Resources for the Comprehensive Geriatric Assessment based
Proactive and Personalised Primary Care of the Elderly
Comprehensive Geriatric Assessment
A multidimensional holistic assessment of an older person which considers health and wellbeing and
formulates a plan to address issues which are of concern to the older person ( and their family and carers when relevant ) ,
arranges interventions according to the plan and then reviews the impact.
Brief CGA Template
Data collection template for the initial abbreviated Comprehensive Geriatric Assessment
x min. variable
Annual GEriatric Data Template
Annual notes template for the full Comprehensive Geriatric Assessment
x min. variable
CGA includes 8 domains of assessment :
Successful ageing is contingent upon three elements : avoiding disease and disability, sustaining high cognitive and physical function, and engaging with life.
The Medical Assessment domain of Comprehensive Geriatric Assessment (CGA) includes five sub-domains:
- Physical Examination
- Medication Review
- Nutrition Assessment
- Bone Health Assessment
- Pain Assessment
Normal aging changes, acute illness, worsening chronic illness, and hospitalization can contribute to a decline in the ability to perform tasks necessary to live independently in the community.
The information from a functional assessment can provide objective data to assist with targeting individualized rehabilitation needs or to plan for specific services such as meal preparation, nursing care, home-maker services, personal care, or continuous supervision.
An estimated 20 % of adults aged 65 and older meet the criteria for a mental disorder during the previous 12 months.
Because of their coexisting physical conditions, older adults are significantly more likely to seek and accept services in primary care versus specialty mental health care settings.
GPs are often the first and only mental healthcare contact that older people actively seek.
The Psychological Assessment domain of Comprehensive Geriatric Assessment (CGA) includes four sub-domains, often referred to as the 4Ds :
- Cognitive Decline
Socially-involved individuals suffer less illness, overcome sickness more readily, and experience better health outcomes than more socially isolated persons.
Social and financial circumstances have a direct impact on physical (Keller BK, 2003) and mental wellbeing.
They influence patients’ ability and inclination to comply with medical advice and the frequency of attendance in primary care and the emergency department.
It is vitally important that health care professionals are aware of a patient’s social situation and support structures in order to best tailor their advice and support.
There is a complex relationship between the home environment and health.
An older person's home circumstances may determine their ability to remain at home or go into a care facility.
As the elderly tend to spend more time in their homes than other members of society they are particularly vulnerable to environmental factors.
There may be factors within the home that pose a risk to either the patient or people going into the home to provide care.
There needs to be adequate facilities for food storage and preparation, personal hygiene, sleeping, adequate warmth in the winter and ability to remain cool in the summer.
There may be specific environmental issues with direct health effects such as Carbon Monoxide excess from a faulty heater or asbestos from old insulation material.
The local neighbourhood is also important in determining factors such as fear of crime access to services and the ability to interact socially.
Advance Care Planning refers to a process of discussion and reflection about goals, values and preferences for future treatment in the context of an anticipated deterioration in the patient's condition with loss of capacity to make decisions and communicate these to others.
The difference between Advance Care Planning and planning more generally is that the process of ACP is to make clear a person’s wishes in the context of an anticipated deterioration in the individual’s condition in the future, with attendant loss of capacity to make decisions and/or ability to communicate wishes to others.
This may lead to making an Advance Statement, or Advance Healthcare Directives such as an Advance Decision to Refuse Treatment (ADRT), a Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decision, or other types of decision (such as making a Lasting Power of Attorney).
"Spirituality" refers to the personal search for meaning and purpose in life (relationship to self, others, nature, world, God), as distinct from "Religion" which refers to beliefs, practices and traditions associated with religious groups (e.g. Catholic, Protestant, Jewish, Buddhist).
Spiritual care is defined as “meeting people where they are and assisting them with connecting or reconnecting with things, practices, ideas, and principles that are at the core of their being-the breath of their life, making a connection between yourself and that person.
Spiritual welbeing is conducive to better health outcomes, while spiritual distress is lnked to delayed and inferior outcomes.
Sexuality is a central aspect of being human. It encompasses sex, gender identities and roles, sexual orientation, pleasure, eroticism, and intimacy, and is a major contributor to an individual’s quality of life and sense of wellbeing.
Positive sexual relationships and behaviors are integral to maintaining good health and general well-being in later in life.
The need for intimacy doesn’t decrease in older adults, though physical sexual activity may decline and disorders, medication or circumstances may interfere.
The figure below demonstrates the processes of CGA :