Comprehensive Geriatric Assessment

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Comprehensive Geriatric Assessment (CGA)

CGA is defined as a multidimensional functional, social, and mental assessment of the patient and caregivers and an assessment of the environment in order to plan care and prevent problems. It is a multi-disciplinary assessment that is a prerequisite for the comprehensive care of the older patients – it addresses both biomedical and psychosocial aspects. The aim is to catalogue the resources and strengths of the older person and the need for services are assessed  co-ordinated care plan is developed. Such comprehensive assessments have been shown to be useful in improving health status of older patients, prolonging survival, reducing health care cost and less use of acute hospitals  so should be incorporated into all acute and long term facilities that provide services for the older patient. A meta-analysis of comprehensive geriatric assessment trials supports there effectiveness .

Objectives of the assessment :
• appreciate overall functional status
• define all factors interfering with or modifying normal function
• identify all correctable factors to optimise function
• appreciate caregivers problems and potential
• judge appropriateness of current and future environment
• objectively test the mental status
• evaluate the rehabilitation potential
• define the existing support and services available
• implement provision of other support as necessary
• evaluate overall prognosis
• construct an anticipatory plan for the future

Barriers to CGA include time and cost as well as availability of team members.
Team members generally include a geriatrics nurse and social worker, but can be enhaced by geriatric psychiatry, neurologist, podiatrist, pharmacil palliative care specialist; dentist; spiritual counsellers; rehabilitation specialists; etc.

The goals of geriatric assessment need the collection and documentation of the following information :
1. Current symptoms and their functional impact
2. Current illnesses and syndrome and their functional impact
3. All current medications, their indications, and effects
4. Current health professionals involved
5. Relevant past illnesses
6. Recent and planed life changes
7. Current and future living environment
8. Objective measure of overall functionality
9. Appropriateness of environment to function and prognosis
10. Family situation and availability
11. Current caregiving network, it problems and potential
12. Objective measurement of cognitive status
13. Objective assessment of mobility and balance
14. Rehabilitative status or prognosis if disabled or ill
15. Emotional health (mood and motivation)
16. Nutritional status and needs
17. Preventive, screening, and health maintenance status
18. Overall social functioning
19. Health promoting activities
20. Services received and required
21. Problem-oriented plan for future care

Evaluations of physical functioning that use objective performance tests can play a valuable role in clinical geriatrics. Functional assessment is used to determine what an individual can do for themselves (most commonly self care activities).
Tools for functional assessment:
Barthel Index
Physical Self-Maintenance Scale (PSMS)
Katz Index of ADL
Beck Depression Index
MiniMental State Examination (MMSE)
Functional Independence Measure

Two levels of functional assessment:
1) Basic – feeding, bathing, dressing, ambulation etc
2) Complex – cooking, shopping, managing money etc

The benefits of a comprehensive geriatric assessment include the more appropriate placement of the older person in care, an increased diagnostic accuracy, better use of community services, improved medication use, improvements in function and a decrease in the length of hospital stays.

Poor lower extremity performance (assessed by tests of balance; walking; chair to stand etc) in the non-disabled older person have been shown to be strong predictors of adverse health outcomes such as subsequent admission to hospital and with poorer health status, poor muscle strength, obesity, and physical inactivity. Pennix et al (2000) suggest that lower extremity performance assessment may be a suitable instrument for identifying non-disabled older persons “at risk” for subsequent adverse events

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