A Comprehensive Geriatric Assessment (CGA) is a specialized, multidisciplinary evaluation designed to capture a complete picture of an older adult’s overall health and well-being. This process extends beyond a standard physical examination, which typically focuses on treating isolated symptoms or diseases. The CGA systematically evaluates an older person’s functional abilities, medical status, psychological condition, and socioenvironmental circumstances. This assessment helps to identify previously unrecognized or complex issues that impact quality of life and independence, ensuring care is tailored to the unique and interconnected needs of the older individual.
The Goal of Comprehensive Geriatric Assessment
The central purpose of the CGA is to shift the focus of care from merely treating acute or chronic diseases to maximizing an older person’s functional status and independence. By systematically identifying treatable conditions, the assessment aims to optimize health outcomes and maintain a high quality of life. This proactive evaluation is instrumental in preventing further decline or disability, especially in individuals who are frail or at risk of frailty.
The assessment minimizes the risk of polypharmacy (the use of multiple medications that can lead to adverse drug interactions or side effects). Ultimately, the goal is to create a unified management strategy that addresses the complexity of aging. Evidence indicates that this structured approach can lead to improved functional status and a decreased reliance on nursing home or hospital care.
Key Domains of the Assessment
The CGA is structured around four main dimensions, ensuring a detailed review of the individual’s life and health. This multidimensional framework allows the team to understand how various factors interact and influence the person’s well-being. The data gathered from these domains is synthesized into the final, individualized care recommendations.
Functional Status
Functional status is a primary focus, as it directly relates to an older person’s ability to live independently. This domain evaluates Activities of Daily Living (ADLs), which include basic self-care tasks such as bathing, dressing, eating, and transferring. It also assesses Instrumental Activities of Daily Living (IADLs), which involve more complex tasks necessary for community living, like managing finances, preparing meals, and using transportation. A gait and balance evaluation is also included, often using timed tests to measure walking speed or stability, which helps quantify the risk of falls.
Physical Health
The physical health domain evaluates issues common among older adults that affect function, going beyond standard disease management. This includes a thorough medication review to identify interactions or unnecessary prescriptions. Nutritional status is assessed to screen for malnutrition or unintentional weight loss, which can compromise recovery and immune function. Evaluations of sensory function, such as vision and hearing impairments, are conducted because these issues often contribute to social isolation, falls, or cognitive decline.
Cognitive and Psychological Status
This domain screens for cognitive and mood disorders, recognizing their profound impact on daily function. Cognitive status is evaluated using validated screening tools, such as the Mini-Mental State Examination (MMSE) or the Montreal Cognitive Assessment (MoCA), to check for signs of dementia or mild cognitive impairment. Psychological status screening typically involves tools like the Geriatric Depression Scale to identify depression, which is common in older adults and often presents as physical symptoms. Untreated depression and anxiety can significantly reduce quality of life and complicate the management of chronic diseases.
Socioenvironmental Status
The final domain examines the environment and support systems surrounding the older adult, recognizing that these factors influence health and treatment choices. This involves an evaluation of the individual’s social support network, including family, friends, and caregivers, to ensure adequate assistance is available. Financial resources are also considered, as they can limit access to necessary medications, equipment, or community services. An environmental assessment may include a home safety checklist to identify hazards, such as throw rugs or poor lighting, that could increase the risk of falls.
The Interdisciplinary Team and Setting
A comprehensive geriatric assessment is an interdisciplinary process, requiring the coordinated effort of multiple healthcare professionals. The team typically involves a geriatrician, who specializes in the care of older adults, to oversee the medical management and synthesis of the findings. A specialized nurse often manages the complex coordination, while a social worker assesses psycho-social and environmental needs, including connecting the individual with community resources.
Physical and occupational therapists are also involved to evaluate mobility, strength, and the ability to perform daily tasks, recommending modifications or assistive devices. A pharmacist may conduct the in-depth medication review, optimizing the regimen to minimize side effects and interactions. The assessment is most often conducted in specialized outpatient clinics, but it can also be adapted for use in hospital settings or in the individual’s home, depending on their needs and mobility.
Developing the Individualized Care Plan
Following data collection, the interdisciplinary team synthesizes the findings to develop a practical and actionable plan by prioritizing identified problems based on severity and potential for improvement. The plan moves beyond simple recommendations by establishing specific, measurable, and goal-driven interventions.
For example, if the assessment identifies gait instability and poor nutrition, the care plan will include a specific referral to physical therapy for balance training and a consultation with a dietitian. The plan also details who is responsible for each intervention and coordinates the services to ensure they are integrated and not conflicting. This individualized care document acts as a roadmap for treatment, support, and long-term follow-up, ensuring continuous monitoring and adjustment.