Understanding the Fundamentals of Geriatric Assessment
A geriatric assessment differs significantly from a standard medical evaluation. It's a multidimensional process evaluating functional ability, physical health, cognitive and mental status, and socioenvironmental circumstances. This holistic approach considers the complex interplay of physical, psychological, and social factors influencing an older adult's health, aiming for effective care plans focused on function and quality of life.
Key Domains of a Comprehensive Geriatric Assessment (CGA)
Healthcare providers often use structured frameworks, such as the “Geriatric 5Ms,” to cover critical areas. These domains are essential for a complete picture of the patient's health.
Mind: Cognitive and Psychological Health
Assessing mental and cognitive health is vital. Providers screen for dementia, depression, and delirium using tools like the Mini-Cog, MoCA, or MMSE. Early detection helps initiate interventions and future planning. Depression screening with tools like PHQ-2 or PHQ-9 can identify mood disorders often mistaken for normal aging.
Mobility: Assessment of Movement and Falls Risk
Mobility is crucial for independence. The assessment includes gait, balance, and physical function evaluation. The "Timed Up and Go" (TUG) test is a common tool to assess fall risk. Results inform interventions like physical therapy. Providers also inquire about fall history.
Medications: Managing Polypharmacy
Older patients are prone to adverse drug events due to age and multiple medications. A thorough medication reconciliation is key, including all prescriptions, OTCs, vitamins, and supplements. Discussing side effects, interactions, and adherence is necessary. The Beers Criteria offers guidance. Using a single pharmacy aids management.
Multicomplexity: Managing Co-existing Conditions
Many seniors have multiple chronic conditions. A CGA addresses these interactions, not just individual conditions. Managing multimorbidity involves coordinating specialist care and creating personalized plans to reduce hospitalizations and improve well-being.
What Matters Most: Patient-Centered Goals
Understanding a patient's goals and values is paramount. Discuss their priorities to align care decisions with their wishes, enhancing quality of life. This may involve advanced care planning.
Assessment of Functional Status and Socioenvironmental Situation
Functional status and socioenvironmental factors are also critical.
Functional Status
Functional status, the ability to perform daily tasks, is split into Activities of Daily Living (ADLs) like bathing and dressing, and Instrumental Activities of Daily Living (IADLs) such as managing finances or shopping. Scales like the Katz ADL and Lawton IADL help quantify abilities.
Socioenvironmental Factors
The patient's environment and social support significantly impact health. Assessment includes home safety (fall hazards), social support (availability of help), financial security (access to care/meds), and transportation.
Standard vs. Comprehensive Geriatric Assessment
| Aspect | Standard Medical Assessment | Comprehensive Geriatric Assessment (CGA) |
|---|---|---|
| Focus | Primarily on acute medical conditions and isolated diseases. | Holistic, multidimensional view including medical, functional, cognitive, and social factors. |
| Time | Often shorter, focusing on the chief complaint. | Can take longer, potentially rolled out over several visits to cover all domains. |
| Team | Typically conducted by a single physician or provider. | Involves a multidisciplinary team (physician, nurse, social worker, therapists, etc.). |
| Goal | Diagnosis and treatment of specific diseases. | Optimizing function, independence, and quality of life. |
| Emphasis | Lab results, imaging, and physical exams. | Functional capacity, patient values, and environmental safety. |
The Role of a Multidisciplinary Team
A team approach is often most effective for a comprehensive assessment, potentially including a geriatrician, nurse, social worker, pharmacist, and therapists. This collaboration integrates various aspects of the patient's life into a cohesive care plan, improving outcomes.
Conclusion
Assessing an older patient requires a comprehensive approach covering physical, mental, and social well-being. Using a CGA framework helps providers understand unique needs, create patient-centered plans, diagnose conditions, identify risks, maintain independence, and enhance quality of life. To learn more, consult resources from organizations like the American Geriatrics Society.
