Care of the elderly: geriatric assessment, falls, frailty and medicines review explained

Geriatric medicine is built around the observation that illness in later life rarely comes singly. Someone with heart disease may also have arthritis, mild memory change, poor eyesight and a long list of tablets, and a treatment that helps one problem may worsen another. A consultant geriatrician, trained first in general medicine and then in several years of specialist training, coordinates this picture and aims to protect independence and quality of life.

The team usually includes specialist nurses, physiotherapists, occupational therapists, pharmacists, dietitians, speech and language therapists and social workers. The British Geriatrics Society, the UK membership body for multidisciplinary professionals working in healthcare of older people, promotes this team model. Geriatricians often work alongside old-age psychiatrists, neurologists, orthopaedic surgeons and palliative care teams.

The core tool of the specialty is comprehensive geriatric assessment (CGA). The British Geriatrics Society describes holistic assessments with tailored management plans as including a medical history, physical examination, functional assessment, cognitive assessment, mood screening, social support evaluation and medication review. In practice that translates into questions about how you manage washing, dressing, shopping and stairs, a memory test, a check of blood pressure sitting and standing, a look at your gait and balance, a review of eyesight and hearing, and a conversation about who helps you at home.

The BGS also explains that primary care in England uses the electronic frailty index, which draws on information in GP records across 36 clinical factors to identify older people living with frailty and predict their risk of outcomes such as serious falls, a new home care package or a care home admission. Frailty is not the same as old age or disability: it describes a reduced ability to bounce back from illness or stress, and it can sometimes be improved with exercise, nutrition and treating underlying problems.

The outcome is a written plan that might cover medicines changes, exercise, equipment, home adaptations, referrals and what matters most to you, including preferences for future care.

• Falls and balance problems: the NHS lists causes including weaker muscles, conditions affecting mobility or balance such as arthritis, stroke or Parkinson disease, low blood pressure, side effects of medicines, problems with eyesight or hearing, and dementia.

• Memory change and dementia: the NHS advises seeing a GP, who may rule out other causes with a physical examination and tests and then refer to a memory service. Specialists who diagnose dementia include old-age psychiatrists, geriatricians and neurologists.

• Delirium: sudden confusion caused by a medical problem such as infection, which the NHS lists as one cause of memory and thinking problems and which needs prompt assessment.

• Osteoporosis: the NHS says it weakens bones, develops slowly over years and is often only diagnosed when a fall or sudden impact causes a fracture; bone-strengthening medicines can treat it, and DEXA scans measure bone density.

• Parkinson disease: the NHS describes tremor, slow movement and stiff muscles caused by loss of nerve cells in the brain; there is no cure but treatments help reduce symptoms.

• Medicines and polypharmacy: taking many tablets increases the chance of side effects, interactions, dizziness and falls, and regular review is a standard part of the work.

• Continence, swallowing, hearing and sleep problems, pressure sores and weight loss are also common reasons for referral.

The NHS describes falls services as offering checks for muscle weakness, weak bones or eyesight problems, strength and balance training, home safety checks and adaptations and a review of medicines. Physical activity guidance for older adults recommends being active every day and doing activities that improve strength and balance at least twice a week. Well-fitting shoes with a good grip, personal alarms, non-slip mats, grab rails, regular eye and hearing checks, and enough calcium and vitamin D are part of prevention.

Medicine review is often the single most useful intervention. It means asking for each drug: is it still needed, is the dose right, does it interact with another, could it be causing dizziness, confusion or constipation. The NHS advises speaking to a GP or pharmacist if you think your medicines could be affecting your balance. Treatment is also shared with other specialties: Parkinson disease services, memory clinics, osteoporosis clinics, cardiac and pulmonary rehabilitation and palliative care.

Support can extend beyond medicine. The NHS says anyone worried about falls can ask their local council for a free care needs assessment, including changes to make the home safer.

In the NHS the route is normally through a GP, who may refer you to a geriatrician, a memory service, a falls service or a community frailty team. In England the maximum waiting time for non-urgent consultant-led care is 18 weeks from referral, and you generally have a right to choose your hospital or team, although many community services are not consultant-led and have their own waiting lists. Hospital teams also provide geriatric input for older people admitted as emergencies.

Privately, you can usually see a consultant geriatrician by self-referral or GP referral for a single long assessment, often including blood tests, a memory screen and a medicines review. Insurers may cover new symptoms investigated by a consultant but are less likely to pay for long-term care, ongoing rehabilitation or social care. Costs depend on the length of consultation, tests and scans, and any follow-up, so ask for an itemised estimate. The Private Healthcare Information Network offers independent information on private hospitals and consultants.

Bring all your medicines in their boxes, including over-the-counter products and supplements, a list of past illnesses and operations, glasses and hearing aids, and someone who knows you well who can describe changes you may not notice. Note the dates and circumstances of any falls, and whether you felt dizzy, tripped or blacked out. Write down what matters most to you.

After a fall, call 999 if the head, back, neck or hip may be injured or you cannot get up, and get help from NHS 111 if you may be in pain, injured or unwell. Stay warm and try to change position about every 30 minutes if you are waiting for help, as the NHS advises. Seek urgent help for sudden confusion, a new weakness on one side, chest pain or acute breathlessness.