What is a comprehensive geriatric assessment?
BACKGROUND — Comprehensive geriatric assessment (CGA) is defined as a multidisciplinary diagnostic and treatment process that identifies medical, psychosocial, and functional limitations of a frail older person in order to develop a coordinated plan to maximize overall health with aging [1,2].
What are the issues of concern in geriatric assessment?
Issues of concern in geriatric assessment can be broadly divided into the following 4 classes: Functional Status Physical Health Vision impairment Hearing loss Nutrition status Fall prevention Urinary Incontinence Osteoporosis and arthritis Polypharmacy and Medication Reconciliation Cognitive Assessment Dementia Sleep and insomnia Mood disorder
What is included in the health care of an older adult?
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.
What are the benefits of in-home geriatric assessment?
● Home geriatric assessment has been shown to be effective in improving functional status, preventing institutionalization, and reducing mortality. CGA performed in the hospital, especially in dedicated units, also has benefit on survival. Most programs of hospital discharge management with in-home follow-up have reduced readmission rates.
What are the three fundamental concepts of geriatric assessment?
How to assess geriatric health?
What are the questions about geriatric patients?
How does CGA affect geriatrics?
What is a CGA?
How old do you have to be to get a geriatric assessment?
Why is it important to do a geriatric assessment?
See 4 more
About this website
Geriatric Assessment - an overview | ScienceDirect Topics
Lee Goldman MD, in Goldman-Cecil Medicine, 2020. A Strategic Approach to Geriatric Assessment for the Practicing Clinician. Although assembling an interdisciplinary assessment team is beyond the capability of most practitioners, even small group practices can use teamwork and simple practice design to perform geriatric assessments efficiently and comprehensively.
Geriatric Assessment Tools - University of Maryland, Baltimore
Assessment Area Available Tools; Cognitive Ability: Clinical Dementia Rating Scale; Mini-Mental State Examination, 2 nd Edition™; Criteria for Alzheimer's Disease
Geriatric assessment: Essential skills for nurses
America’s elderly population is expected to rise from 34 million in 2000 to approximately 70 million by 2030. To ensure optimal health outcomes for older adults, nurses in all settings should be familiar with geriatric health problems and demonstrate proficiency in providing care.
What are the three fundamental concepts of geriatric assessment?
Three fundamental concepts guide geriatric assessment and the resulting medical management. At the core of geriatric assessment is functional status, both as a dimension to be evaluated and as an outcome to be improved or maintained. The maintenance and restoration of functional status is an essential overriding objective of good geriatric and geriatric oncologic care. 2,5,6,7 A second overarching concept guiding geriatric assessment is prognosis, particularly life expectancy. Finally, geriatric assessment must be guided by patient goals. 2
How to assess geriatric health?
Inquiring about recent socioeconomic changes, functional losses, or life transitions is also important. The physician should obtain the patient’s medical records before the first visit. A questionnaire targeted to the geriatric assessment domains should be completed by the patient, with family assistance if needed ( Figure 4-2 ). Language, education, social support, economic status, and cultural/ethnic factors play a vital role in the patient’s health care outcome. A multidisciplinary approach is used to interventions and management. Preserving function and maintaining quality of life are the primary goals of the geriatric assessment (Miller et al., 2000).
What are the questions about geriatric patients?
Some of these are the following: What is the value of treating dysphoric mood that falls short of full-blown depression? Some data suggest that patients with dysphoria may be inappropriately high utilizers of healthcare resources. How stable are people's advance directives? Do they change when patients are more immediately confronted with life-threatening situations and the issues are more immediate and less abstract than when the directive was originally formulated? How valuable are exercise prescriptions in later life? What are some of the long-term effects of nutrition on health? Higher folate intakes may have an antiatherogenic effect mediated through homocysteine levels. Are there ways to ameliorate the effects of bedrest deconditioning and the development of delirium that so often add to the morbidity of hospitalization of geriatric patients? Is there a role for anticipatory conditioning prior to elective hospitalizations or procedures (so-called prehabilitation)?
How does CGA affect geriatrics?
In general geriatrics, the CGA has succeeded in reducing the rate of functional dependence and of admission to the hospital and to adult living facilities. 35,37 In geriatric oncology, the CGA may unearth conditions that may compromise cancer treatment. 35-37 Three studies exploring the effects of CGA in older patients with cancer demonstrated some degree of functional dependence in approximately 70% of those patients, some degree of comorbidity in more than 70%, and dementia, malnutrition, and depression in approximately 20%. 38-40 The value of geriatric assessment in directing antineoplastic chemotherapy was demonstrated in a recent study.41 Older patients with large cell lymphoma were treated according to the results of the geriatric assessment or according to the clinical impression of the investigator. The CGA proved more precise in identifying patients at risk for toxicity.
What is a CGA?
The CGA is an interdisciplinary diagnostic and treatment protocol similar to physiatric assessments that is designed to identify biomedical, functional, environmental, and psychosocial limitations of older adults with the goal of developing a coordinated and personalized plan to maximize health and assist in clinical decision making. 124,125 In general, the interdisciplinary team consists of a physician (usually a geriatrician), nurse, social worker, and neuropsychologist and may draw on the expertise of physical and occupational therapists, nutritionists, pharmacists, podiatrists, opticians, and other medical personnel. It is imperative to consider the relevant social, spiritual, and economic domains when addressing geriatric syndromes in addition to the traditional biological framework for diseases. 23 There are six key steps in the assessment process, including data gathering, frequent team-based discussions with the patient and caregivers, development of treatment plan, implementation, monitoring for response, and revision of plan as needed. While gathering data, it is essential to evaluate the following components: frailty status, function, fall history and risk assessment, cognition, mood, polypharmacy, social support, finances, goals of care, advanced directives, and nutrition status.
How old do you have to be to get a geriatric assessment?
The National Cancer Center Network recognizes that some form of geriatric assessment may provide information essential to the treatment of persons 70 years old or older26:
Why is it important to do a geriatric assessment?
It is important to remember, however, that patients may underreport medical problems because they worry about losing their independence. Patients may also be reluctant to repeat their health concerns to their primary care physician because they fear being perceived as having an emotional or psychiatric illness. Often, older patients will rationalize their symptoms as being a “normal” component of aging.
What is an outpatient CGA?
One outpatient approach would be to refer patients for CGA who are found to have problems in multiple areas during geriatric assessment screens. Major illnesses (eg, those requiring hospitalization or increased home resources to manage medical and functional needs) should also prompt referral for CGA, particularly for functional status, fall risk, cognitive problems, and mood disorders. (See "Geriatric health maintenance" and 'Major components' below.)
How to identify geriatric syndrome?
Geriatric syndromes can best be identified by a geriatric assessment. Although the geriatric assessment is a diagnostic process, the term is often used to include both evaluation and management.
Why do CGA programs rely on post discharge assessment?
Some CGA programs rely on post-discharge assessment due to the decrease in length of hospital stay. Furthermore, while most of the early CGA programs focused on restorative or rehabilitative goals (tertiary prevention), many newer programs are aimed at primary and secondary prevention.
How is CGA initiated?
CGA programs are usually initiated through a referral by the primary care clinician or by a clinician caring for a patient in the hospital setting. The content of the assessment varies depending on different settings of care (eg, home, clinic, hospital, nursing home).
Why are outpatient CGA programs excluded?
Most outpatient CGA programs exclude patients who are unlikely to benefit because of terminal illness, severe dementia, complete functional dependence, and inevitable nursing home placement. However, some of these patients (eg, those with severe dementia) may benefit by increasing the capabilities of caregivers when the assessment is accompanied by ongoing care management [ 4 ]. Exclusionary criteria have also included identifying older persons who are "too healthy" to benefit, such as those who are completely functional without any medical comorbidities.
Why is CGA not available?
CGA is not available in all settings, due to issues related to the time required for evaluation, need for coordination of multidisciplinary specialties, and lack of reimbursement for some components (eg, outpatient social work, pharmacy, and nutrition). INDICATIONS FOR REFERRAL.
What is geriatric assessment?
Geriatric assessment is sometimes used to refer to evaluation by the individual clinician (usually a primary care clinician or a geriatrician) and at other times is used to refer to a more intensive multidisciplinary program, also known as a comprehensive geriatric assessment (CGA).
How does geriatric assessment help the elderly?
When done right, comprehensive geriatric assessment can improve elderly’s functional status and quality of life. It can also reduce mortality and length of stay in hospitals. Studies find that older patients who stayed in hospitals a lot longer experience higher risk of functional decline. Geriatric Syndrome.
What age do you need to be to get a geriatric assessment?
It’s done usually to frail old people with complex problems. All older adults over the age of 70 who are identified as being frail or at risk of frailty are recommended to have timely comprehensive geriatric assessment performed and documented in their health records.
Who Needs CGA?
The main significance of a geriatric assessment is to gather data for the physician in order to create an accurate diagnosis and plan of care for older people. It will allow them to create a treatment and rehabilitation program that will support the patient’s long-term needs. CGA is timely and comprehensive. It’s done usually to frail old people with complex problems.
What are the benefits of CGA?
CGA is a structured approach to patient assessment that has helped encouraged older person and their family to consider effective and advance treatment to improve quality of life. It has proved valuable in modern medical treatment plans through the following benefits: 1 Improved diagnostic accuracy 2 Less complication during hospitalization or in-care treatment 3 Optimized rehabilitation treatment 4 Enhanced health and functional outcome 5 Effective discharge planning and less readmission
How can a geriatrician determine a person's ability to live without assistance?
These activities will determine the older person’s capacity to live without assistance or if he will require help from someone else to complete these basic tasks. Geriatricians can measure functional status by simply watching older patients complete various tasks such as putting on his shoes, writing on a piece of paper, and unbuttoning and buttoning a shirt.
What is CGA in healthcare?
CGA determines the appropriate care for them in the hospital or an elderly’s eligibility for clinical trials. It also evaluates elderly patients considering chemotherapy. Advocates of CGA believe that a full evaluation of an older patient may help identify treatable health problems which can lead to better outcomes.
Why is CGA important?
CGA is useful in treating hospitalized, in-care, and with cancer older patients who needs primary care. Evidence shows that patients who receive CGA are more likely to return home, have less functional decline, and lower mortality rate.
How can you carry out a comprehensive geriatric assessment?
An initial risk screen of all older people in hospital aged over 70 years should identify those who would benefit from a comprehensive assessment. This need may change during the patient’s hospital stay, as indicated by ongoing monitoring of their health status.
What is the purpose of geriatric assessment?
Information gained from a comprehensive geriatric assessment allows clinicians to implement a person-centred care plan which can reduce functional decline, support independence and improve quality of life.
What is a geriatric team?
A specialist interdisciplinary team approach involving a geriatrician to undertake a comprehensive assessment.
Why is it important to use a person centred approach to find out what matters to our older patients?
It requires us to use a person centred approach to find out what matters to our older patients to maximise their strengths, functional independence and outcomes.
What is CGA in healthcare?
The most widely used definition of CGA was: 'a multidimensional, multidisciplinary process which identifies medical, social and functional needs, and the development of an integrated/co-ordinated care plan to meet those needs'. Key clinical outcomes included mortality, activities of daily living and dependency.
What are the key outcomes of CGA?
Key outcomes are death, disability and institutionalisation. The main beneficiaries in hospital are older people with acute illness. The presence of frailty has not been widely examined as a determinant of CGA outcome. we confirm a widely used definition of CGA. Key outcomes are death, disability and institutionalisation.
How many articles were reviewed in the CGA?
Results: we screened 1,010 titles and evaluated 419 abstracts for eligibility, 143 full articles for relevance and included 24 in a final quality and relevance check. Thirteen reviews, reported in 15 papers, were selected for review. The most widely used definition of CGA was: 'a multidimensional, multidisciplinary process which identifies medical, social and functional needs, and the development of an integrated/co-ordinated care plan to meet those needs'. Key clinical outcomes included mortality, activities of daily living and dependency. The main beneficiaries were people ≥55 years in receipt of acute care. Frailty in CGA recipients and patient related outcomes were not usually reported.
What is a geriatric assessment?
Geriatric assessment should include detailed medical history and physical examination, with particular focus on problems specific to the elderly such as vision, hearing, nutrition, fall prevention, urinary incontinence, osteoporosis, and preventative health. Preventative Health.
Why is it important to use standardized tools in assessing older patients?
The use of various standardized tools can help alleviate confusion and discrepancy in assessing older patients. It is important to address such issues on a rollover basis during each clinic visit to improve outcomes for this vulnerable population. [4]
Why are elderly people at increased risk of adverse outcomes?
Due to multiple comorbidities and frailty, the elderly are at increased risk of adverse outcomes with each clinical insult.[1] Besides the common comorbidities such as diabetes and hypertension, older patients can present with atypical presentation too. For example, a patient with sepsis may present without fever, or a patient with Urinary Tract Infection (UTI) may present with confusion. The elderly population varies in cognitive, physical, and social functioning and thus requires different levels of care based on individual needs and functional status. [3][4]
How to evaluate incontinence?
Initial evaluation of incontinence should comprise a non-invasive approach, including detailed medical history, fluid intake assessment, self-voiding diary, etc.; however, complicated cases may necessitate urodynamic studies. A simple and reproducible validated tool to differentiate stress and urge incontinence is 3 Incontinence Questions which comprises questions about urinary leaks.[38] Conservative treatments such as behavioral modification, dietary modification, pelvic floor muscle training, timed voiding, and weight loss should be tried first. Various pharmacological therapies are available for urge incontinence. A systematic review of 13 trials showed anticholinergics as the only pharmacological therapy that decreased urinary leakage in urge incontinence.[39] Devices such as pessaries can be used for incontinence associated with pelvic organ prolapse. Similarly, surgical options such as sling procedures and neuromodulation can be offered to carefully selected patients with incontinence. [36]
What are preventative health screenings?
Preventative health includes screening for diseases such as diabetes mellitus, hypertension, cancer, etc. Early identification and treatment may be beneficial in diabetes, hypertension as well as in certain malignancies. However, the American Geriatric Society recommended that such screenings be based on patient's preferences, life expectancy, and co-morbid conditions rather than solely on age-based criteria. Older patients may have many co-morbid conditions that can shorten their life, hence the potential benefits of such screening tests and patient's preference for further evaluation and invasive procedure if screened positive should be taken into account before the screening. For the same reason, screening should be focused on treatable conditions which can provide immediate benefit to their quality of life rather than on asymptomatic diseases.[9] Similarly, vaccine-preventable infections such as influenza, pneumonia, herpes zoster, etc., represent major causes of morbidity and mortality in older patients. Hence, most societies recommend following vaccines routinely for older patients: influenza vaccine, pneumococcal vaccine, herpes zoster vaccine and tetanus, Diptheria, and acellular pertussis vaccine. Depending on specific co-morbidities, an older patient may qualify for other vaccines as well. [10][11]
What is functional status assessment?
Evaluation of one's ability to perform activities required to live independently comprises functional status assessment. It can be broadly divided into 2 levels - basic activities of daily living (BADL), which includes activities of self-care such as feeding, dressing, bathing, toileting, grooming, controlling bladder and bowel movements, etc. and instrumental activities of daily living (IADL) which includes activities to live independently such as taking medications, shopping, preparing meals, driving/using public transport, handling finances, doing household works, using telephone, etc. Commonly used indices to assess such activities are the Katz index for BADL and the Lawton scale for IADL. Information about functional status can also be achieved by asking open-ended questions about their daily activities. Functional status is directly affected by physical health, so any change in functional status should prompt further evaluation. There are various validated tools to measure functional ability, such as the Vulnerable Elders Scale-13 or Clinical Frailty Scale. [5][6] Recently, gait speed has also been proposed as a screening tool for functional status.[7] One pooled analysis showed gait speed is associated with better survival for every 0.1 m/s increments. [8]
How should clinicians discuss goals of care?
Clinicians should discuss goals of care and advance directives primarily in ambulatory settings, well in advance of facing health crises . Effective communication allows the patient to cope with the serious illness and empowers them to direct their treatment. Goals of care discussion should be individualized as different patients would have different short or long-term goals. Similarly, advanced directives discussion allows the providers to know about the patient's wishes, prevents confusion at the end of life, and minimizes healthcare costs by deferring unwanted medical procedures. Such discussions do not increase depression, anxiety, or hopelessness in patients rather improve their quality of life and even survival by up to 25%. It also decreases stress, anxiety, and depression among family members and improves family satisfaction. [59][60][61]
What are the three fundamental concepts of geriatric assessment?
Three fundamental concepts guide geriatric assessment and the resulting medical management. At the core of geriatric assessment is functional status, both as a dimension to be evaluated and as an outcome to be improved or maintained. The maintenance and restoration of functional status is an essential overriding objective of good geriatric and geriatric oncologic care. 2,5,6,7 A second overarching concept guiding geriatric assessment is prognosis, particularly life expectancy. Finally, geriatric assessment must be guided by patient goals. 2
How to assess geriatric health?
Inquiring about recent socioeconomic changes, functional losses, or life transitions is also important. The physician should obtain the patient’s medical records before the first visit. A questionnaire targeted to the geriatric assessment domains should be completed by the patient, with family assistance if needed ( Figure 4-2 ). Language, education, social support, economic status, and cultural/ethnic factors play a vital role in the patient’s health care outcome. A multidisciplinary approach is used to interventions and management. Preserving function and maintaining quality of life are the primary goals of the geriatric assessment (Miller et al., 2000).
What are the questions about geriatric patients?
Some of these are the following: What is the value of treating dysphoric mood that falls short of full-blown depression? Some data suggest that patients with dysphoria may be inappropriately high utilizers of healthcare resources. How stable are people's advance directives? Do they change when patients are more immediately confronted with life-threatening situations and the issues are more immediate and less abstract than when the directive was originally formulated? How valuable are exercise prescriptions in later life? What are some of the long-term effects of nutrition on health? Higher folate intakes may have an antiatherogenic effect mediated through homocysteine levels. Are there ways to ameliorate the effects of bedrest deconditioning and the development of delirium that so often add to the morbidity of hospitalization of geriatric patients? Is there a role for anticipatory conditioning prior to elective hospitalizations or procedures (so-called prehabilitation)?
How does CGA affect geriatrics?
In general geriatrics, the CGA has succeeded in reducing the rate of functional dependence and of admission to the hospital and to adult living facilities. 35,37 In geriatric oncology, the CGA may unearth conditions that may compromise cancer treatment. 35-37 Three studies exploring the effects of CGA in older patients with cancer demonstrated some degree of functional dependence in approximately 70% of those patients, some degree of comorbidity in more than 70%, and dementia, malnutrition, and depression in approximately 20%. 38-40 The value of geriatric assessment in directing antineoplastic chemotherapy was demonstrated in a recent study.41 Older patients with large cell lymphoma were treated according to the results of the geriatric assessment or according to the clinical impression of the investigator. The CGA proved more precise in identifying patients at risk for toxicity.
What is a CGA?
The CGA is an interdisciplinary diagnostic and treatment protocol similar to physiatric assessments that is designed to identify biomedical, functional, environmental, and psychosocial limitations of older adults with the goal of developing a coordinated and personalized plan to maximize health and assist in clinical decision making. 124,125 In general, the interdisciplinary team consists of a physician (usually a geriatrician), nurse, social worker, and neuropsychologist and may draw on the expertise of physical and occupational therapists, nutritionists, pharmacists, podiatrists, opticians, and other medical personnel. It is imperative to consider the relevant social, spiritual, and economic domains when addressing geriatric syndromes in addition to the traditional biological framework for diseases. 23 There are six key steps in the assessment process, including data gathering, frequent team-based discussions with the patient and caregivers, development of treatment plan, implementation, monitoring for response, and revision of plan as needed. While gathering data, it is essential to evaluate the following components: frailty status, function, fall history and risk assessment, cognition, mood, polypharmacy, social support, finances, goals of care, advanced directives, and nutrition status.
How old do you have to be to get a geriatric assessment?
The National Cancer Center Network recognizes that some form of geriatric assessment may provide information essential to the treatment of persons 70 years old or older26:
Why is it important to do a geriatric assessment?
It is important to remember, however, that patients may underreport medical problems because they worry about losing their independence. Patients may also be reluctant to repeat their health concerns to their primary care physician because they fear being perceived as having an emotional or psychiatric illness. Often, older patients will rationalize their symptoms as being a “normal” component of aging.