• Cognitive concerns: In an older adult with concerns regarding cognition or mood, perform and interpret an appropriate assessment to distinguish normal aging from other conditions, including dementia, delirium, mood disorders, substance use disorder, and address the interactions among them.

• Capacity: Determine if an older adult has capacity for making a medical decision, and if not, identify and engage the legal surrogate decision maker.

• Delirium: Recognize that delirium is a medical emergency: as such, diagnose, initiate workup for precipitating factors, and treat underlying causes. Mitigate risk factors for hospitalized older adults.

• Agitation management: When managing an older adult with confusion and disruptive behaviors, identify and treat reversible causes of agitation. Collaborate with an interprofessional team to identify treatment strategies that minimize the use of pharmacological and physical restraints.

• Functional assessment: Perform a functional assessment in an older adult that includes basic and instrumental activities of daily living. Collaborate with appropriate interprofessional team members to optimize the older adult's functional status, especially during hospitalization, transitions of care, and post discharge follow-up.

• Mobility assessment: Mobility assessment: Perform and interpret a gait and balance assessment using validated screening tools, and screen older adults for intrinsic and extrinsic fall risk factors.

• Fall and fracture risk reduction: Identify older adults at increased risk of falls or fractures, and develop a multicomponent plan to mitigate risk, in collaboration with appropriate interprofessional team members, that may include, but is not limited to, physical and occupational therapy, assistive devices, medication review, environmental modification, optimization of vision and management of bone health.

• Deprescribing: Perform a review of the older adult's medications (prescribed and non-prescribed) and deprescribe those that are duplicates or potentially inappropriate, high risk, or lack a current indication. When appropriate, discuss alternatives, ways to decrease adverse effects, and develop a monitoring plan.

• Adherence and deprescribing: Identify and address barriers to adherence. When appropriate, discuss alternatives and ways to decrease adverse effects.

• Geriatric pharmacology: When reviewing or prescribing medications, justify drug selection and dosing based on 1) how age-related physiologic changes may impact drug pharmacokinetics and pharmacodynamics, and 2) how the older adult’s comorbidities, functional status, and other medications may increase the risk of side effects.

• Prescribing cascades: Determine whether a new symptom in an older adult may be due to a medication adverse effect, drug-drug interaction, and/or drug-disease interaction, and modify the treatment plan as needed to avoid a prescribing cascade.

• Aging physiology: Account for the interaction of age-related physiological changes and co-morbidities when evaluating and developing treatment plans for older adults.

• Atypical presentations: Identify conditions that may present differently as people age or as geriatric syndromes, when developing differential diagnoses and treatment plans.

• Frailty: Define and apply appropriate tools to assess frailty in older adults and incorporate this into clinical decision making.

• Nutritional status: Assess an older adult's nutritional status, identify underlying causes for weight and body composition changes, and develop initial management plans, including involvement as appropriate of interprofessional team members, specialty consultants, and caregivers.

• Sensory impairment: Identify if an older adult has difficulty with hearing, vision, and/or speech, and include interprofessional team members, specialty consultants, and caregivers in a person-centered treatment plan.

• Safety and autonomy: Identify when older adults are in a potentially unsafe situation, which may include, but is not limited to living environment, caregiver stress, elder mistreatment, self-neglect, or at-risk driving. Collaborate with interprofessional team members and caregivers to balance safety and autonomy.

• Health equity: Define ageism and identify how it intersects with racism, sexism, and other forms of bias to negatively impact the health of older adults. When caring for older adults, assess for experience of discrimination, identify relevant social determinants of health that may contribute to health disparities, and develop holistic care plans to promote equity in access and quality of care for older adults and their caregivers.

• Hazards of hospitalization: Identify and act to reduce hazards of hospitalization and promote safety for an older adult during inpatient stays and transitions of care.

• Transitions of care: Coordinate and document a safe, person-centered care transition, considering the older adult's preferences, baseline and current functional and mental status, advance care plan, and need for community-based resources.

• Patient Priorities: Ask what matters most to each older adult and individualize treatment plans and preventive care recommendations in the context of these priorities, prognosis, function, and cognition.

• Communication: When communicating with older adults and their caregivers, demonstrate cultural humility and use their preferred language, self-identifiers, and pronouns. Adapt communication strategies to the older adult's cognitive abilities and setting.

• Advance care planning: Lead a person-centered discussion and document health care proxies, advance directives, and life sustaining treatment orders, in the context of the laws of the state in which one is training.

• Psychosocial and spiritual needs: Incorporate the psychological, social, and spiritual needs of an older adult into their care, including caregivers and interprofessional team members as appropriate.

• Symptom assessment: Manage pain and other symptoms in an older adult, considering comfort and function, utilizing non-pharmacologic and pharmacologic treatments, and collaborating with interprofessional team members as appropriate.

Andrea Schwartz, MD MPH, AGSF – Co-Chair

Mandi Sehgal, MD – Co-Chair

Rosanne Leipzig, MD, PhD – Senior Advisor

Omar Amir, MD, MS – Working Group Member

Steve Barczi, MD – Working Group Member

Sara Bradley, MD, AGSF – Working Group Member

Laura Byerly, MD – Working Group Member

Anne Halli, MD – Working Group Member

Elizabeth Harlow, MD – Working Group Member

Alison Holliday, MD, MPH – Working Group Member

Julia Loewenthal, MD – Working Group Member

Mallory McClester Brown, MD – Working Group Member

Anthony Okolo, MD – Working Group Member

Carrie  Rubenstein, MD – Working Group Member

Amit Shah, MD, AGSF – Working Group Member