Working Diagnosis.
Consultation Support

Geriatric Assessment Toolkit.

Five validated scales for rapid frailty and functional assessment in older adults. Complete one or all; focus emerges in real time.

CIRS-G: Cumulative Illness Rating Scale-Geriatric

14 organ systems, severity 0-4 per system. Reflects burden of chronic disease. Total score: ≤20 mild, 21-40 moderate, >40 severe.

Used for age-adjusted interpretation

CIRS-G Severity Scale

  • 0 = None: No problem with this system
  • 1 = Mild: Symptom(s) present but no functional impairment
  • 2 = Moderate: Definite functional impairment limited to specific activities
  • 3 = Severe: Severe functional impairment; need assistance with basic activities
  • 4 = Very Severe: Incapacitating; immediate risk to life if untreated

Comorbidity Index: Add 1 point if any domain rated 3 or 4; multiplies total score by 1.0 + index. (Higher burden = geometric increase in complexity.)

FRAIL Scale

5-item frailty screener. Score 0-5: 0-1 robust, 2 pre-frail, 3-5 frail. Used widely in primary care for rapid triage.

FRAIL Interpretation

  • 0-1: Robust - no frailty concerns
  • 2: Pre-frail - counsel on exercise, nutrition, medication review
  • 3-5: Frail - intensive review; consider falls assessment, polypharmacy audit, social support

Clinical Use: Rapid triage tool. Positive FRAIL (≥3) predicts hospitalisation, falls, disability, mortality. One question per domain makes it ideal for busy consultations.

Katz Index of Independence in Activities of Daily Living

6 basic self-care functions. Rates independence in bathing, dressing, toileting, transferring, continence, feeding. Total score 0-6 (0 = fully dependent, 6 = fully independent).

Katz ADL Interpretation

  • 6: Fully independent in all ADLs
  • 5: Independent except bathing
  • 4: Independent except bathing and dressing (or toileting)
  • 3: Requires assistance with bathing, dressing, toileting
  • 0-2: Dependent in 4+ domains; may require residential care

Clinical Use: Gold-standard measure of basic self-care. Helps determine care needs, service referrals, and level of independence. Decline in Katz score predicts mortality and institutionalisation.

Lawton Instrumental Activities of Daily Living (IADL)

8 higher-order activities (shopping, cooking, money, housework, laundry, transport, phone, meds). Score 0-8 (0 = fully dependent, 8 = fully independent). Detects early decline before basic ADL loss.

IADL Interpretation

  • 8: Fully independent in all IADLs
  • 6-7: Independent in most; may need help with complex tasks
  • 4-5: Significant impairment; needs care co-ordination
  • ≤3: Dependent in most or all IADLs; may require residential/day care support

Clinical Use: Captures decline earlier than Katz ADL. Loss of IADL function (e.g., medication management) is often first sign of cognitive change, depression, or functional decline. Predicts need for community services, help at home, or residential placement.

Rockwood Clinical Frailty Scale (CFS)

9-point visual scale (1 = very fit to 9 = terminally ill). Integrates fitness, comorbidity, and disability into single holistic judgment. Quick clinical impression; no scoring formula.

No chronic conditions. Excellent physical and cognitive function. High activity level. This is the reference category (best possible health status).

May have controlled chronic conditions (e.g., hypertension, diabetes on stable meds). Normal cognitive function. Fairly active.

Multiple chronic conditions well-managed. Physically and cognitively independent. May have some functional limitations (e.g., can't run but can walk).

Unintentional weight loss, exhaustion, low activity, slowed walking. Or mild cognitive impairment. Functionally independent but clearly slowing. At high risk of future decline with health stress (illness, hospitalisation).

Difficulty with complex tasks (shopping, cooking, finances, meds). Still manages basic self-care (bathing, dressing, eating). Needs help with instrumental activities.

Help needed with some basic activities (e.g., dressing, bathing) and most instrumental activities. May need prompting for safety. Often cognitively intact but physically dependent.

Completely dependent for personal care. May have significant cognitive impairment. Barely alert. Requires 24-hour supervision/care.

Vegetative state or minimally responsive. Complete dependence on others. Not expected to survive more than 6 months without intervention.

Expected to pass away within 6 months. May be appropriate for palliative/comfort care.

Clinical Use of CFS

Holistic judgment: Combines fitness, comorbidity, disability, cognition into one impression. Scored clinically by observation and conversation, not formulaic.

Cut-offs for intervention:

  • CFS 1-3: Robust to managing well; standard preventive care
  • CFS 4: Vulnerable; initiate proactive assessment, falls/polypharmacy review, exercise program
  • CFS 5-6: Frail; intensive MDT input (geriatrics, physio, OT, community care planning)
  • CFS 7-9: Severely frail or terminal; advance care planning, palliative focus, goals of care conversation

Predictive value: CFS is strong predictor of mortality, hospitalisation, institutionalisation in older adults. Used widely in Canadian and UK healthcare for frailty screening and resource allocation.