BSN Tracker

Assessment Tool: SPICES Geriatric Screening

Assess each of the six SPICES domains using the prompts provided. Any positive finding should trigger a targeted, comprehensive assessment and interdisciplinary care planning. Document findings in the patient record and communicate to the care team.

SPICES Geriatric Screening

A six-domain geriatric assessment framework developed by Fulmer (1991, revised 2007) for identifying common nursing-sensitive geriatric syndromes. Each domain is associated with significant morbidity; positive findings should trigger targeted comprehensive assessment and interdisciplinary care planning.

SPICES domains

S

Sleep Disorders

P

Problems with Eating or Feeding

I

Incontinence

C

Confusion

E

Evidence of Falls

S

Skin Breakdown

S — Sleep Disorders

Difficulty falling asleep, staying asleep, early awakening, daytime somnolence, or changes in sleep pattern. Assess for obstructive sleep apnea, restless legs, nocturnal confusion.

Does the patient report difficulty sleeping or staying asleep?

Is there evidence of excessive daytime sleepiness?

Has there been a recent change in sleep pattern or schedule?

P — Problems with Eating or Feeding

Unintentional weight loss, poor appetite, chewing or swallowing difficulty, dependence in feeding, or meal skipping. Screen for dysphagia, dentition issues, and nutritional risk.

Has the patient had unintentional weight loss (≥ 5% in 3 months or ≥ 10% in 6 months)?

Is there evidence of difficulty chewing or swallowing?

Does the patient require assistance with eating or feeding?

I — Incontinence

Urinary or fecal incontinence; urgency, frequency, or nocturia. Assess for new-onset versus chronic incontinence. Note impact on skin integrity and dignity.

Does the patient have urinary incontinence (any involuntary leakage)?

Is fecal incontinence present?

Is incontinence new-onset or a change from baseline?

C — Confusion

Acute confusion (delirium), chronic cognitive impairment (dementia), or depression. Distinguish new onset from baseline. Assess orientation, attention, memory, and behavior.

Is there evidence of acute confusion or delirium (onset hours to days)?

Does the patient have known or suspected dementia or cognitive impairment?

Is there evidence of depression or mood disturbance affecting cognition?

E — Evidence of Falls

Recent falls, near-falls, or fear of falling. Assess gait, balance, orthostatic hypotension, vision, footwear, and environmental hazards. Screen for fall risk factors.

Has the patient fallen in the past 3 months?

Does the patient report fear of falling or self-restricting activity?

Is there evidence of gait instability, balance problems, or dizziness?

S — Skin Breakdown

Pressure injuries, skin tears, moisture-associated skin damage (MASD), or wound complications. Assess bony prominences, moisture exposure, and nutritional status.

Is there evidence of any pressure injury or skin breakdown?

Is the patient at elevated risk for skin breakdown (immobility, incontinence, malnutrition)?

Are moisture-associated skin changes (MASD, IAD) present?