Of course, one begins with the usual history and physical examination, but several additional inquiries and examinations are needed. A first addition includes careful attention to the medication regimen and the patient’s adherence to it. Elderly patients often do not take medications as prescribed. They may take only half doses or take daily doses only once weekly. In other cases they may not take the medication at all, perhaps because of excessive expense or their perception of side effects. In addition, one must ask them about their intake of all over-the-counter medications and herbal or other supplements that can affect their health. The average person over age 70 takes four to five prescription medications and two to four supplemental medications. These all must be recorded so that all personnel know what is actually taken.

One risk buried below this medication problem is that one must avoid the routine rewriting on admission of all medications “found in the record.” What happens if you order an alpha-blocking agent such as terazosin to a patient who has not in reality taken this prescribed medication? One risks side effects such as postural hypotension and falls. On admission, order only those necessary drugs that the patient actually takes and those needed for procedural preparation (e.g., antibiotics).

Another challenge is the recovery of information specific to prior treatment. Older people tend to forget details of treatments received years ago. If the patient has received radiation, what was the total dose and area of the field(s)? If the patient had surgery, what was actually done? Did the prior surgeon take out over four feet of small bowel? Even though chasing down such information can be difficult, it is very necessary.

Other significant additions to the geriatric evaluation are an assessment of the cognitive, mobility, and flexibility functions. These three elements can be combined to give an estimate of the patient’s overall functional ability. First,