geriatrics

Cumulative Illness Rating Scale — Geriatric (CIRS-G)

14-organ-system comorbidity scoring tool designed for older adults. Each system scored 0 (no problem) to 4 (extremely severe). Total score 0–56. Used for risk stratification, research, and clinical decision-making in geriatric medicine.

Cardiac (heart disease — heart failure, coronary artery disease, arrhythmia)*

Vascular (peripheral/cerebrovascular disease — hypertension, stroke, PVD)*

Haematological (anaemia, haematological malignancy, bleeding disorders)*

Respiratory (lung disease — COPD, asthma, pneumonia)*

Eye, ear, nose, throat, larynx (sensory impairment, ENT disease)*

Upper GI (oesophagus, stomach, duodenum, biliary system, pancreas)*

Lower GI (bowel — colon, rectum, hernia)*

Liver (hepatic disease — cirrhosis, hepatitis)*

Renal (kidney disease — CKD, dialysis)*

Genitourinary (bladder, prostate, genital organs)*

Musculoskeletal (bone, joint, muscle disease)*

Neurological (brain/CNS disease — dementia, stroke, Parkinson's, epilepsy)*

Endocrine and metabolic disease (diabetes, thyroid, adrenal, obesity)*

Psychiatric illness (depression, anxiety, psychosis, substance use)*

Score interpretation

Low Comorbidity Burden 0–6

CIRS-G 0–6 — minimal comorbidity

→ Standard care; focus on preventive health measures; annual review; standard surgical/procedural risk — no specific modifications needed for comorbidity

Moderate Comorbidity Burden 7–14

CIRS-G 7–14 — moderate multimorbidity

→ Structured multimorbidity review; medication reconciliation; coordinate care across specialties; consider comprehensive geriatric assessment (CGA); pre-operative risk assessment for major surgery; falls and frailty screen

High Comorbidity Burden 15–56

CIRS-G ≥15 — high multimorbidity burden

→ Comprehensive geriatric assessment (CGA); MDT approach (geriatrics, pharmacy, OT, PT, social work); advance care planning; medication rationalisation (Beers Criteria, STOPP/START); high surgical risk — discuss alternatives; palliative care involvement if appropriate; regular carer/family communication

Interpretation bands for the CIRS-G. Apply clinical judgement and local guidance.

References

Miller MD et al. Rating chronic medical illness burden in geropsychiatric practice and research: application of the Cumulative Illness Rating Scale. Psychiatry Res. 1992;41(3):237–248.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Elixhauser Comorbidity Index · Comorbidity Assessment

Pathways

Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.

Score interpretation

References

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