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Description Older patients often undergo morbid and invasive surgeries despite the presence of frailty and cognitive impairment, which increases the risk for post-operative complications such as delirium and hospital-acquired debility. These complications rarely align with patients’ health goals, leaving them worse off than their pre-surgical state. Comprehensive geriatric assessment offers a way to evaluate older adults before surgery, and address topics such as polypharmacy, cognitive impairment, frailty, and goals of care. The Oregon Health and Science University (OHSU) Geriatric Transitions of Care clinic uses the 4Ms framework to identify patients at risk for poor cognitive and functional outcomes while there is still time to intervene. Baseline cognitive and mobility assessments are performed, as well as medication reconciliations. Recommendations are provided to the patient and surgical team to make the procedure safer, such as de-prescribing harmful medications, completing physical therapy, and sometimes foregoing surgery altogether if in the patient’s best interest. This is an early-stage pilot project, and we anticipate having preliminary data by Fall 2025. We hypothesize that this work will provide frail patients at risk for post-operative complications with essential tools to mitigate risks ahead of time and align goals of care with treatment options.