What is a geriatric assessment?
A geriatric assessment, also known as a comprehensive geriatric assessment (CGA), is a multidisciplinary, holistic evaluation of an older person's health and functioning. Unlike a standard doctor's visit, which might focus on a single health issue, a geriatric assessment considers the interconnectedness of all aspects of an individual's life. A team of specialists typically conducts the assessment, including geriatricians, nurses, social workers, physical therapists, and other relevant professionals.
The process evaluates an older adult's physical health, cognitive function, mental health, social support systems, and environmental factors. The ultimate goal is to develop a coordinated, individualized care plan to improve overall well-being, maintain independence, and enhance the quality of life for the individual.
The key components of a comprehensive geriatric assessment
- Physical Health Evaluation: A thorough review of medical history, current chronic conditions, nutrition status, and a detailed medication review to identify potential side effects or drug interactions.
- Functional Assessment: This evaluates an individual's ability to perform activities of daily living (ADLs), such as bathing, dressing, and eating, as well as instrumental activities of daily living (IADLs), which include managing finances, housekeeping, and meal preparation.
- Cognitive and Mental Health Assessment: This includes screening for dementia, memory issues, and mental health disorders like depression and anxiety. Standardized tools, such as the Geriatric Depression Scale, are often used.
- Socioenvironmental Evaluation: The assessment looks at the individual's living situation, support network, financial stability, and potential environmental hazards in their home that could increase the risk of falls.
- Mobility and Balance Assessment: Professionals evaluate gait, balance, and the risk of falls, a common and serious concern for many older adults.
Key indicators for a geriatric assessment
So, when to do a geriatric assessment? The signs can be subtle and often accumulate over time. Waiting for a crisis, such as a severe fall or a sudden hospitalization, can result in a rushed and less-effective evaluation. Instead, recognizing early indicators is key. Look for a combination of these signs in yourself or a loved one.
Signs of declining function and mobility
- Increased difficulty with daily activities: Struggling with tasks that were once easy, like cooking, cleaning, or personal hygiene.
- Frequent falls or near-falls: A sign of unsteady balance or mobility issues.
- Unexpected weight loss: Unintentional loss of appetite or difficulty preparing meals could indicate health problems.
- Decreased social engagement: A noticeable withdrawal from social activities or a loss of interest in hobbies.
Changes in cognitive and mental health
- Memory loss: Significant changes in memory that affect daily life, such as forgetting important appointments or conversations.
- Personality or mood changes: Increased irritability, apathy, or signs of depression that are not normal for the individual.
- Confusion or disorientation: Difficulty with orientation, problem-solving, or making sound judgments.
- Mismanaging medications: Forgetting to take doses, taking the wrong amount, or struggling to organize prescriptions.
Multiple and complex medical conditions
- Multiple chronic diseases: Managing multiple conditions can be overwhelming and require a coordinated care plan.
- Side effects from polypharmacy: Taking multiple medications can lead to complex side effects and drug interactions. An assessment can help streamline medications.
- Frequent hospital visits: A pattern of repeated hospitalizations may suggest underlying health issues are not being adequately managed.
Post-hospitalization or major life event
- After a major surgery or illness: The recovery period can be a critical time to assess needs for rehabilitation and ongoing support.
- Change in living situation: Moving to a new home or assisted living facility is a significant transition that can impact overall well-being. A comprehensive geriatric assessment during a major transition can help ensure a smoother and safer adjustment.
- Caregiver concerns: Family members or caregivers who notice changes in the individual's ability to manage their health often trigger the need for an assessment.
Geriatric assessment vs. standard doctor’s visit
| Feature | Comprehensive Geriatric Assessment (CGA) | Standard Doctor's Visit |
|---|---|---|
| Scope | Multidimensional: physical, cognitive, functional, social, environmental. | Typically focuses on one or a few specific medical complaints. |
| Team | Interdisciplinary team (geriatrician, nurse, social worker, PT, etc.). | Primarily led by a general practitioner or single specialist. |
| Goal | Develop an integrated, holistic care plan to optimize function and independence. | Diagnose and treat specific diseases or conditions. |
| Duration | Can take several hours, often spread across multiple appointments. | A standard 15–30 minute appointment. |
| Outcome | Detailed report with recommendations for a range of interventions. | Prescription for medication, referral to a specialist, or advice on a specific issue. |
| Timing | Proactive, triggered by changes in health or function, not just crisis. | Reactive, typically scheduled when a patient experiences symptoms. |
The steps involved in a geriatric assessment
- Referral: The process often begins with a referral from a primary care physician, a family member, or a caregiver who has observed changes.
- Initial Consultation: The first meeting involves collecting detailed information about the individual's medical history, current medications, lifestyle, and concerns.
- Multidisciplinary Evaluation: The patient is assessed by different professionals, each focusing on their area of expertise (e.g., a physical therapist for mobility, a social worker for social support).
- Team Discussion: The interdisciplinary team meets to discuss their findings and create a unified, coordinated care plan.
- Care Plan Development: The team creates a personalized care plan that may include medication adjustments, rehabilitation services, nutritional counseling, mental health support, or home modifications.
- Review and Follow-up: Regular follow-ups are scheduled to monitor the care plan's effectiveness and make necessary adjustments over time.
Conclusion: Taking proactive steps for healthy aging
Knowing when to do a geriatric assessment is about shifting from a reactive approach to a proactive one. It’s not just for those in crisis but for anyone who has noticed gradual changes in their health, function, or well-being. By considering a CGA when key signs appear, you can address potential issues early, optimize health outcomes, and help ensure a higher quality of life and greater independence for older adults. It is a powerful tool for promoting healthy aging and providing the right support at the right time.
