What is a Comprehensive Geriatric Assessment (CGA)?
A comprehensive geriatric assessment (CGA) is a holistic and interdisciplinary evaluation designed for older adults, particularly those with complex health and social needs. Performed by a team of healthcare professionals, such as a geriatrician, nurse, pharmacist, and social worker, the CGA aims to identify and address medical, psychosocial, and functional issues to improve well-being, function, and care coordination. It's an ongoing process focused on assessment, intervention, and monitoring to meet the individual's changing needs. Studies show that CGA can lead to reduced mortality, shorter hospital stays, and better long-term outcomes.
The Key Components of a Geriatric Evaluation
A comprehensive geriatric evaluation involves assessing multiple aspects of an individual's health and life, recognizing that these areas are often connected. A detailed medical assessment is included, alongside evaluation of functional status, which considers Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). Cognitive and mental health are screened, including for dementia and depression. Psychosocial and environmental factors are also evaluated, such as social support, caregiver burden, home safety, and abuse risk. Attention is given to geriatric syndromes like falls, polypharmacy, nutrition, and incontinence.
Geriatric Evaluation vs. Standard Medical Exam
| Feature | Geriatric Evaluation | Standard Medical Exam |
|---|---|---|
| Scope | Multidimensional and interdisciplinary; addresses a person's entire well-being. | Focuses primarily on managing specific diseases and presenting symptoms. |
| Team | A multidisciplinary team of specialists, including a geriatrician, nurse, social worker, and various therapists. | A single physician, potentially with referrals to other specialists. |
| Emphasis | Maximizing function and quality of life; emphasizes how conditions affect daily living. | Curing or managing individual diseases with less emphasis on holistic well-being. |
| Functional Assessment | Includes detailed screening for ADLs and IADLs, gait, and balance. | Typically limited to discussing physical symptoms related to disease. |
| Psychosocial Screening | Routinely assesses mood, cognition, social support, and environmental factors. | May not be routinely included or is less in-depth than in a geriatric evaluation. |
| Follow-Up | Ongoing, coordinated process that monitors health and adapts the care plan over time. | Follow-up is often problem-directed and less comprehensive. |
The Geriatric Evaluation Process
The process typically involves initial data gathering, often through questionnaires, followed by assessment by the multidisciplinary team, potentially over several visits.
- Initial Data Gathering: Questionnaires completed by the patient or caregivers gather information on medical history, medications, functional status, and psychosocial details.
- Multidisciplinary Assessment: Specialists on the team assess the patient within their area of expertise.
- Team Discussion and Problem List: The team reviews the data to create a list of identified medical, functional, and psychosocial issues.
- Care Plan Development: A personalized care plan is developed collaboratively with the patient and family, focusing on their goals and including specific interventions.
- Implementation and Monitoring: The care plan is put into action, and the patient's progress is monitored, with adjustments made as needed.
Conclusion
A geriatric evaluation is a comprehensive, multidisciplinary, and patient-centered assessment offering a holistic view of an older adult's health. Unlike a standard medical exam, it considers the complex interaction of physical, cognitive, functional, and psychosocial factors. By identifying problems and creating a coordinated care plan, a CGA can significantly improve an older adult's quality of life, independence, and well-being. This approach is especially beneficial for frail seniors with complex needs, helping them manage their health and navigate aging challenges. For further information, the American Geriatrics Society provides valuable resources on optimizing care for older adults {Link: American Geriatrics Society https://www.ncbi.nlm.nih.gov/books/NBK570572/}.
