mood, amitriptyline, and hearing loss adding to it. Bloods including CBC, calcium, TSH, and B12; CT head; memory clinic referral; MoCA repeated in 3 months. 2. Weight loss of about 6% in 6 months: metformin stopped; dental visit to reline the denture; dietitian; meal delivery 5 days a week; weighed monthly. 3. Low mood since his wife’s death, GDS-15 7: grief and depression discussed; seniors’ day program twice a week; counseling referral; an antidepressant discussed if no better in 6 weeks. 4. Amitriptyline: 10 mg at bedtime for 2 weeks, then stopped; sleep routine agreed. 5. Hearing: audiology referral. 6. Safety: his daughter will take the rifle and ammunition to her house this week; stove shut-off device; he agreed not to drive until an on-road driving assessment, and the reporting rules where he lives were checked. 7. Medicines: pharmacy blister packs, with home care prompting the morning dose. 8. Caregiver strain: home care assessment for meals and medicines; caregiver support and respite information for his daughter; family call with his son next week. 9. Advance care planning: powers of attorney for health and money with a lawyer this month. Shared with him, his daughter, and his family physician. Phone call in 2 weeks with the results; home visit in 6 weeks to weigh him and repeat the GDS-15.
Why the patient is here, what matters most to them, and the conditions and recent events behind the referral.
Avoid: Starting from the referral alone. The patient’s goals decide which problems come first in the plan.
Every medicine the patient takes, checked against explicit criteria, with a decision for each one flagged.
Avoid: Flagging a medicine with no decision. Write whether it stops, tapers, or stays, and why.
What the patient does day to day, and how they walk, scored so the next assessment can compare.
Avoid: “Mobility reduced.” Record the TUG time: 12 seconds or more flags fall risk, and a number can be compared next time.
A cognitive screen, a check for delirium, and a depression screen, with what the interview added.
Avoid: A score with no context. A low Mini-Cog in someone who couldn’t hear the words, or who has delirium, says little about memory.
The domains that are easy to skip and often easy to fix: each can explain falls, confusion, or low mood.
Avoid: A weight with no baseline. Find a past weight and its date, and work out the change: 5% or more in 6 to 12 months is the usual flag.
How much reserve the patient has, who helps, what at home could cause harm, and who decides if the patient can’t.
Avoid: Scoring frailty on a bad day. The Clinical Frailty Scale is scored on the baseline, about 2 weeks before any acute illness.
The part that makes it a comprehensive assessment and not a set of screens: each problem found, with its own plan.
Avoid: A plan that only covers the referral question. A medicine causing falls, or low mood behind poor memory, needs its own line.
A comprehensive geriatric assessment isn’t a set of screens. Every abnormal finding becomes a numbered problem, with a plan, a person who acts, and a date.
Ask for the bottles or the pharmacy record, include over-the-counter products, and name the criteria, Beers or STOPP, beside each medicine you flag.
Change one or two medicines at a time, starting with the most harmful, with what to watch for and a date to recheck. If something goes wrong, you’ll know which change caused it.
When a symptom started soon after a new medicine, ask whether the next prescription treated a side effect. Stopping the first drug can make the second unnecessary.
The caregiver often carries the plan. Ask what they do each week, how they’re coping, and what help they need, and put their strain on the problem list.
Vero Scribe writes the geriatric assessment in your template from the visit, with the patient’s consent, or from your dictation, including the scores you read out. You review and edit every section, then copy it into your record or export it to Word or PDF. Vero works in 60+ languages.
A structured look at an older adult’s medical, functional, mental, and social health, often by a team, that ends in a plan for each problem found. It’s used for frail older adults, after falls or a decline, and before major treatment. A Cochrane review found that older people who had one on admission to hospital were more likely to be alive and in their own homes 3 to 12 months later.
The patient’s goals, medical problems, a medication review, function with the Katz ADL and Lawton IADL, mobility and falls with a Timed Up and Go, cognition with the Mini-Cog or MoCA, mood with the GDS-15, nutrition and weight, continence, vision and hearing, frailty with the Clinical Frailty Scale, social support and the caregiver, home safety, advance care planning, and a problem list with a plan for each domain.
Many services use both. The American Geriatrics Society Beers Criteria list medicines to avoid or use with care in adults 65 and older. STOPP/START lists medicines to stop and, in START, treatments that are missing. Both are updated every few years, so name the criteria and version beside each medicine you flag.
A fall risk assessment looks at one problem in depth, and a dementia care plan follows a diagnosis. A comprehensive geriatric assessment covers every domain, so it often finds what sits behind the referral, such as a blood pressure medicine causing falls or low mood behind poor memory. Its plan can lead to either of the other two.
Yes. Copy it, or download it as a Word or text file. No account needed.
The physician or NP visit to a resident: reason, nursing reports, trends, exam, medication record review, safety events, goals of care, and orders.
Long visits and many-problem notes, drafted for your review.
Score the six basic activities of daily living.
Score the eight tasks of living on your own.
How to time it, and what each band means.
The 3-minute cognitive screen, with scoring.
The GDS-15, its scoring, and its cutoffs.
Choose the level from 1 to 9, scored on the baseline.
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