Practical geriatrics checklist for primary care (adult/geriatric scope). Use this as a reminder framework and confirm current guidelines, local resources, and patient goals.

Core domains to cover (quick agenda)#

  • Function: ADLs/IADLs, mobility, falls, assist devices
  • Cognition and mood: memory concerns, depression/anxiety, sleep
  • Medications: polypharmacy, high-risk meds, adherence, affordability
  • Sensory: vision, hearing
  • Home safety and supports: living situation, caregiver strain, transportation, food insecurity
  • Prevention: vaccines, cancer screening appropriateness, osteoporosis/fracture risk
  • Goals of care: advance directives, surrogate decision maker, priorities (longevity vs function vs symptom relief)

Falls: CDC STEADI-style approach (clinic friendly)#

Screen (at least annually, and after any fall)#

  • Any fall in the last year?
  • Do you feel unsteady when standing or walking?
  • Do you worry about falling?

If “yes” to any: treat as fall risk and proceed to assessment + interventions.

Assess (pick what fits the visit)#

  • Orthostatics (if dizziness/lightheadedness)
  • Gait/balance observation; consider standardized test (e.g., timed up-and-go) per clinic workflow
  • Vision and footwear check
  • Home hazards review (see below)
  • Medication review focusing on fall-risk-increasing drugs (FRIDs)
  • Alcohol use and sedating substances

Intervene (high-yield)#

  • Strength/balance program or PT referral
  • Optimize vision/hearing and footwear
  • Home safety modifications (OT/home eval when available)
  • Treat contributing medical issues (orthostasis, neuropathy, Parkinsonism, BPPV, anemia, hypoglycemia, etc.)
  • Deprescribe or adjust FRIDs when possible
  • Vitamin D and other supplements: follow current guideline/payer policy and individualize

Medication safety (polypharmacy + Beers awareness)#

Practical workflow#

  • Reconcile the actual med list (including OTC/supplements)
  • For each med: indication, benefit, harms, dose appropriateness (renal/hepatic), duration, monitoring
  • Target the highest-risk/lowest-benefit meds first; taper with a follow-up plan

“Beers” (high-risk medication reminders)#

The AGS Beers Criteria is a commonly used reference for potentially inappropriate meds in older adults. Don’t treat it as a blanket “never use” list; use it to trigger a risk/benefit conversation and safer alternatives.

High-yield classes that often increase harm in older adults:

  • Benzodiazepines (falls, delirium, dependence)
  • Z-drugs (e.g., zolpidem; falls/delirium)
  • Strong anticholinergics (confusion, constipation, urinary retention, falls)
  • Skeletal muscle relaxants (sedation, falls)
  • Chronic NSAIDs in higher-risk patients (GI bleed, kidney injury, BP effects)
  • Certain diabetes meds with hypoglycemia risk (individualize; avoid “tight control” without a goal-of-care reason)

Documenting deprescribing well#

  • Why now (falls risk, delirium risk, lack of benefit, interactions, renal dosing)
  • Taper plan (dose steps and timing)
  • Monitoring/follow-up interval and what to do if symptoms recur

Vision and hearing (annual habit)#

Vision#

  • Ask: new vision changes, glare/night driving issues, falls related to vision
  • Confirm last eye exam; consider referral for cataracts/glaucoma/diabetic eye care when applicable
  • If ordering vision-related DME (glasses, low-vision aids): document functional need

Hearing#

  • Ask: difficulty hearing, needing repetition, TV volume, social withdrawal
  • Simple screen in clinic (whisper test or device-based screen if available)
  • If suspected: refer for audiology/hearing aids; document functional impact (safety, communication, isolation)

Home safety (fast checklist)#

  • Tripping hazards: loose rugs, cords, clutter
  • Lighting: night lights, stair lighting
  • Bathroom safety: grab bars, non-slip mats, shower chair if needed
  • Stairs: handrails, minimizing stair use if unstable
  • Footwear: supportive, non-slip; avoid barefoot/socks on slick floors
  • Fire safety: smoke/CO detectors; safe cooking plan
  • Emergency plan: how they call for help (phone access, medical alert)

Cognitive health (when to screen)#

  • Screen when there is concern (patient/family report), functional decline, medication mismanagement, new delirium risk, or safety concerns.
  • Document: who noticed what, timeline, IADL impact (finances, meds, driving), safety risks, and next steps (labs, imaging, referral) as appropriate.

Preventive care: “should we still do this?”#

For older adults, prevention should be individualized by life expectancy, functional status, comorbidity burden, and patient priorities.

  • Vaccines: influenza, COVID, pneumococcal, shingles, RSV (age/risk-based), Tdap
  • Osteoporosis/fracture risk: screen/treat when it will change outcomes
  • Cancer screening: document shared decision-making (benefit horizon vs harms)

Other high-yield topics for older adults#

  • Incontinence (screen, reversible causes, meds, pelvic floor referral)
  • Sleep (avoid sedatives when possible; treat OSA/restless legs thoughtfully)
  • Pain management (nonpharm first, topical options, careful opioid/NSAID use)
  • Driving safety counseling (vision/cognition/function triggers)
  • Social isolation, caregiver strain, elder abuse risk
  • Advance care planning: surrogate, POLST/MOST (if used locally), code status in context

Quick documentation snippets (optional)#

Falls risk#

  • Falls in last year: ___; unsteady: ___; worried about falling: ___
  • Interventions: PT/strength program, home safety, med review, vision/hearing, orthostatics, follow-up

Med review#

  • High-risk meds reviewed: ___; deprescribing/taper plan: ___; monitoring: ___
Backward DME and Supplies Differentials Forward