Step-by-step process for getting a comprehensive geriatric assessment
1. Identify if a CGA is right for you or a loved one
A comprehensive geriatric assessment (CGA) is not necessary for all older adults, but it is particularly beneficial for those with specific health complexities. A healthy, highly functioning 75-year-old may not need one, but an older adult with one or more chronic conditions, a history of falls, or signs of dementia would benefit greatly. This assessment is a detailed, multidimensional process that goes far beyond a standard physical exam.
Look for specific signs that a CGA may be necessary, such as:
- Frequent falls or mobility issues.
- Changes in memory, cognition, or mental health.
- Managing multiple chronic medical conditions (multicomplexity).
- Changes in functional ability, such as dressing, bathing, or preparing meals.
- Social isolation or changes in living situation.
- Unintentional weight loss or poor nutritional status.
- Concerns about managing multiple medications (polypharmacy).
2. Talk to your primary care physician
The first and most crucial step is to speak with the primary care provider (PCP). Frame the discussion around observable changes or specific concerns that point toward a decline in health or function, not simply a desire for a "check-up." You can initiate this conversation by discussing specific observations you or a caregiver have made.
When speaking with the PCP, you might say:
- “I've noticed my parent is having more trouble with balance and has fallen twice in the last year. Could they benefit from a geriatric assessment?”
- “My mother seems to be forgetting things more often, and I'm concerned about her ability to manage her medications. What are the next steps?”
- “We are struggling to manage my father's multiple health conditions. Is there a more comprehensive approach we can take?”
Based on these concerns, the PCP can make a formal referral to a geriatrician or a geriatric assessment team.
3. Seek a referral to a geriatrician
A geriatrician is a physician who specializes in the care of older adults. While the PCP can coordinate some aspects, a geriatrician is typically the central point for a full CGA, involving a multidisciplinary team. This team often includes:
- Geriatrician/Physician: Oversees the entire process and coordinates the care plan.
- Nurse: Assists with personal care assessment and monitoring.
- Social Worker: Assesses psychosocial needs, social support, and environmental factors.
- Physical Therapist: Evaluates mobility, balance, and fall risk.
- Occupational Therapist: Focuses on activities of daily living (ADLs) and instrumental ADLs (IADLs).
- Pharmacist: Conducts a comprehensive medication review.
4. Attend the assessment and provide information
When you or your loved one goes for the assessment, be prepared to share detailed information. The process can take an hour or more and may occur over one or several visits. Bring all medication bottles—including over-the-counter drugs and supplements—to the appointment. Caregivers or family members who spend significant time with the older adult are crucial for providing valuable context about daily functioning and behavior changes.
The assessment will evaluate several domains:
- Mind: Cognitive function and mental health.
- Mobility: Physical function, including balance and walking.
- Medications: Reviewing all drugs for potential interactions or side effects.
- Multicomplexity: Addressing multiple chronic conditions.
- What Matters Most: Understanding the patient's personal goals and priorities for care.
Differences between a CGA, an Annual Physical, and a Medicare Annual Wellness Visit
| Feature | Comprehensive Geriatric Assessment (CGA) | Annual Physical Exam | Medicare Annual Wellness Visit (AWV) |
|---|---|---|---|
| Purpose | Multidimensional evaluation to identify and manage complex health issues in older adults. | General health screening and physical checkup. | Preventive planning, risk assessment, and creating a personalized prevention plan. |
| Focus | Holistic approach covering medical, functional, cognitive, and psychosocial domains. | Hands-on physical examination, bloodwork, and vital signs. | Discussion and assessment of health risks, without a hands-on physical exam. |
| Team | Multidisciplinary team (geriatrician, nurse, PT, OT, social worker, pharmacist). | Typically performed by a single primary care provider. | Can be performed by a nurse or other healthcare professional. |
| Duration | Can be lengthy, taking 60+ minutes over one or more visits. | Varies, generally shorter than a CGA. | Generally shorter than a physical or CGA. |
| Outcome | A coordinated, comprehensive care plan to optimize function and quality of life. | General health summary and prescriptions based on findings. | Health Risk Assessment and Personalized Prevention Plan. |
5. Develop and implement the care plan
Following the assessment, the geriatric team will formulate a personalized care plan based on the findings. This is a crucial step for setting goals and determining the best course of action. The plan might include:
- Referrals to other specialists.
- Changes to medication schedules.
- Recommendations for physical or occupational therapy.
- Suggestions for home safety modifications.
- Coordination with social services for additional support.
6. Follow up and monitor progress
As the name suggests, a CGA is a comprehensive and ongoing process, not a one-time event. The care plan will need regular monitoring and adjustment. The geriatric team will schedule follow-up appointments to track progress toward the established goals, ensuring the older adult continues to receive optimal care. Effective communication between all team members—and with the patient and caregivers—is essential for success.
Conclusion
Obtaining a comprehensive geriatric assessment is a proactive and highly effective way to address the complex health needs of older adults. The process begins with recognizing the signs that a CGA is needed and discussing these concerns with a primary care provider. This leads to a referral to a multidisciplinary team of experts, who perform a thorough evaluation covering all aspects of an individual's well-being. By developing and continuously monitoring a personalized care plan, a CGA can significantly improve an older person's health, independence, and overall quality of life.
Frequently asked questions
What is a comprehensive geriatric assessment (CGA)?
A CGA is a multidisciplinary evaluation of an older person's medical, functional, cognitive, and psychosocial issues, designed to create a coordinated and personalized care plan.
Who should get a comprehensive geriatric assessment?
A CGA is recommended for older adults with complex health issues, such as multiple chronic conditions, frailty, memory problems, or a history of falls. It is most beneficial for those with significant health concerns, not typically for highly functioning individuals.
What is the first step to get a CGA?
The first step is to talk to your or your loved one's primary care physician. The PCP can identify if a CGA is appropriate and provide a referral to a geriatrician or a geriatric assessment team.
What does a multidisciplinary team do in a CGA?
A multidisciplinary team, which may include a geriatrician, nurse, social worker, and therapists, collaborates to provide a comprehensive evaluation and create a coordinated care plan addressing all facets of an older adult's health.
Is a CGA covered by insurance?
Many insurance plans, including Medicare, cover a comprehensive wellness visit, which includes some elements of a CGA, particularly for prevention and risk assessment. It's best to check with your specific provider regarding the coverage details for a full multidisciplinary assessment.
How long does a comprehensive geriatric assessment take?
A CGA is not a one-time, brief appointment. It can take an hour or more and may be completed over several visits to gather all necessary information from the patient and caregivers.
What is the difference between a CGA and an annual physical?
A CGA is a holistic, multidisciplinary evaluation for complex issues in older adults, while an annual physical is a more traditional, hands-on medical checkup focused on general health.
How can a caregiver assist during a CGA?
Caregivers play a vital role by providing important insights into the patient's daily life, behavioral changes, and functional abilities that the healthcare team may not otherwise observe. It is helpful for a caregiver to attend the assessment with the patient.
