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Resources for the Comprehensive Geriatric Assessment based
Proactive and Personalised Primary Care of the Elderly

In this Toolkit

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 video Overview of


The United Kingdom has an increasingly ageing population.

Percentage of persons aged 65 and over, UK : 1985, 2010, 2035

Population aged 65 and over, UK 2010

A similar ageing trend is predicted for all other EU countries:

Percentage of persons aged 65 and over, EU : 2010

Population aged 65 and over, EU 2010

Percentage of persons aged 65 and over, EU : 2035

Population aged 65 and over, EU 2035

This means that the care of older people will continue to make up an increasingly higher proportion of the workload of the general practitioner (GP).


The health care of an older adult extends beyond the traditional medical management of illness.

It requires evaluation of multiple issues including physical, cognitive, affective, social, financial, environmental, and spiritual components that influence an older adult's health.

The GP is increasingly called upon to help lighten the burden on hospital and A+E services by adopting a proactive approach to the care of the elderly, while at the same time reducing the demands on residential and care homes by improving the quality and prolonging the duration of elderly persons life at home.

This complex and multifaceted task includes the early identification of the frail, and systematic monitoring and management of the elderly and their often multiple co-morbidities and medications, with the formulation of personalised care plans to meet their needs.


The Comprehensive Geriatric Assessment (CGA) is 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.


However, the G.P. may also utilise the full CGA process as a framework for the ongoing systematic and focussed proactive care, monitoring, and management of both the community and residential care-home elderly. 


Locally available resources dictate the extent to which the GP is able to rely on the support of consultant geriatricians and/or MDTs, or must shoulder alone more of the burden of care.

This toolkit defines the 8 domains of the CGA and presents validated approved tools for use in each domain:

Medical Assessment

Assessment of Functioning

Psychological Assessment

Social Assessment

Environmental Assessment

Advance Care Planning

Spiritual Welbeing Assessment

Sexuality and Intimacy Assessment


Tools on Paper, are immediately downloadable and ready for use.


Tools on paper, Tools on Computer and Tools for Mobile Devices are associated with notes on their use and interpretation.


Where appropriate links are provided to the best applicable guidelines, as well as to the best current concise topical summaries.


The assessment and management of Frailty is similarly illustrated and tools usable in the task are provided.


Further tools and resources are provided for the assessment and management of Geriatric Syndromes :


Urinary Incontinence

Pressure Ulcers and

Sleep Disorders


Proactive Care and Personalised Care Planning are defined and resources for their implementation in a variety of settings are provided.


Pathways to the gradual implementation of a system of GP care delivering proactive personalised management of the frail and elderly are defined, Making It Happen by staring with the simplest possible modifications to practice and moving on to a fully integrated multidisciplinary team.


Videos and reports of GP practices that have successfully accomplished selected aspects of geriatric care in their respective settings, are provided in the Practice Spotlight section of the Toolkit.


The GP is further assisted by the provision of Keep It Short and Simple (KISS) summary reports covering several selected topics.


Ready to print Caregiver and Patient Handouts covering a variety of topics are provided for distribution,


The entire toolkit is extensively referenced, and direct links to accessible references are provided.


The GP engaged in the care of elderly persons is likely to be confronted by any number of Thorny Issues. These are discussed and resources useful in meeting the challenge are provided.


Further cause for pause and reflection is provided for Primary Carers in the form of a collection of articles published in the Perspectives section of the Toolkit.


The What’s New pages direct frequent Toolkit users to the latest updates and additions.


A History of this Toolkit is to be found in the About This Toolkit pages together with a Site Map, Copyright and Disclaimer notes, and Contact Us details.

Back To : About This Toolkit

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