Understanding the Comprehensive Geriatric Assessment (CGA)
The CGA is a multidimensional evaluation tailored to the unique needs of older adults, going beyond a standard medical check-up. It is a dynamic, multidisciplinary process that examines the whole person to distinguish between normal aging and treatable health problems. The CGA is particularly helpful for older individuals who are frail, have multiple health conditions, or are experiencing a decline in function.
CGA findings guide treatment decisions, enhance overall health, and predict responses to interventions. A team of healthcare professionals often performs it to cover all aspects of a patient's life.
The 5 Core Domains of the CGA
1. Medical Domain (Somatic)
This domain involves a detailed assessment of physical health, including existing medical conditions, medications, nutritional status, and common issues like incontinence, pain, and sensory impairments. Addressing these factors can improve quality of life and reduce hospital readmissions.
2. Psychological Domain
Crucial for overall health, this domain screens for cognitive issues (like dementia or delirium), mood disorders (depression, anxiety), and other emotional health concerns. Early identification is key for timely intervention and better outcomes.
3. Functional Domain
Focused on independence, this domain assesses the ability to perform Activities of Daily Living (ADLs) such as bathing and dressing, and Instrumental Activities of Daily Living (IADLs) like managing finances. Evaluation of mobility and balance is also essential for assessing fall risk.
4. Social Domain
Social circumstances significantly impact health and well-being. This domain assesses social support networks, caregiver needs, potential isolation or loneliness, and financial concerns that might affect access to care.
5. Environmental Domain
The patient's physical environment is important for safety and independence. This domain assesses home safety hazards (like fall risks), accessibility, potential use of assistive technology, and access to transportation and community resources.
CGA vs. Traditional Medical Assessment
The table below highlights the differences in scope and focus:
| Aspect | Comprehensive Geriatric Assessment (CGA) | Traditional Medical Assessment |
|---|---|---|
| Scope | Multidimensional and holistic | Narrowly focused on specific disease states |
| Focus | Function, quality of life, and independence | Diagnosis and treatment of specific medical problems |
| Team | Multidisciplinary team | Typically a single physician |
| Goals | Integrated, goal-oriented care plan | Problem list and medical treatment plan |
| Evaluation | Broad range of medical, social, and functional issues | Medical diagnoses and test results |
Implementing the CGA Process
CGA is a systematic, iterative process. It begins with screening to identify patients who would benefit. A multidisciplinary team then conducts the in-depth assessment across the five domains, gathering information from the patient, family, and caregivers. This leads to the development of a coordinated, goal-driven care plan. The plan is implemented with regular follow-ups to monitor progress and adjust interventions as needed, ensuring responsive care.
The Power of a Holistic Approach
A holistic approach, evaluating all five domains, provides a detailed picture of a patient's health, leading to better decisions and interventions. For example, falls might be linked to multiple factors like poor lighting (environmental), medication side effects (medical), and social isolation. The resulting care plan addresses all these factors for safer, more comprehensive care.
For further information, the British Geriatrics Society offers a {Link: Comprehensive Geriatric Assessment (CGA) Hub https://www.bgs.org.uk/CGA}.
Conclusion
Understanding what are the 5 domains of CGA reveals a powerful, integrated process that assesses the full spectrum of an older adult’s life. This multidisciplinary approach ensures personalized care that prioritizes independence, well-being, and quality of life for older adults with complex health needs.
