Understanding the Comprehensive Geriatric Assessment (CGA)
For elderly patients, a standard physical examination is often not enough. Healthcare providers perform a Comprehensive Geriatric Assessment (CGA), which is a multidisciplinary process evaluating a patient's medical conditions, mental health, functional capacity, and social circumstances. The CGA is person-centered and yields a more complete list of problems than a typical medical evaluation alone. Instead of a single test, the CGA includes several components and specialized examinations tailored to the unique needs of older adults.
The Timed Up and Go (TUG) Test: A Common Assessment Tool
Among the most widely adopted instruments is the Timed Up and Go (TUG) test, particularly for assessing functional mobility and fall risk. This simple, reliable, and easy-to-administer test requires minimal equipment and can be performed almost anywhere. The TUG test measures the time it takes for a person to rise from a standard armchair, walk 3 meters (10 feet), turn around, walk back to the chair, and sit down.
How the TUG Test is Performed
- The patient sits in a standard armchair with their feet flat on the floor.
- A line or cone is placed 3 meters away.
- On the command “go,” the patient stands up and walks at their normal pace to the line.
- They turn around and walk back to the chair.
- The timer is stopped when the patient is seated back in the chair.
For a community-dwelling older adult, completing the test in more than 12 seconds may indicate an increased risk of falling. However, a healthcare provider will also observe the patient's gait, posture, and balance for a more comprehensive qualitative assessment.
Cognitive Assessment: The Mini-Mental State Examination (MMSE)
Another crucial aspect of the geriatric exam is cognitive assessment, often done using a tool like the Mini-Mental State Examination (MMSE) or the Mini-Cog. The MMSE is a brief, 30-point questionnaire used to screen for cognitive impairment and track changes over time. It assesses orientation, memory, attention, language, and calculation. While a quick and valuable screening tool, the MMSE has limitations and should not be the sole determinant of a diagnosis like dementia. A provider will also consider factors like the patient's education and cultural background when interpreting the results.
Other Important Functional Assessments
Beyond TUG and MMSE, other functional assessments are commonly used to create a holistic picture of a senior's health:
- Short Physical Performance Battery (SPPB): A comprehensive tool that includes subtests for balance, gait speed, and a five-time sit-to-stand test. It provides a more detailed view of physical function than the TUG alone.
- Four-Stage Balance Test: A quick screening tool that requires a patient to hold increasingly challenging stances (feet side-by-side, semi-tandem, tandem, and single-leg) for 10 seconds each. Failure to hold any position indicates an increased fall risk.
- Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs): These assessments evaluate a person's ability to perform self-care tasks (e.g., eating, dressing) and more complex tasks required for independent living (e.g., managing finances, shopping).
Why Geriatric Exams Differ from Standard Physicals
The geriatric exam is distinct from a general adult physical because of its emphasis on specific areas affecting older adults' functional capacity and quality of life. A typical physical may not adequately capture issues like fall risk, polypharmacy effects, or mild cognitive decline. The focused approach of a geriatric exam ensures that topics such as vision, hearing, nutrition, continence, and mental status are specifically addressed.
| Assessment Tool | Primary Focus | Administration Time | What It Measures |
|---|---|---|---|
| Timed Up and Go (TUG) | Mobility, Balance, Fall Risk | Very brief (minutes) | Functional mobility through standing, walking, turning, and sitting. |
| Mini-Mental State Exam (MMSE) | Global Cognitive Function | Brief (5–10 minutes) | Orientation, memory, attention, calculation, language, and recall. |
| Short Physical Performance Battery (SPPB) | Lower Extremity Function | Brief (minutes) | Balance, gait speed, and lower body strength. |
| Four-Stage Balance Test | Balance & Fall Risk | Very brief (minutes) | Ability to hold different standing positions. |
The Role of Preventative Health
Regular geriatric assessments are a form of preventative health for seniors, aiming to identify problems early for timely intervention. For instance, a poor TUG result can lead to physical therapy to improve mobility and reduce future fall risk. Similarly, early detection of cognitive decline can inform care planning. In addition to formal assessments, monitoring vital signs, reviewing medications (polypharmacy), and checking for issues like malnutrition or visual/hearing impairment are key.
Conclusion
While the TUG test is arguably the most commonly used specific physical examination for assessing functional mobility in the elderly, it is just one component of the broader, more specialized Comprehensive Geriatric Assessment. This holistic approach ensures that medical, physical, cognitive, and social factors are all considered to maximize an older person's health, independence, and quality of life. For more resources on fall prevention and assessment tools, consult the CDC's STEADI initiative at https://www.cdc.gov/falls/steadi/index.html.
