Makindo Medical Notes

Comprehensive Geriatric Assessment (CGA)

A Comprehensive Geriatric Assessment (CGA) is a multidimensional, interdisciplinary diagnostic process designed to evaluate an elderly person's medical, psychological, and functional capabilities. The primary goal of CGA is to develop a coordinated and integrated plan for treatment and long-term follow-up that maximizes an older adult’s functional independence, well-being, and quality of life.

Key Components of a Comprehensive Geriatric Assessment

CGA covers a wide range of domains that are critical to the overall health and well-being of older adults. These include:

• Medical Assessment:
  • Review of Medical History and Chronic Conditions: Identifies and manages chronic diseases such as hypertension, diabetes, heart disease, and arthritis.
  • Medication Review (Polypharmacy): Evaluates all current medications for appropriateness, side effects, drug interactions, and adherence.
  • Assessment of Nutritional Status: Detects malnutrition, unintentional weight loss, or vitamin deficiencies.
  • Screening for Common Geriatric Syndromes: Identifies syndromes like frailty, delirium, urinary incontinence, and sensory impairments.
• Functional Assessment:
  • Activities of Daily Living (ADLs): Assesses the patient’s ability to perform basic self-care activities.
  • Instrumental Activities of Daily Living (IADLs): Evaluates more complex tasks required for independent living.
  • Mobility and Gait Analysis: Assesses the patient’s balance, risk of falls, and ability to move independently.
• Cognitive and Psychological Assessment:
  • Cognitive Function: Screens for cognitive impairment or dementia using tools like the Mini-Mental State Examination (MMSE) or the Montreal Cognitive Assessment (MoCA).
  • Depression and Anxiety: Assesses mood and mental health, often using standardized tools like the Geriatric Depression Scale (GDS).
• Social Assessment:
  • Social Support Networks: Evaluates the presence and quality of social support from family, friends, or caregivers.
  • Living Situation: Assesses the patient’s home environment, access to resources, and the appropriateness of their living situation.
  • Financial Status: Identifies any financial challenges that could affect access to healthcare, medications, or services.
• Environmental Assessment:
  • Home Safety: A home environment assessment can reveal risks such as poor lighting, trip hazards, or a lack of accessibility features.
  • Access to Services: Determines whether the patient has access to medical care, social services, transportation, and community resources.
• Advance Care Planning:
  • Goals of Care: Explores the patient’s preferences for future medical care, including advance directives, living wills, or healthcare proxy appointments.

Benefits of Comprehensive Geriatric Assessment

• Improved Diagnosis: CGA enables the identification of previously unrecognized health issues, including cognitive impairments and undiagnosed chronic diseases.
• Personalized Care: The interdisciplinary approach ensures that care plans are tailored to the individual’s specific needs.
• Prevention of Functional Decline: CGA helps prevent further functional decline by addressing risk factors early.
• Reduction in Hospitalizations: CGA can reduce hospital admissions and length of stay.
• Improved Outcomes in Frail Older Adults: CGA is particularly beneficial for frail individuals, improving survival rates and functional ability.
• Enhanced Quality of Life: CGA addresses the holistic needs of patients, improving well-being and promoting independence.

Who Benefits Most from CGA?

• Frail Older Adults: CGA helps address the complex needs of frail individuals.
• Older Adults with Complex Medical Conditions: Those with multiple comorbidities benefit from the careful assessment and management provided by CGA.
• Patients with Cognitive Impairments: CGA is essential for individuals with dementia or other cognitive issues.
• Older Adults at Risk of Functional Decline: CGA is key in preventing further deterioration in patients who have experienced falls or weight loss.

The Multidisciplinary Approach

• Geriatricians: Lead the medical assessment and chronic condition management.
• Nurses: Assist with medication management, wound care, and patient education.
• Physiotherapists and Occupational Therapists: Focus on mobility, rehabilitation, and activities of daily living.
• Social Workers: Address social and environmental concerns, including caregiving and access to resources.
• Psychologists or Psychiatrists: Provide mental health assessment and management for depression, anxiety, or dementia.