MICA · CLINICAL LEARNING
A cross-cutting clinical approach
Internal medicine considers functional trajectory alongside diagnoses. Geriatric assessment connects clinical condition, cognition, mobility, nutrition, medicines and environment to build a plan proportionate to the person’s priorities.
01 · Establish baseline status
Compare current status with usual independence in basic and instrumental activities. Obtain family observations with appropriate consent, sensory abilities, pain, mood and available support. Frailty cannot be reduced to age or number of diagnoses. Comprehensive geriatric assessment, Independence and dependence, and Frailty develop complementary dimensions without replacing clinical examination.
[1][2]02 · Identify acute change
New confusion, a fall, reduced intake or loss of independence may reveal acute illness with several contributing causes. Consider infection, pain, dehydration and medication harm according to context. Distinguish pre-existing cognitive impairment from delirium, including quieter presentations. When the two are difficult to separate, prioritise delirium management and investigation of its triggers.
[3][1]03 · Protect functional reserve
Assess gait, balance, fall risk, nutrition and ability to participate in care. Reduce environmental barriers, preserve orientation, sleep and sensory aids, and arrange appropriate mobilisation. Interventions should target identified factors rather than applying only a risk label. Hospital admission or intercurrent illness warrants reassessment because previous abilities may decline rapidly or become recoverable with appropriate support.
[2][3][1]04 · Balance benefits, burden and priorities
Discuss what matters to the person: comfort, independence, prevention of an event or reduced treatment burden. Review medicines, monitoring demands and potentially conflicting disease-specific targets. Identify the follow-up coordinator and home support. A justified reduction in treatment may help, but it needs discussion, monitoring and a plan if symptoms return.
[1]A learning situation
FICTIONAL SITUATION · WITHOUT A SCORE
Fictional situation: after a medication change, an older person becomes quieter, eats less and falls. The family attributes everything to ageing.
What assessment should take priority?
Read the reasoning
Treat the functional change as a clinical warning: assess delirium, medication tolerability and other acute causes. Reconstruct the timeline with the patient and family, then arrange necessary care and safety measures. Age alone does not explain recent deterioration. Reassess independence after identified contributors have been addressed.
References and scope
- Multimorbidity: clinical assessment and management — NG56 recommendations ↗
- Falls: assessment and prevention in older people and in people 50 and over at higher risk — Recommendations (NG249, 2025) ↗
- Delirium: prevention, diagnosis and management in hospital and long-term care — Recommendations (CG103, updated 2023) ↗
Original educational synthesis for adult internal medicine. Individual care depends on the clinical setting, applicable product information and local pathways. These notes are not an institutional protocol or a certification. Independent human scientific review remains to be confirmed.