Comprehensive geriatric assessments

The medical world has adopted the term Comprehensive Geriatric Assessment (CGA) to describe a package of measurable multi-disciplinary investigations and diagnostics. CGAs are conducted for frail people past age 70 to find geriatric syndromes by assessing the patient's overall health including medical, psychiatric and functional abilities. The idea is that CGAs will yield better overall medical management and improve wellbeing, minimize hospital visits, and extend lifespan.

A CGA team typically includes a specialized clinician (not necessarily a geriatrician), a nurse, an occupational therapist, a physiotherapist, and a social worker. The patient or caretaker may be included. A team lead coordinates. The primary care clinician or geriatrician generally initiates the CGA referral, including patient’s age, clinical comorbidities (heart attack, injury), mental disorder (depression), any particular geriatric disorder (fall history or functional instability), previous medical history, and any particular change in living (from home to nursing care or from assisted living to isolation). Patients who have a terminal illness don't get CGAs because due to very less impact of patient's well being. Standard patient selection criteria are not readily defined.

Five CGA models:

  • Community base/Home base CGA: focused on preventive care measures to reduce the mortality rate and hospital admissions. Patients having any functional disorder, depression and cognitively impairment are at high risk and are good candidates for this type of CGA.
  • Acute CGA: hospital settings designed Acute Care of the Elderly (ACE) units and promote acute patient care by conducting CGA
  • Post-hospital discharge CGA: conducted to focus on vulnerable factors, discharge plan and follow up instructions
  • Outpatient CGA: focus on the high-risk patient group, but no significant outcome is reported
  • Inpatient/hospitalized CGA: is usually more adapted and allows a clinician to design discharge plan, reduction of hospital stay, prescription of medicines, and future admission needs.  

Information technology has enabled a "virtual CGA" in which data collection happens electronically, supplemented by analogue systems. CGA teams might send a questionnaire to a patient or caretaker before the office visit. This approach can reduce time and enable collection of detailed information while maintaining the privacy of records.

The components of the CGA questionairre include:

  • Previous medical history
  • Mood
  • Social support (family/friends)
  • Mental stability
  • Depression and stress
  • Medicines used
  • Nutritional well being
  • Pain
  • Fall risk
  • Mood intolerance
  • Urinary incontinence
  • Fecal incontinence
  • Sexual functioning
  • Hearing and vision
  • Dentistry
  • Advance care concerns
  • Functional abilities
  • Financial concerns

Functional abilities evaluated by the CGA include:

  • Basic activities of daily living (BADLs): includes basic functional tasks like bathing, clothing, continence maintenance, feeding, self attire maintenance etc
  • Instrumental/intermediate activities of daily living (IADLs): are cooking, grocery shopping, driving, public transportation usage, household repair and activities, telephone usage, medicine intake, laundry, handling in-house finances
  • Advanced activities of daily living (AADLs): includes use of smartphones, use of internet, maintaining a daily activities schedule

The information the geriatrician or CGA team gather aid them in design of a patient-centered integrated care plan to improve quality of life, functional abilities, reduce support dependence, and minimize hospital visits.

The University of Missouri has a webpage summarizing some things evaluated in a CGA.

More people now live to what used to be called an advanced age, so CGAs are valuable.