What is a Comprehensive Geriatric Assessment (CGA)?
A comprehensive geriatric assessment (CGA) is a multidisciplinary, holistic evaluation of an older adult's health and well-being, going beyond a standard physical exam. It involves a team of healthcare professionals working together to create an integrated care plan. This assessment aims to identify hidden issues impacting independence and quality of life.
The Core Domains of a Comprehensive Geriatric Assessment
A CGA covers several key areas to build a full picture of an older adult's health, allowing for targeted interventions.
Functional Abilities
This assesses an individual's capacity to perform daily tasks essential for independent living, divided into two types:
- Activities of Daily Living (ADLs): Basic self-care such as bathing, dressing, eating, and toileting. Difficulties here may signal a need for personal care support.
- Instrumental Activities of Daily Living (IADLs): More complex tasks for community living like managing finances, using transportation, or preparing meals. Declines may be early indicators of age-related changes.
Medical and Physical Health
This domain examines various health conditions and geriatric syndromes:
- Chronic Medical Conditions: A review of existing illnesses and their severity.
- Nutritional Status: Checking for malnutrition risk and weight changes.
- Sensory Impairments: Screening for vision and hearing issues.
- Incontinence: Evaluating bladder and bowel function.
- Gait and Balance: Assessing mobility and fall risk, often using tests like the "Timed Up and Go".
- Polypharmacy: A review of all medications to check for interactions or side effects.
Cognitive and Mental Health
Evaluating cognitive function and mood is essential for identifying conditions like dementia or depression. Screening tools like the Mini-Cog or Geriatric Depression Scale are frequently used. Assessment for delirium is also included.
Social and Environmental Factors
The CGA considers the influence of a person's social situation and living environment on their health. This includes evaluating social support, financial resources, and home safety to mitigate risks like falls. More comprehensive assessments may also touch upon spirituality and sexuality.
Future Wishes and Goals of Care
Discussing personal values and preferences for future care is a crucial part of the CGA. This involves setting goals of care and reviewing or completing advance directives to ensure decisions align with the patient's wishes.
Comparison of Standard Physical Exam vs. Comprehensive Geriatric Assessment
| Feature | Standard Physical Exam | Comprehensive Geriatric Assessment (CGA) |
|---|---|---|
| Focus | Organ-specific diagnoses and disease management. | Holistic, multidimensional evaluation of the whole person. |
| Domains Covered | Medical history, current symptoms, standard lab work. | All standard medical items plus functional, cognitive, psychological, social, and environmental factors. |
| Team | Typically involves one or a few healthcare professionals (e.g., primary care physician). | Multidisciplinary team (MDT) including geriatricians, nurses, social workers, therapists, and pharmacists. |
| Goal | To identify and treat specific medical diseases. | To create an integrated care plan that improves overall function and quality of life. |
| Patient Involvement | May be limited; patient input focuses primarily on medical symptoms. | High patient-centered focus; prioritizes the patient's goals, preferences, and what matters most to them. |
| Complexity Addressed | Treats each medical problem individually. | Considers the impact of multiple chronic conditions and geriatric syndromes on overall function. |
| Outcomes | Diagnosis and medical treatment plan. | Holistic care plan covering medical interventions, social support, environmental modifications, and rehabilitation. |
The Role of the Multidisciplinary Team
The strength of a CGA lies in its team-based approach, bringing together various experts to provide a comprehensive evaluation and care plan. This team may include a geriatrician, nurse, pharmacist, social worker, physical therapist, occupational therapist, and dietitian, each contributing their specialized knowledge.
Conclusion: The Path to Optimized Senior Health
The comprehensive geriatric assessment is considered the best approach for evaluating older adults, especially those with complex health needs. By thoroughly assessing multiple dimensions of a person's life, the CGA helps uncover problems, create personalized care plans, and support independence. The documented benefits, such as reduced hospitalizations and improved function, highlight its significance for healthy aging. Engaging in this process is a proactive step for senior health.
For more information on the principles and outcomes of CGAs, an excellent resource can be found on the Merck Manuals website.
Summary of Comprehensive Geriatric Assessment Findings
- Holistic Evaluation: The CGA provides a holistic, multidimensional evaluation of an older person's health, unlike a standard physical exam which focuses on medical issues alone.
- Key Domains: It assesses medical status, functional ability (ADLs and IADLs), cognitive function, mood, social circumstances, and environmental safety.
- Interdisciplinary Team: A team of healthcare professionals, including a geriatrician, nurse, pharmacist, social worker, and therapists, collaborates to develop a coordinated care plan.
- Focus on Patient Goals: A core component is understanding the patient's preferences and what matters most to them, which guides treatment decisions and advance care planning.
- Environmental Safety Check: The evaluation includes considering the patient's living environment to identify and address safety concerns and support needs.
- Improved Outcomes: Evidence shows that CGAs can lead to better health outcomes, including reduced hospitalizations, improved functional status, and enhanced quality of life for frail older adults.
- Addresses Geriatric Syndromes: It specifically identifies and addresses common syndromes like frailty, falls risk, polypharmacy, and incontinence that affect older adults.
