What is a Comprehensive Geriatric Assessment?
Unlike a standard medical check-up that focuses on specific illnesses, a comprehensive geriatric assessment (CGA) is a holistic, multidimensional evaluation. It involves a team of healthcare professionals working together to create a full picture of an older person’s physical, mental, functional, and social well-being. This process is particularly valuable for older adults with complex health needs, or those experiencing a recent decline in function or independence. The questions posed during the assessment are designed to uncover and address problems that might otherwise go unnoticed.
Functional Status Questions
Functional status refers to a person’s ability to perform tasks necessary for living independently. A geriatric assessment often includes questions about two key types of activities:
- Activities of Daily Living (ADLs): These are basic self-care tasks. A provider might ask about the patient's ability to perform the following without assistance:
- Bathing and showering
- Dressing
- Using the toilet
- Eating and feeding oneself
- Transferring from bed to a chair
- Instrumental Activities of Daily Living (IADLs): These are more complex activities that enable independent living. Common questions include:
- Can you use the telephone?
- Can you manage your own finances?
- Can you prepare your own meals?
- Do you handle your own laundry and housework?
- Do you manage your own medications?
Cognitive and Mental Health Questions
Assessing cognitive function is a crucial part of the evaluation. This helps identify memory problems, dementia, and other cognitive impairments. Doctors might use validated screening tools, such as the Mini-Cog or Montreal Cognitive Assessment (MoCA). Common questions include:
- Have you or your family noticed any recent memory problems?
- Do you repeat the same stories or questions?
- Do you have difficulty with tasks like paying bills or managing a calendar?
- Do you ever get lost in familiar surroundings?
Mental health is also evaluated, with a particular focus on depression and mood disorders, which are often underdiagnosed in older adults. The Geriatric Depression Scale is a common tool that includes questions such as:
- Are you basically satisfied with your life?
- Have you dropped many of your activities and interests?
- Do you often get bored or feel helpless?
Medication Review Questions
Many older adults take multiple medications, a condition known as polypharmacy, which increases the risk of side effects and dangerous interactions. A comprehensive medication review includes questions about:
- A complete list of all medications, including prescriptions, over-the-counter drugs, and supplements.
- Whether the patient understands why they are taking each medication.
- Any difficulty with following the medication schedule.
- Whether multiple doctors or pharmacies are involved in prescribing and dispensing.
- Recent changes to medication dosage or type.
Socioenvironmental Questions
An individual's living situation and social support network significantly impact their health. The assessment explores this with questions such as:
- Who are the people in your support network (family, friends, neighbors)?
- Is there anyone you can count on for help or emotional support?
- What are your living arrangements like? Is your home safe?
- How often do you talk with friends and family?
- Do you have any financial concerns that affect your care?
Physical Health and Risk Factors
Beyond a standard physical exam, geriatric assessments focus on specific age-related vulnerabilities. Questions will be asked about:
- Falls: Have you fallen in the past year? Do you have any problems with balance or walking?
- Sensory Issues: Do you have vision or hearing problems?
- Nutrition: Have you experienced any unintentional weight loss? How is your appetite?
- Urinary Continence: Do you ever experience urinary incontinence?
- Mobility: Is your mobility impaired, and are you able to walk without difficulty?
- Health Promotion: What is your immunization status (flu, pneumonia, shingles)?
Geriatric Assessment vs. Standard Physical Exam
| Feature | Geriatric Assessment (CGA) | Standard Physical Exam |
|---|---|---|
| Focus | Holistic view of physical, mental, and social health | Medical issues, specific illnesses, and disease screening |
| Domains Covered | Functional ability (ADLs/IADLs), cognition, mood, polypharmacy, social support, environment, nutrition, falls, incontinence | Chief complaint, review of systems, standard vital signs and organ systems check |
| Interdisciplinary | Often involves multiple healthcare professionals (physician, social worker, physical therapist, etc.) | Typically conducted by one physician or provider |
| Goal | Enhance quality of life, optimize care, maintain independence, and create a coordinated, long-term care plan | Diagnose and treat acute or chronic conditions |
| Patient-Centered | Emphasis on patient values, goals, and advanced care planning | Primarily clinician-driven based on presenting symptoms |
Putting It All Together: Preparing for Your Geriatric Assessment
Preparing for the assessment ensures the most accurate and comprehensive results. To prepare, it is helpful to gather information and bring it to the appointment, or consider having a trusted family member or caregiver accompany you. A prepared patient can provide more precise details, leading to a more effective, tailored care plan.
Here are some steps to take before your appointment:
- Create a Medication List: Write down all prescriptions, over-the-counter drugs, vitamins, and supplements, including dosages and frequency. Bringing all the actual medication bottles is even better.
- Document Concerns: Note any recent changes in memory, balance, mood, or sleep. Also, write down any recent falls or accidents.
- List Daily Challenges: Think about what daily tasks have become more difficult, such as bathing, cooking, or managing finances.
- Consider Your Goals: Reflect on what is most important to you regarding your health and independence.
- Write Down Questions: Prepare a list of questions to ask the healthcare provider about your health, medications, and future care.
Conclusion
Understanding what questions are asked in a geriatric assessment can help older adults and their families feel more prepared and empowered. The questions span far beyond a typical physical exam, delving into function, cognition, medication use, and social well-being. By thoroughly addressing each of these areas, healthcare providers can build a comprehensive and personalized plan that maximizes independence, improves quality of life, and promotes healthy aging. For more in-depth resources on aging, consider exploring the materials provided by authoritative organizations like the American Geriatrics Society.
