A comprehensive geriatric assessment (CGA) is a cornerstone of modern geriatric medicine, recognizing that older adults have unique and complex healthcare needs that go beyond standard medical evaluations. A CGA is a multidimensional process that uses a multidisciplinary team to systematically evaluate the physical, mental, and social health of an older person to create a coordinated plan that promotes maximum health and independence. The five core domains serve as a framework to ensure all key aspects of a patient's well-being are considered.
1. Medical/Physical Domain
The medical domain focuses on the older adult's overall physical health, including the management of acute and chronic conditions. This assessment is a detailed review of medical history, current health issues, and preventative care. Unlike a standard physical exam, it emphasizes age-specific concerns that are vital for maintaining function and quality of life.
Key components of the medical domain
- Chronic Conditions: Assessment of chronic diseases like diabetes, hypertension, and arthritis is essential for understanding the patient's baseline health and multi-morbidity.
- Polypharmacy: Older adults often take multiple medications, which increases the risk of side effects and dangerous drug interactions. A detailed medication review is a critical part of the assessment.
- Nutritional Status: Malnutrition is common in older adults and can significantly impact physical health, wound healing, and immunity. Screening tools like the Mini Nutritional Assessment are used to evaluate dietary intake and weight loss.
- Sensory Impairment: Vision and hearing loss are prevalent in older adults and can be a significant factor in functional decline, social isolation, and depression. Assessment includes vision and hearing tests.
- Continence: Urinary and bowel incontinence are common but not normal parts of aging. These issues are assessed to prevent complications and improve quality of life.
- Pain: Pain management is a crucial part of the physical assessment, as chronic pain can severely impact an older adult's functional ability and mood.
2. Functional Domain
The functional domain evaluates a person's ability to perform tasks necessary for living independently. This is often the most impactful area for assessing quality of life. It is categorized into two levels: Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). Functional status can be determined through observation, patient report, or validated tools.
Assessing functional ability
- Activities of Daily Living (ADLs): These are basic self-care tasks required for daily living, such as bathing, dressing, eating, using the toilet, and transferring (moving from bed to chair). The Katz ADL scale is a common tool for this assessment.
- Instrumental Activities of Daily Living (IADLs): These are more complex activities that are needed for independent living in a community setting. Examples include managing finances, using the telephone, shopping, preparing meals, and doing housework. The Lawton IADL scale is often used to measure these abilities.
- Mobility and Falls: A key component is assessing gait, balance, and the risk of falls. The Timed Up and Go Test, which measures the time it takes a person to rise from a chair, walk a short distance, and sit back down, is a standard test for this.
3. Cognitive Domain
The cognitive domain assesses the mental functions essential for daily living, as impairment can significantly affect a person’s independence, safety, and decision-making. Cognitive deficits can range from mild impairment to advanced dementia.
Evaluating cognitive function
- Screening Tools: Simple screening tests are used to evaluate areas like orientation, attention, calculation, and memory. The Mini-Cog test, which combines a three-word recall with a clock-drawing task, is an easy-to-administer tool. Other options include the Montreal Cognitive Assessment (MoCA) and the Saint Louis University Mental Status (SLUMS) exam.
- Executive Function: This includes evaluating abilities such as planning, problem-solving, and decision-making, which are crucial for complex tasks like managing medications or finances.
- Delirium: Screening for delirium, an acute state of confusion often caused by an underlying illness, is an important part of a geriatric assessment, particularly in hospital settings.
4. Psychological Domain
The psychological domain evaluates an older adult's mental and emotional health, which can profoundly influence their physical health and functional abilities. Mood disorders like depression and anxiety are common but are not a normal part of aging.
Assessing psychological well-being
- Mood: Screening for depression is a crucial part of the assessment. The Geriatric Depression Scale (GDS) is a validated tool specifically designed for older adults. Symptoms of depression in older adults can be subtle and often present as physical complaints.
- Anxiety: High levels of anxiety can lead to a reduced quality of life and is often under-recognized.
- Coping Mechanisms: The assessment also evaluates a person's coping strategies for dealing with life changes, losses, and health challenges.
- Social Isolation: Loneliness and social isolation are risk factors for poorer health outcomes, including depression.
5. Socio-Environmental Domain
The socio-environmental domain focuses on the patient's social support system and living situation, both of which are critical for maintaining independence and well-being. Many older adults rely on caregivers, and their home environment can present risks to their health and safety.
Examining social and environmental factors
- Social Support: The assessment reviews the patient's network of family, friends, and caregivers. Social isolation is a significant predictor of mortality.
- Financial Status: Concerns about finances can be a major stressor for older adults. A social worker may assess whether the patient has adequate resources and access to financial assistance.
- Home Safety: A home environment assessment identifies potential hazards that could increase the risk of falls, such as poor lighting, stairs, or clutter. This helps in recommending modifications to improve safety.
- Community Resources: The evaluation includes determining the patient's access to local services and support programs, which can be essential for independent living.
Comparison of Geriatric Assessment Domains
| Feature | Medical/Physical | Functional | Cognitive | Psychological | Socio-Environmental |
|---|---|---|---|---|---|
| Primary Focus | Managing chronic conditions & overall physical health | Ability to perform daily tasks independently | Evaluating mental functions like memory & concentration | Assessing mood, emotional health, & coping | Reviewing social support system & living situation |
| Key Examples | Polypharmacy review, nutrition screening, pain management | Assessing ADLs and IADLs, gait speed test | Mini-Cog test, MoCA exam, delirium screening | Geriatric Depression Scale (GDS), anxiety assessment | Social network assessment, home safety check, financial review |
| Key Provider | Geriatrician, Physician, Nurse | Occupational therapist, Physical therapist, Nurse | Geriatrician, Psychologist, Nurse | Psychologist, Social Worker, Geriatrician | Social Worker, Occupational therapist |
| Impact of Impairment | Decreased mobility, organ function, risk of medication issues | Loss of independence, increased risk of institutionalization | Impaired decision-making, confusion, safety risks | Depression, anxiety, reduced quality of life | Social isolation, financial strain, higher fall risk |
Conclusion
In conclusion, understanding what are the 5 domains of geriatric assessment is critical for providing holistic, patient-centered care to older adults. The CGA is a comprehensive and integrated approach that extends beyond standard medical evaluations to address the complex interplay of a patient's physical, functional, cognitive, psychological, and socio-environmental health. By evaluating these core areas, a multidisciplinary team can proactively identify issues, develop targeted interventions, and create a coordinated care plan. This systematic process helps to improve diagnostic accuracy, guide appropriate treatment decisions, and ultimately enhance the overall well-being, quality of life, and independence of the geriatric population.
References
- American Academy of Family Physicians (AAFP). "The Geriatric Assessment." American Family Physician, 1 Jan. 2011, www.aafp.org/pubs/afp/issues/2011/0101/p48.html.
- British Geriatrics Society (BGS). "CGA: Physical domain." British Geriatrics Society, 18 June 2025, www.bgs.org.uk/cga-physical-domain.
- Physiopedia. "Comprehensive Geriatric Assessment." Physiopedia, www.physio-pedia.com/Comprehensive_Geriatric_Assessment.
