Addressing Frailty and Reducing Risk
CMS Domain 3 focuses on identifying and addressing frailty. It includes a range of high-yield strategies for reducing preventable harm and shortening length of stay for older adults who are vulnerable to delirium, falls, deconditioning, and malnutrition while in the emergency department (ED).
To help your ED operationalize Domain 3, the Geriatric Emergency Department Accreditation (GEDA) program has developed care processes that address mentation, mobility, malnutrition, and boarding.
Domain 3 | AFHS 4Ms | GEDA
Making the Connections
Meeting the CMS Measure means having concrete processes rooted in evidence. The Age-Friendly Health System (AFHS) and GEDA frameworks provide exactly that. Discover how each approach aligns with Domain 3 — and brings value to your ED, hospital, and health system.
Linking CMS with AFHS and GEDA
CMS Domain 3
Frailty Screening and Intervention
Aligns With AFHS’s 4Ms
Mentation
Mobility (and Malnutrition)
Achieved Through GEDA Care Processes
A3: Reducing Restraints
A2: Promoting Food and Drink
C2: Geriatric Psych consult in ED
C3: Volunteers in the ED
D1: Delirium Screening & Intervention
D2: Cognitive Impairment Screening & Intervention
D3: Functional Assessment
D4: Falls and Mobility Assessment
D6: Depression Screening & Intervention
F1: Minimizing Boarding
F2: Optimizing Care for Patients who are Boarding
Why It Matters
Identifying Frailty Improves Outcomes
Systematic screening for delirium, dementia, depression, functional decline, mobility, falls risk, mood, and malnutrition allows your ED to identify high-risk patients early. Care teams can trigger targeted interventions before small problems become costly complications.
When older adults are mobilized safely, delirium is detected and managed, nutritional risk is addressed, and boarding is mitigated, outcomes improve across the whole hospital and health system. Inpatient complications decrease, along with escalations of care, length of stay, and readmissions.
By embedding processes that support Domain 3 at the ED front door, health systems can deliver age-appropriate care in practical, measurable ways. They can also avoid downstream utilization, improve throughput, and preserve bed capacity.
Explore Resources
We have a large library of resources to support hospitals and EDs as they work to meet the CMS Measure.
This domain covers a range of topics in geriatric emergency medicine including delirium, dementia, falls, mobility, boarding, and functional assessment and decline. For support in these areas, we have curated a list featuring some of our most relevant resources with links to our full library.
Boarding
TOOLKIT
Addressing Boarding in the Geriatric ED
Concrete strategies for alleviating boarding in the geriatric ED, informed by real-world success stories.
WEBINAR
Boarding and the Geriatric ED
Experts discuss how to provide guidance and processes to help every ED meet the requirements for the CMS Hospital Measure.
COURSE
Battling Boarding: Caring for Older Adults in a Bed-locked ED
A 30-minute presentation covering the effects of boarding and interventions to mitigate harm.
View All Boarding Resources >
Delirium
COURSE
Cognitive Impairment in the Older ED Patient
1 hour AMA & ANCC certified module covering delirium, dementia, and depression – essential topics in the geriatric ED.
TOOLKIT
Management of Delirium in Older Adults in the Emergency Department
Tools, resources, and evidence to help your ED enhance care for older adults facing delirium.
PODCAST
Delirium Clinical Practice Guidelines: What do we know, and what should we do?
Hear about new evidence-based guidelines on risk stratification, screening, and brain imaging for delirium in the ED.
Dementia
TOOLKIT
Emergency Department Care of Individuals Who Have Dementia
Practical resources to help EDs identify and address dementia — with tools for implementing key protocols.
COURSE
Cognitive Impairment in the Older ED Patient
1 hour AMA & ANCC accredited module covering delirium, dementia, and depression – essential topics in the geriatric ED.
PODCAST
Acute care of persons living with dementia: From the clinic to the ED and back
Explore strategies for supporting older adults with dementia, through better communication, system protocols, and interdisciplinary teamwork.
Falls & Mobility
TOOLKIT
Management of Older Adult Falls and Mobility in the ED
Make changes in your ED to enhance the assessment of older patients who have fallen and to ensure safe mobility post-discharge.
COURSE COLLECTION
Skills Fair | Mobility Risks and Falls
Five short modules explore causes, impact, and critical interventions for safe management of mobility risks and falls.
COURSE
Emergency Management of Falls in the Older ED Patient
1-hour AMA and ANCC accredited module exploring assessment and management of falls in the frail older adult.
Frailty
PODCAST
Frailty Frontline: How to Identify Frailty, and What to Do Next
Experts examine how to assess and approach ED patients presenting frailty while drawing from recent studies.
WEBINAR
Frailty Screening and Intervention and the CMS Hospital Measure
Our panel discusses frailty screening practices and proven interventions that help EDs meet CMS requirements.
COURSE COLLECTION
Geri-EM Online
Eight one-hour modules provide practical knowledge for functional assessment, transitions of care, falls, and cognitive impairment.
Trauma
PODCAST
Revive & Survive: Pearls for Resuscitation of Older Adults in the ED
Hear about differences and challenges of resuscitation of an older adult, and how to safely treat this population.
COURSE
Major Trauma in the Older ED Patient
1-hour AMA and ANCC accredited module exploring how normal changes in aging affect standard trauma resuscitation.
COURSE
Geri Trauma – an ED Approach to 3 Common Injuries
Learn how rib fractures, hip fractures, and head injuries can be associated with disproportionately high morbidity and mortality for older adults.
GEDA Care Processes
Ways to Implement Change
Putting Domain 3 into action requires practical, replicable protocols. To help operationalize Domain 3, GEDA has developed a range of care processes that address frailty directly — with practical interventions that can be hardwired into ED workflows. Interested in learning more about GEDA accreditation for your ED?
Applying GEDA Care Processes?
You’re Meeting the Mark
If you adhere to these care processes, your ED is doing its part to meet CMS criteria. This is because GEDA care processes directly support Domain 2 of the CMS Measure — and the IHI’s “Medication” framework. By implementing them, your emergency department can position itself as a clinical innovator that improves hospital flow, alleviates boarding, and advances system reliability — all while delivering better, more humane care.
When these safeguards are consistently and thoughtfully applied, hospitals experience fewer adverse drug events, fewer downstream complications, and more reliable care processes. This leads to fewer avoidable admissions, shorter length of stay, and better bed utilization.
Subject Matter Expert
Payal Sud, MD, FACEP
Payal Sud, MD, FACEP, an Associate Professor of Emergency Medicine and a Medical Toxicologist, is a leading voice in Geriatric Emergency Medicine (GEM). As Chief of GEM for Northwell Health and Associate Chairperson of Emergency Medicine at North Shore University Hospital, she works to optimize patient flow in the emergency department (ED) based on what matters most to older adults and caregivers.
Beyond her administrative work, Dr. Sud investigates the impact of early Palliative Care in the ED, and conducts NIH-funded research on ED care for older adults with delirium and dementia. Applying her extensive experience leading successful GEM initiatives, Dr. Sud now helps shape national standards as a reviewer for ACEP’s GEDA program.
