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:
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) Personal care goals Mental stability Depression and stress Medicines used Nutritional well being Spiritual stability Impairment 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:
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.
More people now live to what used to be called an advanced age, so CGAs are valuable.