Understanding the Comprehensive Geriatric Assessment
Unlike a standard physical exam, a Comprehensive Geriatric Assessment (CGA) provides a holistic view of an older adult's health and well-being. This multidimensional, interdisciplinary process is designed to address the unique and complex health needs of older adults, particularly those who are frail or have multiple chronic conditions. By identifying medical, psychosocial, and functional limitations, a CGA helps healthcare teams develop an integrated plan to maximize overall health and quality of life.
The Six Core Domains of an Older Person's Assessment
A typical CGA evaluates several critical domains that are often overlooked in conventional medical evaluations. A collaborative team, which may include a geriatrician, nurse, social worker, physical therapist, and pharmacist, works together to gather information across these areas.
Medical and Physical Health Assessment
This domain includes a thorough review of the patient's medical history and a physical examination specifically tailored to older adults, focusing on conditions common in this age group. Key areas include chronic conditions, preventative health, sensory impairments, continence, and nutrition.
Functional Status
Functional assessment measures an individual's ability to perform tasks necessary for daily living, divided into Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). ADLs cover basic self-care like bathing and dressing, while IADLs involve more complex tasks like managing finances and medications.
Cognitive and Mental Health Evaluation
This part of the assessment focuses on detecting cognitive issues and mood disorders. It includes screening for cognitive dysfunction or dementia using tests like the MMSE or MoCA, and assessing for depression using tools like the Geriatric Depression Scale. Psychological well-being is also evaluated.
Medication Review and Polypharmacy
Older adults often take multiple medications, leading to a risk of adverse effects. A medication review identifies potentially inappropriate drugs based on criteria like the Beers Criteria and checks for interactions between prescription and over-the-counter medications and supplements.
Social and Environmental Factors
An older person's living situation and social support are crucial for their health. This assessment evaluates the social support network, home safety, financial resources, and community engagement.
Advance Care Planning and Patient Goals
This component helps align care with the patient's preferences. It includes discussing goals of care and documenting advance directives such as a living will or power of attorney for healthcare.
Comparing ADLs and IADLs
| Feature | Activities of Daily Living (ADLs) | Instrumental Activities of Daily Living (IADLs) |
|---|---|---|
| Focus | Basic self-care tasks | Complex, higher-level tasks |
| Skills Involved | Fundamental personal functions | Cognitive, organizational, and social skills |
| Examples | Bathing, dressing, feeding | Managing finances, using transportation, meal prep |
| Significance | Indicates fundamental independence | Measures ability to live independently in the community |
| Assessment Tool | Katz Index of Independence | Lawton Scale |
A Multidisciplinary Approach to Optimal Care
The information gathered from a CGA is used by a multidisciplinary team to create a personalized care plan. This collaborative effort leads to targeted interventions designed to improve an older person's health outcomes, functional independence, and quality of life.
For more in-depth information, the American Academy of Family Physicians offers extensive resources on the geriatric assessment.
