What Is a Comprehensive Geriatric Assessment (CGA)?
A comprehensive geriatric assessment (CGA) is not a routine medical exam. Instead, it is a holistic, multi-dimensional diagnostic and treatment process. The core purpose of a CGA is to identify and address the medical, psychosocial, and functional challenges experienced by frail or vulnerable older adults. This systematic approach recognizes that aging involves complex changes that cannot be addressed by focusing solely on a single disease or symptom.
The Multidisciplinary Team
One of the defining features of a CGA is its reliance on a multidisciplinary team of healthcare professionals. This collaborative effort ensures that all aspects of an individual's health are considered. The team typically includes:
- A Geriatrician or Physician: Provides medical leadership and oversees the overall care plan.
- Nurses: Assess general health, functional status, and coordinate care.
- Social Workers: Evaluate social support networks, financial stability, living conditions, and connect patients with resources.
- Physical and Occupational Therapists: Assess mobility, balance, and the ability to perform daily activities, and develop strategies for improvement.
- Pharmacists: Conduct a thorough review of all medications to check for interactions or side effects.
- Nutritionists or Dietitians: Address nutritional needs, appetite changes, and weight loss.
- Mental Health Specialists: Screen for cognitive issues and mood disorders like depression or anxiety.
Key Components of a Geriatric Assessment
To ensure all factors affecting an older adult's health are considered, the CGA covers several key domains. Many healthcare systems use a framework known as the Geriatric 5Ms to structure this evaluation:
1. Mind: Cognitive and Emotional Health
This domain assesses the patient's mental and emotional state. Screening for cognitive impairment is a crucial part of the process, often using tools like the Mini-Cog, which involves a simple word recall and clock-drawing test. The assessment also checks for depression and anxiety, which can significantly impact an older adult's quality of life but are often misdiagnosed or dismissed as a normal part of aging. The team evaluates the patient's ability to make informed decisions and checks for signs of delirium or other psychological issues.
2. Mobility: Functional Status and Fall Risk
Functional status refers to a person's ability to perform tasks necessary for daily living. This includes both basic activities of daily living (ADLs) and instrumental activities of daily living (IADLs).
- ADLs include basic self-care tasks like bathing, dressing, and eating.
- IADLs are more complex tasks essential for independent living, such as managing finances, shopping, and cooking.
Mobility is also key, and the assessment includes a review of gait, balance, and fall risk. Tests like the Timed Up and Go Test, which measures how long it takes to stand up, walk a short distance, and sit down, are commonly used. Physical therapists provide exercises and interventions to improve strength and balance.
3. Medications: Polypharmacy Review
Polypharmacy—the use of multiple medications—is a significant concern for older adults due to the increased risk of adverse drug reactions and drug-drug interactions. During a CGA, a pharmacist performs a comprehensive review of all medications, including prescriptions, over-the-counter drugs, and supplements. The goal is to optimize the medication regimen by eliminating unnecessary or potentially harmful drugs, aligning with criteria like the Beers Criteria, and ensuring the patient can manage their medications effectively.
4. What Matters Most: Patient-Centered Goals
This pillar places the older adult's personal values and preferences at the center of the care plan. It involves open discussions about their goals for care, priorities, and what quality of life means to them. Advance care planning, including discussions about advance directives and preferences for end-of-life care, is also addressed. This ensures that all treatment decisions are aligned with the patient's wishes and personal values.
5. Multicomplexity: Managing Complex Conditions
Most older adults have multiple chronic conditions, which can complicate treatment and management. The CGA evaluates how these conditions interact and affect the patient's overall health and functioning. This includes assessing chronic illnesses like heart disease and diabetes, as well as common geriatric syndromes such as incontinence, malnutrition, and sensory impairments like hearing or vision loss. The team devises an integrated plan to manage this complexity effectively, avoiding fragmented care.
The Assessment Process: From Start to Finish
The CGA process can vary depending on the patient's setting (e.g., hospital, clinic, home), but generally follows these steps:
- Data Gathering: This begins with the collection of medical records and patient questionnaires, often completed with help from family or caregivers. The team performs a thorough physical examination, standardized screenings (Mini-Cog, Timed Up and Go), and interviews with the patient and family to gather information across all assessment domains.
- Team Discussion: The multidisciplinary team meets to discuss the findings, analyze the patient's strengths and vulnerabilities, and review potential problems.
- Treatment Plan Development: Based on the team's discussion and the patient's goals, a detailed, personalized care plan is created. This might include new interventions, medication adjustments, social support referrals, or rehabilitation goals.
- Implementation and Monitoring: The care plan is put into action, with regular monitoring and follow-up to track progress. This can involve home visits by nurses or therapists and regular check-ins with the coordinating physician.
- Revising the Plan: The care plan is dynamic and continuously revised as the patient's needs or circumstances change.
CGA vs. Standard Medical Evaluation
A table illustrates the key differences between a CGA and a standard medical evaluation.
| Feature | Comprehensive Geriatric Assessment (CGA) | Standard Medical Evaluation |
|---|---|---|
| Focus | Holistic; evaluates medical, functional, cognitive, and psychosocial factors. | Problem-directed; focuses on specific diagnoses or symptoms. |
| Team | Multidisciplinary (geriatrician, nurse, social worker, therapists, etc.). | Primarily led by a single physician. |
| Duration | Can be lengthy, sometimes involving multiple visits to cover all domains. | Typically a shorter, single office visit. |
| Outcome | Integrated, personalized care plan to maximize overall well-being. | Diagnosis and treatment for specific medical issues. |
| Participation | Actively involves patient, family, and caregivers in the planning process. | Patient-focused, with less emphasis on family/caregiver input. |
Conclusion: A Holistic Approach to Aging
The comprehensive geriatric assessment offers a powerful approach to optimizing the health and well-being of older adults. By moving beyond a simple disease-focused model, it addresses the interconnected web of factors that impact a person's life in their later years. The systematic evaluation performed by a dedicated team helps identify subtle issues before they become major problems, ultimately improving quality of life, maintaining independence, and enabling seniors to age with dignity and security. For more details on the importance of this process, see this resource from the American Academy of Family Physicians.
