Reference — Geriatrics
SPICES Assessment Reference
SPICES is a six-domain screen for the common, preventable problems of hospitalized older adults. It takes minutes, and every positive answer has a concrete nursing follow-up.
Data Source: Fulmer SPICES (Hartford Institute for Geriatric Nursing)
Educational use only. SPICES is a screen, not a diagnosis — positive findings are assessed further and reported per unit protocol. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
The Six Domains
| Letter | Domain | Screening Questions | If Positive |
|---|---|---|---|
| S | Sleep disorders | Trouble falling or staying asleep? Napping all day? | Sleep hygiene bundle; review stimulants, diuretic timing, pain, nocturia |
| P | Problems with eating or feeding | Appetite change? Weight loss? Trouble chewing or swallowing? | Nutrition screen, swallow evaluation referral, dentition check, assist plan |
| I | Incontinence | Any urine or stool leakage? New since admission? | Identify type and reversible causes; toileting schedule; skin protection |
| C | Confusion | New or fluctuating disorientation or inattention? | Delirium screen (CAM), cause-hunt, reorientation bundle, notify provider |
| E | Evidence of falls | Fallen in the last 3 months? Unsteady? Afraid of falling? | Fall risk score and bundle, orthostatic vitals, med review, mobility plan |
| S | Skin breakdown | Redness or open areas? Risk factors present? | Full skin inspection, Braden score, repositioning and surface plan |
Why SPICES Works
It targets the syndromes
Each letter maps to a geriatric syndrome with a known prevention bundle — the screen exists to trigger those bundles early, not to generate paperwork.
Repeat it
SPICES is most useful serially — on admission, with any condition change, and at routine intervals. The trend identifies decline the single snapshot misses.
NCLEX Pearls
- ✦SPICES = Sleep, Problems eating, Incontinence, Confusion, Evidence of falls, Skin breakdown.
- ✦A positive confusion screen triggers a delirium evaluation — not a “confused at baseline” note.
- ✦Pair every fall question with orthostatic vitals and a medication review.
- ✦Screening tools earn their value through the action that follows; chart the intervention, not just the score.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with American Geriatrics Society (AGS) · AGS Beers Criteria. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →