The document discusses the importance of comprehensive geriatric assessment (CGA) from a physiotherapy perspective, highlighting the increasing elderly population and the need for effective health care to address functional limitations and frailty. It outlines the assessment process, core principles, and the necessity of interdisciplinary approaches to develop holistic treatment plans. The document emphasizes functional assessments in older adults, particularly over 75, and details various assessment tools for evaluating mobility, balance, and other functional capabilities.

1. Comprehensive Geriatric
Assessment: Physiotherapy
perspective
Shyam Krishnan K
Assistant Professor Sr. Scale
Dept. Physiotherapy
KMC Mangaluru

2. Background
 By the year 2050:
20% of the population will be older than 65 years
850,000 people will be centenarians
 In the 4,500 years from the Bronze Age to the year 1900, life
expectancy increased 27 years
 In the next 90 years, from 1900-1990, life expectancy also
increased 27 years
 Of all human who have EVER lived to be 65 or older, half are
currently alive

3. The necessity
 Advancement at all levels of health care delivery → increased life
expectancy → adding of years to life not necessarily life to years
 Self reported epidemiological data of older people show, over half of the
advanced years of life is lived with some disability
↓
Often associated with identified medical condition
 Many individual diseases produce similar outcomes in terms of functional
limitations and QOL
 Many elderly anyways lose functional abilities without there being a clear
cut single diagnosis to explain it

4. Causations
 Presence of one or more identifiable medical condition
 Age related changes affecting cell metabolism, organs function, mental
health, and homeostasis
↓
Loss of critical amounts of reserve at any one or more levels
↓
Vulnerability to adverse health events like hospitalization, functional
dependence or death
 VULNERABILITY → FRAILITY
 “A biological syndrome of decreased reserve and resistance to stressors,
resulting from cumulative declines across multiple physiological systems
and causing vulnerability to adverse outcomes"

6. How to identify?

7. What is CGA?
 A multidimensional, interdisciplinary, diagnostic process designed to determine a
frail older person’s
Medical conditions
Mental health
Functional capacity
Social circumstances

8. Purpose
Planning and carrying out a holistic treatment
plan
Rehabilitation
Support
Long-term follow up

9. Core principles
Older person is central to the process
Their capacity to participate voluntarily must be
assessed, and if lacking, their needs be addressed in
an ethical fashion
Good link between social and healthcare , for CGA to
be delivered in an efficient and timely manner
Assessment should be standardized and carried out
to a reliable standard

10. Circumstances
Acute illness → functional limitation
Transfer for care → rehab/re-enablement
A frail patient prior to surgery, or experiencing two or
more “geriatric syndromes” of falls, delirium,
incontinence or immobility

11. The team

12. Dimensions of CGA

13. Elements

14. Purpose
Highest priority:
• Prevention of decline in the independent performance of
ADLs
• Drives the diagnostic process and clinical decision making
Screen for preventable diseases
Screen for functional impairments that may
result in physical disability and amenable to
intervention

15. Relevance of PT
 The extensive knowledge of causation and outcomes of
movement dysfunctions and frailty
 Tools for evaluating , planning, and executing corrective
interventions for disabling conditions
 Role in prevention
 Cost effectiveness when actively involved in health care
delivery.

16. The domains

17. Physiotherapy perspective
 Who needs??

18. Functional
assessment
Way of determining health
needs now and in the
future
Assessments of patients
with frailty should occur
after every illness or injury
to establish the effect the
episode had on the
patient’s functional ability
Functional
assessments should
be done on every
patient over 75 years
old
Elements
• ADL/IADL
• Gait
• Balance
• Physical activity/exercise
status

19. Functional
assessment
 Subjective
Usual scheme
Additional data regarding
Any thing changed recently (vision,
hearing, mobility, medications etc.)
Fall risk assessment tool questions (FRAT)
Dietary intake/ changes
Dependence/Independence in ADL/IADL

20. Functional assessment
 Objective
Observation
Posture
Appearance/body shape
Skin Changes
specifics
Relevant
palpation

21. Functional
assessment
 Gait
SPEED: Assessed using a
standardized test like 10 m walk
test/TUG
ENDURANCE: 6 min walk test
ANLAYSIS: Spatial-Temporal
parameters
A gait speed less
than 0.8 m/s
indicates frailty

22. Functional assessment
 Balance
 75% of People over 70 have balance issue
 Standardized assessment tools like Berg Balance Scale and the Tinneti Balance
and Gait Assessment
 Shorter/less time consuming, TUG, Single leg stance, FRT
Falls
An environmental evaluation as well is necessary for the multifactorial
intervention for fall prevention

23. Functional
assessment
Barthel index for
ADL
KATZ index for ADL
Lawton-Brody IADL
scale

24. Functional assessment
 Other routine objective evaluations
Muscle strength → Grip strength
ROM
Miscellaneous like Reaction time

25. Functional
assessment
Outcome Measures (OM) Description of OM Psychometric properties
Frail elderly functional
assessment
Examines functional
ability in the frail
Nineteen point
questionnaire
• Valid
• Reliable
• Sensitive to change
10 Metre Walk Test 10 Metre Walk Test  Excellent test-retest
reliability and high
concurrent validity
when compared to
the shorter 4 metre
walk test
The Barthel Index The Barthel Index
It measures the patient's
ability to look after
themselves by asking 10
questions and answers
that are graded on the
amount of assistance
required
 The interrater
reliability of this
outcome is fair to
good depending on
which activity is being
assessed

26. Functional
assessment
Outcome measure Description Psychometric properties
The Edmonton Frail Scale 12 questions related to cognition,
general health status, mobility,
social status, medication use,
nutrition, mood, continence and
functional performance. It has a
total score of 17 which depicts
severe frailty. It is a very brief way
of assessing for frailty and can be
used to see whether a CGA
should take place
 Good inter-rater reliability
 Takes less than 5 mins to
complete
 Good construct validity
 Acceptable internal
consistency
PRISMA7 A questionnaire devised of
seven yes or no questions that
can be used when the patient
is unable to carry out a Stand
Up and Go or a 10 Metre Walk
Test. It was developed with a
service in Canadian
healthcare, to integrate frailty
assessment and management
and allow for increase patient-
centred care
 Using this approach can
reduce hospitalization and
is an encouraged
approach across systems
 Recommended by the
BGS and can indicate
frailty

27. Functional
assessment
Outcome measures Description Psychometric properties
Tinetti Balance and Gait
Assessment
The Tinetti is a 17 item
OM used to assess gait
and balance
 70% sensitivity score
(good predictor of
falls risk)
 Excellent test-retest
and intrarater
reliability
Elderly Mobility Scale Assesses mobility in the
frail by completing 20
components
 Good concurrent
validity
 Good discriminant
validity
 Good inter-rater
reliability

28. General relevant
evaluation/assessment
(medical domain)
 Subjective and Objective
assessment of Musculo-skeletal,
Neurological, Cardiopulmonary
systems
 Medication review
 Identifying polypharmacy
 Screening for Adverse Drug
Reactions
 Relating symptoms/clinical findings
to polypharmacy
 Screening for pressure ulcer
 Screening for incontinence

29. General relevant
evaluation/assessment
(medical domain)
Poly pharmacy screening

30. General relevant
evaluation/assessment
(medical domain)
Pressure ulcer risk

31. General relevant
evaluation/assessment
(medical domain
 Incontinence
 Frequency volume chart
 Urogenital Distress inventory
(UDI)

32. General relevant evaluation/assessment
(medical domain)
Incontinence Impact Questionnaire- Short form (IIQ-7)

33. General relevant
evaluation/assessment
(medical domain)
Nutrition screening

34. Mental
Health
Cognitive screening
Folstein MMSE
The Short Portable Mini Mental
Status Questionnaire (SPMMSQ)
The Clock Drawing test

35. Mental Health
Cognitive

36. Mental health
Cognitive

37. Mental health
Clock Drawing test

38. Mental health
Clock
drawing
test

39. Mental health
4AT (4 A’s test for delirium)

40. Mental Health
4AT

41. Mental health
Depression screening

42. Social and
environmental
domains
Social
Social support
questionnaire
27 items designed
to measure
perceptions of
social support
Interpersonal
Support Evaluation
List (ISEL)
40 items scale with
four subscales
Tangible support
Belonging support
Self esteem support
Appraisal support

43. Social and
environmental
domains
Social history
Having the patient describe typical day
Frequency and nature of social contacts
Driving and availability of transportation
facilities
Caregivers and support systems
Ability of family members to help the
patient

44. Environmental
evaluation

45. Environmental evaluation
 HSSAT (Home Safety Self Assessment
Tool)

46. Environmental
evaluation
 Home Hazard checklist

48. THANK YOU