Understanding the Comprehensive Geriatric Assessment
A comprehensive geriatric assessment (CGA) is a multidimensional, interdisciplinary evaluation of an older person's medical, psychosocial, and functional status. It aims to create a coordinated care plan to maximize health and independence, differing from standard medical exams by its holistic approach. This detailed process helps identify conditions that might otherwise be missed, improving quality of life and potentially reducing hospitalizations.
Cognitive Impairment and Mood Disorders
Evaluating cognitive health is a key part of the CGA, helping to identify conditions like dementia and depression.
Detecting Dementia and Cognitive Decline
Cognitive assessments use tools like the Montreal Cognitive Assessment (MoCA) to evaluate areas such as memory and language, aiding in the early detection of mild cognitive dysfunction or potential dementia. Early identification is important for initiating interventions, planning future care, and involving individuals in advance care decisions.
Identifying Depression and Affective Disorders
Depression is common but often unrecognized in older adults. Screening tools like the Geriatric Depression Scale (GDS) help identify depression and other mood disorders. Untreated depression can worsen physical health and social isolation. Identifying these issues allows for targeted treatment that can improve overall well-being.
Functional Status and Mobility
Assessing an older adult's ability to perform daily tasks is a core component of the geriatric assessment.
Evaluating Activities of Daily Living (ADLs)
ADLs are basic self-care tasks necessary for independent living, including bathing, dressing, toileting, feeding, and transferring. Tools like the Katz Index measure independence in these areas.
Assessing Instrumental Activities of Daily Living (IADLs)
IADLs are more complex activities needed for independent living in the community, such as using a phone, shopping, meal preparation, and managing medications and finances. Changes in ADLs or IADLs can signal underlying health issues.
Fall Risk and Balance Issues
Falls are a major concern for seniors. A CGA screens for fall risk using tests like the 'Timed Up and Go' (TUG) to assess balance and gait. It also identifies contributing factors like orthostatic hypotension, vision problems, and medications. Interventions like exercise and physical therapy can reduce fall risk.
Polypharmacy and Medication Management
Polypharmacy, the use of multiple medications, is a common issue in older adults due to altered metabolism. The CGA includes a thorough review of all medications to check for inappropriate drugs (using criteria like the Beers list), potential interactions, and side effects.
Malnutrition and Weight Loss
Unintentional weight loss and malnutrition are linked to increased health problems in older adults. A nutritional assessment, which may include using tools like the Mini Nutritional Assessment (MNA), screens for these issues. Various factors can contribute to malnutrition, including dental problems, chronic illness, and social isolation.
Physical Health and Geriatric Syndromes
The CGA also focuses on specific physical health issues common in older age.
Vision, Hearing, and Continence
Screening for vision and hearing impairments is included as they can impact function, cognition, and mood. Referrals are made if issues are found. Urinary incontinence is another common issue assessed and managed in the CGA.
Other Geriatric Syndromes
The assessment may identify other age-related conditions like frailty, osteoporosis, and chronic pain.
The Multidisciplinary Approach: Teamwork for Better Outcomes
A key strength of the CGA is its multidisciplinary approach, involving various healthcare professionals. This teamwork provides a comprehensive view of the patient's health.
| Team Member | Role in CGA |
|---|---|
| Geriatrician | Leads assessment and coordinates care. |
| Nurse | Gathers history and administers screening. |
| Social Worker | Evaluates social support and environment. |
| Pharmacist | Reviews medications. |
| Physical Therapist | Assesses mobility and recommends exercises. |
| Occupational Therapist | Evaluates functional abilities (ADLs/IADLs). |
Conclusion: A Foundation for Proactive Care
In summary, a geriatric assessment is a valuable tool for identifying numerous conditions impacting an older person's health and well-being. By assessing functional status, cognition, mental health, medications, nutrition, and fall risk, it offers a complete health picture. This approach helps create a care plan to improve quality of life and maintain independence, allowing seniors to live healthier lives. For more information on senior health, visit the National Institute on Aging website.
