Understanding the Comprehensive Geriatric Assessment
A comprehensive geriatric assessment (CGA) is a multidisciplinary, multidimensional diagnostic and treatment process. Unlike a standard medical check-up that focuses on specific diseases, the CGA takes a holistic view, evaluating a frail older person's medical, psychosocial, and functional limitations. The goal is to identify treatable problems, develop a coordinated care plan, and maximize overall health and quality of life. This approach is evidence-based and has been shown to improve patient outcomes.
Identifying Candidates for a CGA
Determining who needs a comprehensive geriatric assessment depends on several key indicators, not just a person's chronological age. While the assessment is typically for those over age 65 with certain risk factors, it is not recommended for highly-functioning individuals with no chronic conditions or those with end-stage illnesses receiving palliative care.
Signs and triggers that may warrant a CGA include:
- Frailty: The most common indicator. Frailty is a state of increased vulnerability to stressors, often resulting in diminished function. Frailty can be identified through screening tools like the Clinical Frailty Scale.
- Multimorbidity: The presence of multiple complex, chronic medical conditions that interact with each other and require management.
- Geriatric Syndromes: A cluster of common health problems in older adults that are multifactorial and don't fit neatly into organ-specific categories. Examples include:
- Recurrent falls
- Functional decline or reduced mobility
- Cognitive changes, such as memory loss or delirium
- Urinary or fecal incontinence
- Unexplained weight loss or malnutrition
- Polypharmacy: The use of multiple medications, which increases the risk of drug interactions and side effects.
- Recent Hospitalization: A transition in care setting, such as a recent hospital discharge, can signal a need for a CGA to prevent re-admission and manage ongoing needs.
- Family Concerns: When family members notice subtle but significant changes in a loved one's function, behavior, or safety.
- Considering Complex Treatments: Older patients considering complex procedures, like chemotherapy, can benefit from a CGA to assess their ability to tolerate treatment and predict outcomes.
Core Domains Assessed in a CGA
The CGA is extensive and covers multiple areas of an older adult's life. The multidisciplinary team will evaluate the following domains:
Functional Ability
This area assesses the person's capacity to perform daily tasks and maintain independence. It is split into two categories:
- Activities of Daily Living (ADLs): Basic self-care tasks like bathing, dressing, eating, and walking.
- Instrumental Activities of Daily Living (IADLs): More complex tasks necessary for independent living, such as managing finances, preparing meals, and using the telephone.
Physical and Medical Health
- Full Medical History and Physical Exam: Reviews current and past medical problems, with special attention to issues common in older adults, such as vision, hearing, and balance.
- Medication Review: A pharmacist will review all medications, including supplements, to check for interactions, appropriateness, and simplify complex regimens.
- Gait and Balance Assessment: Measures mobility and fall risk using tests like the Timed Up and Go Test.
- Nutritional Status: Screens for malnutrition or unexplained weight loss, which can indicate underlying health issues.
Cognitive and Psychological Health
- Cognitive Assessment: Evaluates mental functions like memory and language using tools such as the Mini-Cog or Montreal Cognitive Assessment (MoCA).
- Mood and Mental Health Screening: Checks for depression, anxiety, or other mood disorders, often using the Geriatric Depression Scale.
Socioenvironmental Evaluation
- Social Support: Assesses the patient's support network, including family and friends, and available resources.
- Living Environment: Evaluates the safety and suitability of the person's home, identifying hazards like trip risks and assessing accessibility.
CGA vs. Standard Medical Evaluation
A comparison highlights the key differences between a traditional, disease-focused approach and the holistic CGA.
| Feature | Standard Medical Evaluation | Comprehensive Geriatric Assessment (CGA) |
|---|---|---|
| Focus | Treats specific diseases and organ systems. | Holistic approach considering medical, social, psychological, and functional aspects. |
| Team | Typically involves a single physician. | Multidisciplinary team (geriatrician, nurse, pharmacist, social worker, therapists). |
| Assessment Scope | Narrow, symptom-specific. | Broad, multidimensional, including functional capacity, mood, and environment. |
| Care Plan | Focused on managing a single illness. | Coordinated, goal-oriented plan addressing multiple issues. |
| Outcome | Improved management of one disease. | Maximized overall health, quality of life, and independence. |
The Multidisciplinary Team and Continuous Care
The CGA is not a one-time event but an iterative process with a team of professionals working together to achieve the patient's goals. The team's composition can vary based on the patient's needs but often includes a geriatrician, nurse, pharmacist, social worker, and various therapists. After the initial assessment, the team creates a problem list and a goal-driven management plan. This plan is continuously reviewed and adjusted as the patient's health evolves, ensuring long-term, coordinated care. A key resource detailing this approach can be found on the British Geriatrics Society website, which offers an in-depth hub on CGA.
Long-Term Benefits of a CGA
The proven benefits of a CGA extend beyond the initial diagnosis:
- Improved Health Outcomes: Meta-analyses show CGAs lead to measurable health improvements for frail older people.
- Reduced Hospitalization: Helps reduce the use of acute care hospitals and prevents unplanned admissions.
- Enhanced Functional Status: Patients who undergo a CGA often experience less functional decline and are more likely to return home after hospitalization.
- Increased Independence: By identifying and addressing risks, CGA helps older adults maintain their independence and quality of life.
- Greater Patient and Family Satisfaction: The comprehensive and coordinated nature of the assessment leads to a more positive care experience.
Conclusion: A Proactive Approach to Aging
The comprehensive geriatric assessment is a powerful tool for proactive, patient-centered care. For older adults experiencing frailty, multimorbidity, or specific geriatric syndromes, it provides a structured pathway to better health and sustained independence. By moving beyond a disease-focused model to a holistic evaluation, CGAs ensure that older people receive the coordinated, multidimensional support they need to thrive and age gracefully, with improved well-being and reduced harm from complex health challenges.
