# CMS Domain 3: Frailty Screening & Intervention > Operationalize Domain 3 of the Age-Friendly Hospital measure and advance healthcare system priorities. 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 Explore GEDA Care Processes 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. Make the Case Review the evidence for investment in age-friendly care processes with a well-summarized pitch deck to share with your C-suite or board of directors. Continue Domain 3 Resources Supporting CMS and More Align with Domain 3 requirements and GEDA care processes. This domain covers many areas of geriatric emergency medicine. PODCAST | Mentation & Mobility 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. Listen Now WEBINAR | Mentation & Mobility Frailty Screening and Intervention and the CMS Hospital Measure Our panel discusses frailty screening practices and proven interventions that help EDs meet CMS requirements. View Webinar TOOLKIT | Mobility Management of Older Adult Falls and Mobility in the Emergency Department Tools to assess and support older patients who have fallen in the ED — and encourage safe mobility post-discharge. View Toolkit TOOLKIT | Mentation Emergency Department Care of Individuals Who Have Dementia Practical resources to help EDs identify and address dementia — with tools for implementing key protocols. View Toolkit TOOLKIT | Mentation 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. View Toolkit TOOLKIT | Mentation & Mobility Addressing Boarding in the Geriatric ED Concrete strategies for alleviating boarding in the geriatric ED, informed by real-world success stories. View Toolkit 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. View Toolkit 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. Watch Now 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 Course 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.  View Course 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. View Toolkit 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. Listen Now View All Delirium Resources > 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. View Toolkit 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.  View Course 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.  Listen Now View All Dementia Resources > 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. View Toolkit 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. View Course Collection 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. View Course View All Falls & Mobility Resources > 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. Listen Now 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. View Webinar COURSE COLLECTION Geri-EM Online Eight one-hour modules provide practical knowledge for functional assessment, transitions of care, falls, and cognitive impairment. View Course Collection View All Frailty Resources > 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. Listen 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. View Course 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. View Course View All Trauma Resources > 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? Visit GEDA GED Essentials | Cognitive Impairment | Falls & Mobility | Boarding Geriatric-ED Essentials Care Processes Every ED Should Implement Implementation Toolkit Promoting Food and Drink Explore A2 Promoting Food and Drink GEDA Care Process A2 Depression in older adults is associated with higher healthcare utilization, poorer adherence, and longer hospital stays. Screening in the ED allows early identification and linkage to support services that can reduce repeat visits, unnecessary admissions, and avoidable complications. For help implementing D6, access a range of tools and resources from GEDC.   Implementation Toolkit Reducing Restraints Explore A3 Reducing Restraints GEDA Care Process A3 Reducing physical restraints lowers the risk of injury, delirium, and hospital-acquired complications that increase length of stay and liability exposure. Using trained companions or sitters instead supports calmer, safer care for vulnerable elders. It also reduces adverse events and the need for intensive monitoring or escalation of care, reserving restraints for only the most extreme circumstances. To help you implement A3, we’ve provided some practical resources.  Cognitive Impairment & Mental Wellbeing Care Processes for Managing Delirium, Dementia, and Depression Implementation Toolkit Geriatric Psych Consult Explore C2 Access to a Geriatric Psych Consult GEDA Care Process C2 Timely access to geriatric psychiatry helps prevent prolonged ED stays for patients with behavioral health needs, delirium, or complex neuropsychiatric conditions. Early specialist input reduces repeated evaluations, unnecessary admissions, and delays in disposition. This shortens boarding time, improves flow, and decreases avoidable utilization that strains hospital resources. For teams looking to implement this care process, GEDC offers a range of practical resources.  Implementation Toolkit Delirium Screening & Intervention Explore D1 Delirium Screening & Intervention GEDA Care Process D1 Routine delirium screening allows early detection of a high-risk condition that is strongly linked to longer length of stay, higher mortality, and increased costs. Identifying delirium in the ED enables timely interventions that prevent deterioration, reduce care escalations, and shorten hospital stays. This improves outcomes while protecting system capacity and overall performance. Implement this care process with practical guidance from GEDC.  Implementation Toolkit Cognitive Impairment Screening & Intervention Explore D2 Cognitive Impairment Screening & Intervention GEDA Care Process D2 Early identification of underlying cognitive impairment, possible memory issues, or dementia in the ED allows the care team to recognize patients who need memory-sensitive care from the outset. Proactive screening helps tailor communication, consent, discharge planning, and caregiver engagement, reducing the risk of confusion, unsafe discharges, medication errors, or repeat visits. For treat-and-release patients, identifying cognitive vulnerability can also help connect individuals to ongoing community-based support. If you’re looking to implement this care process, our resources can help.  Implementation Toolkit Depression Screening & Intervention Explore D6 Depression Screening & Intervention GEDA Care Process D6 Depression in older adults is associated with higher healthcare utilization, poorer adherence, and longer hospital stays. Screening in the ED allows early identification and linkage to support services that can reduce repeat visits, unnecessary admissions, and avoidable complications. For help implementing D6, access a range of tools and resources from GEDC.   Falls & Safe Mobility Care Processes for Managing Frailty, Falls, and Safe Mobility Implementation Toolkit Functional Assessment Explore D3 Functional Assessment (ISAR, etc.) GEDA Care Process D3 Structured assessment of function in the ED, including use of validated screens such as ISAR, allows early recognition of frailty, functional decline, and emerging vulnerability among older adults. Identifying these risks at the front door enables the ED to trigger targeted supports, care coordination, and appropriate referrals before small problems become significant complications. Implementation Toolkit Falls & Mobility Assessment Explore D4 Falls and Mobility Assessment (Get Up and Go) GEDA Care Process D4 Systematic falls and mobility screening in the ED prevents injuries that commonly lead to longer admissions, surgical interventions, and rehabilitation needs, preventing discharge into the community. Early risk identification in the ED enables safer care plans that reduce inpatient falls, complications, and readmissions. Boarding Care Processes for Minimizing and Managing Boarding Implementation Toolkit Minimizing Boarding Explore D1 Minimizing Boarding GEDA Care Process F1 For busy urban and suburban health systems, minimizing emergency department boarding for high-risk older adults is a strategic priority that improves safety, preserves capacity, and strengthens operational performance. By prioritizing timely bed placement, alternative care pathways, and age-friendly boarding practices for vulnerable older adults, hospitals can reduce avoidable delays, while ensuring safer, more coordinated, and more dignified care. Implementation Toolkit Optimizing Care of Patients Who Are Boarding Explore D2 Optimizing Care of Patients Who Are Boarding GEDA Care Process F2 When boarding is unavoidable, structured age-friendly care for high-risk older adults reduces preventable harm and protects hospital performance, but it also requires intentional investment in the right supports. By dedicating appropriate staffing, clinical partnerships, and systems to manage the known risks of prolonged ED stays, hospitals can decrease delirium, falls, and functional decline that often lead to clinical deterioration, ICU transfers, longer hospitalizations, and readmissions. Standardizing how vulnerable older adults are cared for while awaiting a bed improves safety, shortens total length of stay, and preserves capacity.  Volunteer Programs Care Processes for Volunteers in the ED Implementation Toolkit Volunteers in the ED Explore A2 Volunteers in the ED GEDA Care Process C3 Depression in older adults is associated with higher healthcare utilization, poorer adherence, and longer hospital stays. Screening in the ED allows early identification and linkage to support services that can reduce repeat visits, unnecessary admissions, and avoidable complications. For help implementing D6, access a range of tools and resources from GEDC.   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. < Back to Domain 2 Continue to Domain 4 > 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.