The Comprehensive Geriatric Assessment (CGA) is a systematic, evidence-based approach to improving the care of older adults. It is a multidimensional, multidisciplinary process designed to identify and address the complex needs of people who are frail or at risk of frailty. Unlike a standard medical visit that typically focuses on a single ailment, the CGA recognizes that health issues in older age are often intertwined, involving multiple medical, functional, and social factors. This assessment is undertaken by a specialized team to create a holistic, coordinated plan that supports better outcomes for the patient.
Defining Comprehensive Geriatric Assessment
A Comprehensive Geriatric Assessment (CGA) functions as a diagnostic and therapeutic process specifically tailored for frail older adults or those with complex medical and social needs. The target population is typically older persons with multimorbidity, defined as having two or more long-term health problems. CGA is distinct from a standard physical examination, which focuses on identifying acute disease or monitoring baseline health. The CGA is structured to identify hidden vulnerabilities and limitations that a traditional assessment might overlook.
The team approach is fundamental to the CGA, involving a multidisciplinary group of professionals working closely together. This team often includes a physician specializing in geriatric care, nurses, social workers, physical therapists, occupational therapists, and pharmacists. The purpose is to determine the patient’s medical, psychosocial, and functional limitations to create an integrated care plan. This prevents specialists from treating problems in isolation and aims to maximize overall health by coordinating a response to the individual’s specific needs.
The Core Domains of Assessment
The CGA systematically investigates several core domains to build a complete picture of the older person’s health and well-being. Each domain is evaluated using specific tools and methods to capture objective data on the patient’s current status and potential for improvement.
Functional Status
Functional Status is a major focus, as it directly relates to a person’s ability to live independently. This involves assessing Activities of Daily Living (ADLs), which are basic self-care tasks like bathing, dressing, transferring, and eating. The assessment also covers Instrumental Activities of Daily Living (IADLs), which are more complex tasks necessary for community living, such as managing finances, preparing meals, and using transportation. A physical performance evaluation is also included, often involving testing gait speed and balance to identify fall risks.
Cognitive and Mental Health
Cognitive and Mental Health screening identifies potential neurological or psychological impairments. The assessment screens for conditions such as dementia, depression, and delirium, using validated tools like the Mini-Mental State Examination (MMSE) for cognition and the Geriatric Depression Scale (GDS) for mood. Cognitive assessment is important because impairment affects a patient’s ability to participate in treatment decisions and adhere to care plans. Psychological status also covers emotional well-being, which significantly impacts quality of life and treatment outcomes.
Physical Health and Nutrition
Physical Health and Nutrition are thoroughly reviewed, focusing on issues prevalent in older age. This includes evaluating co-morbidities, which are multiple long-term conditions that can interact with each other. Polypharmacy review is a dedicated part of this domain, involving a detailed look at all medications to identify inappropriate drugs, potential interactions, and opportunities for safe reduction (deprescribing). Nutritional status is also assessed, as malnutrition is a significant predictor of poor outcomes and is often overlooked in routine care.
Socioeconomic and Environmental Assessment
The Socioeconomic and Environmental Assessment focuses on the context of the patient’s daily life. This domain explores the living situation, checking for home hazards that could contribute to falls or injury. Financial stability and the availability of a support network are also evaluated. Social isolation and lack of resources can hinder treatment adherence and recovery, making understanding the patient’s environment crucial for developing a realistic and sustainable care plan.
Translating Assessment into Action
The purpose of the Comprehensive Geriatric Assessment is to synthesize the findings into an actionable, individualized care plan. The multidisciplinary team uses results from the various domains to create an integrated set of interventions designed for the patient’s identified vulnerabilities. This process moves beyond standard diagnosis to create a coordinated treatment and support strategy.
The resulting care plan aims to achieve specific, measurable goals, focusing primarily on improving the patient’s quality of life and preserving functional independence. Interventions may include medication modifications identified during the polypharmacy review, physical therapy to address mobility concerns, and referrals to social services for support. Evidence shows that CGA-informed care can lead to a reduction in hospitalizations and a lower risk of institutionalization compared to less structured care.
The process requires ongoing monitoring and reassessment because the needs of older adults, especially those with frailty, can change rapidly. The initial plan is a starting point, and the team regularly reviews the patient’s response to interventions and adjusts the plan to meet evolving circumstances. This iterative process ensures that the care remains relevant and effective.