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. CGAs are diagnostic processes, but in practice the term is often used to include both evaluation and health management activities. More people now live to what used to be called an advanced age, so CGAs are valuable.

A CGA team typically includes a clinician (not necessarily a geriatrician), a nurse, an occupational therapist, a physiotherapist, and a social worker. The patient or caretaker may be considered part of the team. A team lead coordinates. The primary care clinician or geriatrician generally initiates the CGA referral, including the patient’s age, chronic or acute health problems (e.g. heart attack, injury), mental disorders (e.g. depression), geriatric disorders (e.g. 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).

Five CGA models:

  • Community based/Home based CGA: focused on preventive care measures to reduce the mortality rate and number of hospital admissions. Patients with functional disorders, depression and cognitive impairment are at high risk and are good candidates for this type of CGA.
  • Inpatient/hospitalized CGA.
  • Acute CGA: Acute Care of the Elderly (ACE) units in hospitals.
  • Post-hospital discharge CGA
  • Outpatient CGA

Information technology has made taking a CGA more efficient. Data can be collected from the patient or caregiver electronically, supplemented by traditional means of assessment. 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 gathers aid them in the 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.