Comprehensive geriatric assessment (CGA) is a multidimensional, interdisciplinary diagnostic process to determine the medical, psychological and functional capabilities of a frail elderly person in order to develop a co-ordinated and integrated plan for treatment and long-term follow up

1. Comprehensive
Geriatric Assessment
DR. APARNA SEN CHAUDHARY
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2. Introduction
 “Geriatrics” is the science that deals with study of disease
and their treatment peculiar to old age.
 United Nations (1980) considered 60 years as the age of
transition to the elderly age group
1. “Early old age - up to 75 years (elderly)
2. “Late old age - above 75 years (very elderly)
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3. Introduction
 “Gerontology” is the study of the physical and
psychological changes which are incident to old age.
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Clinical Gerontology
Social Gerontology
Experimental Gerontology
Geriatrics Gynaecology

4. Introduction
WORLD
By 2020, the number of people aged 60 years and
older will outnumber children younger than 5 years.
By 2050, population aged 60 years and older is
expected to total 2 billion, up from 900 million in 2015.
In 2050, 80% of older people will be living in low- and
middle-income countries.
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Source : Ageing and health. Factsheet. World Health Organization.2015

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6. Introduction
INDIA –
 Accounts for 7.4% of total population in 2001, 8.6% in 2011,
and is projected to increase to 19% by the year 2050.
 Poised to become home to second largest number of older
persons.
 Old Age Dependency Ratio increased from 10.9% in 1961 to
14.2% in 2011.
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7. 7
96.30
million
(2011)
133.32
million
(2021)
178.59
million
(2031)
236.01
million
(2041)
300.96
million
(2051)
Source : Operational Guidelines. National Programme for Health Care of the Elderly (NPHCE). Directorate
General of Health Services. Ministry of Health & Family Welfare. Government of India. 2011.

8. Geriatric Health
Problems
Due to the Ageing
Process
Problems
associated with
long term Illness
Psychological
Problems
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9. Geriatric Health Problems
 Problems due to the Ageing process
a) Senile cataract
b) Glaucoma
c) Nerve Deafness
d) Osteoporosis
e) Emphysema
f) Failure of special senses
g) Changes in Mental outlook
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10. Geriatric Health Problems
 Problems associated with Long-Term Illness
a) Degenerative Disease of Heart and Blood Vessels
b) Cancer
c) Accidents
d) Diabetes
e) Disease of Locomotor System
f) Respiratory Illness
g) Genitourinary System
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11. Geriatric Health Problems
 Psychological Problems
a) Mental Changes
b) Sexual Adjustments
c) Emotional Disorders
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12. Geriatric Assessment - Definition
 “A Multidimensional interdisciplinary diagnostic process
focused on determining a frail older person’s medical,
psychological and functional capability in order to develop
a coordinated and integrated plan for treatment and long
term follow up.”
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Rubenstein LZ, Stuck AE, Siu AL, Wieland D. Impact of geriatric evaluation and management programs on defined outcomes: overview of
the evidence. J Am Geriatr Soc.1991;39:8-16S.

13. Geriatric Assessment - Use
 Used to –
 Develop treatment and long-term follow-up plans,
 Arrange for primary care and rehabilitative services,
 Organize and facilitate the intricate process of case
management,
 Determine long-term care requirements
 Make the best use of health care resources.
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14. Implications of Geriatric Assessment
 Improve the assessment of the medical and the
psychological Problems
 To provide Therapy and Rehabilitation services
 To determine optimal posttherapy placement for an
independent functioning
 To provide healthcare both by Healthcare Professionals
and care takers
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15. Geriatric Assessment – Why it is important?
 Focuses on elderly individuals with complex problems,
 Emphasizes functional status and quality of life, and
 Frequently takes advantage of an interdisciplinary team of
providers.
 Effectively addresses The "Five I's of Geriatrics” i.e.,
1. intellectual impairment,
2. immobility,
3. instability,
4. incontinence and
5. iatrogenic disorders.
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16. Comprehensive Geriatric Assessment
Comprehensive
Geriatric
Assessment
Medical
Psychological
Social/
Environmental
Functional
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17. Comprehensive Geriatric Assessment
 Medical
 Comorbidities
 Continence
 Fall risk
 Nutritional Status
 Medication
 Advanced care
 Vision and hearing
 Functional
 Gait and balance
 Mobility and transfers
 Basic activities of daily living,
e.g. feeding, washing, toileting
 Instrumental activities of daily
living, e.g. shopping, cooking,
 Advanced activities of daily
living, e.g. hobbies
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18. Comprehensive Geriatric Assessment
 Psychological
 Mood
 Cognition
 Ideas, concerns and
expectations
 Social or Environmental
 Formal care support
 Home safety and
appropriateness
 Social network providing
informal support
 Accessibility to local
resources and Financial
assessment
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19. Comprehensive Geriatric Assessment
Medical Geriatric
Assessment
Medical History
Standard Medical
Examination
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20. Periodic Geriatric Assessment
Detailed health assessment
once they are 45-50 years
Once in 5 years till 65 years
of age
Thereafter every year or at
least once in 2 years
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Bhalwar R, Gupta RK, Kunte R, Tilak R, Vaidya R. Textbook of Public Health and Community Medicine. Pune: Department of Community Medicine, Armed Forces Medical College
in collaboration with WHO India Office; 2009.

21. Comprehensive Geriatric Assessment
 Medical History
1. Demographic details
2. Chief complaints
3. Present Illness
4. Past history
5. Social History
6. Family History
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22. Comprehensive Geriatric Assessment
 Medical Examination
1. Visual Impairment/ complaints
2. Locomotive disorders, joints, muscles
3. Neurological complaints
4. Cardiovascular disease
5. Respiratory disorders
6. Weight Changes
7. Gastro-intestinal/ Abdominal disorder
8. Psychiatric problem
9. Hearing loss
10.Genitourinary disorder
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26. Geriatric Assessment Tools
 Visual Impairment
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Visual
Acuity
• Snellen
Test
• Near Test
Visual Field
• Confrontat
ion test
• Perimetry
Glaucoma
• Tonometry
• Pachymetry
Macular
Degeneration
• Amsler Grid
Test

27. Geriatric Assessment Tools
 Falls/Gait Disturbance
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Fall Screening Test
• Timed up and go test
• Single leg stand
• Single chair rise
Balance Assessment
Tools
• Timed chair rise
• Tandem stance
• 360⁰ turn protocol
• Alternate step test

28. Geriatric Assessment Tools
 Neurological Complaints
1. Mini Mental State Examination
2. Abbreviated mental status test
3. Clock drawing
4. Mini-cog
5. Montreal Cognitive Assessment
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29. Geriatric Assessment Tools
 Cardiovascular Disease
1. Lipid Screening
2. Lipoprotein (a), Apolipoproteins A1 and B
3. Inflammation biomarkers
a. Homocysteine
b. Fibrinogen
c. Natriuretic peptides (BNP and NT-proBNP)
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30. Geriatric Assessment Tools
 Hearing Loss
1. Whispered Voice Test
2. Calibrated finger rub auditory screening test (CALFRAST)
3. Watch tick test
4. Handheld audiometer
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31. Geriatric Assessment Tools
 Genitourinary
1. 2-item questionnaire
2. Single question
3. The 3IQ questionnaire
4. Urine Dipstick
5. Digital rectal examination
6. Post-void residual volume
7. Prostate Specific Antigen
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32. Geriatric Assessment Tools
 Psychiatric Problems
1. Geriatric Depression Scale,
2. Hospital Anxiety and Depression Scale, and
3. Patient Health Questionnaire.
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33. Geriatric Assessment Tools
 Weight Changes
1. Nutritional Health Checklist
2. Detailed Dietary Assessment using 24-hour recall
3. Physical Examination – over-consumption or inadequate
nutrition
4. Laboratory test
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34. 34Nutritional Health Checklist

35. Comprehensive Geriatric Assessment
 Functional Assessment Tools
1. As a measure of overall impact of health conditions in the
context of a patient’s environment and social support
system
2. This can be assessed at 3 levels:
a) Basic activities of daily living (BADLs),
b) Instrumental activities of daily living (IADLs), and
c) Advanced activities of daily living (AADLs).
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36. 36Basic activities of daily living index

37. Comprehensive Geriatric Assessment
 Social Assessment
a) There is a great deal of interdependency between patients’
social situations and their functional status.
b) Living arrangements, financial security, transportation,
access to medical services
c) Psychosocial/ interpersonal relations
d) A variety of private and public resources
e) Home assessments
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38. Comprehensive Geriatric Assessment
 Polypharmacy
 This is a notable source of harm in older people.
 Increased susceptibility to adverse drug reactions.
 Comprehensive geriatric assessment should always
Process of drug rationalisation.
Adequate monitoring following any change to
medication
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39. Comprehensive Geriatric Assessment
 Advance care planning
 Comprehensive geriatric assessment should aim to elicit
health-care preferences and engage in discussion around
advance care planning.
 Discussions must be sensitive, relevant, open, and centred
on the individual’s wishes.
 The process may result in a number of formalized
outcomes.
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40. Comprehensive Geriatric Assessment
 Challenges
• Unfamiliar concept
• It is often incompletely executed, therefore negating its
benefits.
• Lack of relevant staff training
• Insufficient time and resources
• Lack of continuity of assessment
• Absence of a consistent team leader
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