Comprehensive Geriatric Assessment Sumit. CHOpptx.pptx

1
Comprehensive
Geriatric
Assessment

Learning Objectives
 Understand about Comprehensive geriatric
assessment (CGA).
 Role of CHO and Staff Nurse in CGA.
 Components/Domains that come under
Comprehensive Assessment of Elderly.
[Refer to MODULE Staff Nurse pg- 21- 31
CHO pg 21-29 ]
Also refer to annexures of this modules
June 4, 2025
2

Comprehensive geriatric assessment (CGA)
 CGA is a multi-disciplinary process where the
information captured is used as a basis to plan care
and treatment.
 It includes short term and long-term goals, follow up
and rehabilitative services.
June 4, 2025
3

June 4, 2025
4
Comprehensive
Health care for
elderly
Cardiovascular
Risk
Assessment
Nutritional
Assessment
Mental Health
Assessment
Non
Communicable
disease
management
Oral
assessment
Ophthalmic
Assessment

Role of ASHA
 Completion of Community based assessment
checklist (CBAC) for all the elderly for each village in
the SHC-HWC area will be done by the ASHA.
 The section B3 is specific to the elderly.
June 4, 2025
5

Section B3of CBAC
June 4, 2025
6
B3: Elderly Specific
(60 years and above)
Y/N Y/N
Do you feel unsteady
while standing or
walking?
Do you need help from others to
perform everyday activities such as
eating, getting dressed, grooming,
bathing, walking, or using the toilet?
Are you suffering
from any physical
disability that restricts
your movement?
Do you forget names of your near ones
or your own home address?

Flow of Events
June 4, 2025
7
ASHA- identify any elderly in need of comprehensive
assessment if the answer to any of the questions in Part B3 of
the CBAC is ‘Yes’.
MPW (M/F)- preliminary assessments of these identified elderly
individuals
CHO- comprehensive geriatric assessment .
If required- refer elderly individuals who need specialized
management to the Medical Officer or Specialist

Comprehensive Assessment of Elderly
1. Socio-demographic assessment-
 Information about socio-demographic and socio-
economic details of the person.
Why do CHO/ Staff Nurse have to know about socio-
demographic information/ socio-economic status ?
June 4, 2025
8

Comprehensive Geriatric Assessment Tool
June 4, 2025
9
1. Name: ________________
2. Age (In Completed Years): ________________
3. Sex:
1. Male 2. Female 3. Others
4. Marital Status:
1. Never
Married
2. Currently
Married
3. Divorced 4. Separated 5. Widowed

June 4, 2025
10
5. Who is Head of the family?
1. Myself 2. Wife 3. Son 4.Daughter
in law
5. Others
6. Education:
1.
Illiterate
2. Just
literate
(knows
to read
and write
but nil
educatio
n
3.
Primary
school
(5th
complete
d
4. Middle
school
(8th
complete
d)
5. High
school(1
0th
complete
d
6. Senior
seconda
ry (12th
complete
d
7.
Graduat
e
8. Post-
graduate

June 4, 2025
11
7. Occupation:
1. Not working;
2. Working (Specify) ____
8. Religion:
1. Hindu 2. Muslim 3. Christian 4. Sikh 5. Others
(Specify)__
9. What kind of locality is your house in?
1. Urban (Specify) ______
2. Rural (Specify) ______

June 4, 2025
12
10. Type of Family:
1. Single
2. Nuclear
3. Joint
4. Elderly homes
11. Total Family income per month? /Rs. ____
1. Total number of family members? ________
2. Per capita Income per month: Rs________

June 4, 2025
13
3. Socio-economic status:
(according to B.G. Prasad scale) _
Per Capita monthly income (2020)
1.Upper (Rs 7533 and above)
2.Upper Middle (3766- 7532)
3.Lower Middle (2260-3765)
4.Upper Lower (1130- 2259)
5.Lower (1129 and below)

June 4, 2025
14
12. Comorbidity Profile:
Disease Duration of
Disease
(Months)
Receiving
Treatment?
1.Yes/ 2.No
If Yes, Since
When?
(Months)
If No ,
Reasons
Diabetes
Mellitus
Hypertension
Others
(specify)

June 4, 2025
15
13. Smoking:
1. Smoker (All current smokers and those who quit
smoking less than 1 year before the assessment)
2. Non smoker
14. Have you ever consumed alcohol in any form ?
1. Yes
2. No
3. Occasionally
14.A. If yes -Duration (in years):

June 4, 2025
16
15. Diet preference:
1. Vegetarian
2. Mixed Diet
3. Egg vegetarian
16. Intravenous Drug Use?
1. Yes
2. No
17. Present Complaints of:
_________________________________________
18. History of Presenting Illness:
_________________________________________

June 4, 2025
17
19. Examinations:
A) GENERAL PHYSICAL EXAMINATION:
Oral Examination:
Ophthalmic Examination:
Ear Examination:
Musculoskeletal Examination:
Other Systems (If Required):
B) INVESTIGATIONS:
1. Hemoglobin
2. Serum cholesterol
3. Blood Sugar:
4. Blood Pressure

June 4, 2025
18
2. Physical health assessment-
a. Oral health assessment
b. Assessment of eyes and ears
c. Assessment of cardiovascular disease
risk
d. Assessment of musculoskeletal system

Comprehensive Assessment of Elderly...
a. Oral health assessment:
 Screen- common oral cancers and precancerous lesions
(oral ulceration, red or white patches).
 Ask for denture use- cause oral ulcers.
 Look for dental caries (blackish discoloration of teeth), tooth
and gum lesions- refer to Dental specialist in HWC-PHC
(inform CHO).
 Assess- substance use like Tobacco (smokeless and
smoking), alcohol and other medication abuses- counselling.
June 4, 2025
19

b. Assessment of eyes and ears:
 Age-related diseases of eyes and ears like cataract,
presbyopia and hearing loss.
 Screen for difficulty in vision and hearing and examination of
eyes and ears should be done.
June 4, 2025
20

Role of ASHA for addressing Loss of Hearing and Vision:
1. Fill out the assessment of difficulty in hearing/ seeing/ reading
in the Community Based Assessment Checklist.
2. Empathise with the elderly and assure them about sensory
losses being normal during ageing.
3. Mobilise the elderly and family members to visit the nearby
health and wellness centre for getting checked from CHO and
further provision of any assistive device if needed.
June 4, 2025
21

c. Assessment of cardiovascular disease risk:
 Higher risk of heart diseases- if not treated early- can
develop serious consequences like heart failure and heart
attacks.
 Cardiovascular risk is predicted by the CHO/MO using
WHO/ISH chart.
 High risk of CVD risk prediction- referred to Medical officer at
HWC-PHC by the CHO.
June 4, 2025
22

 At the Community level, you can screen elderly individuals for
certain symptoms and signs which are suggestive of
cardiovascular disease.
You will ask for:
 Breathlessness on lying down
 Breathlessness which makes the person wake up at night
 Dizziness on suddenly standing up
 Any episode of syncope (fainting) in last 3 months
 Chest pain
 Palpitation (the person can feel his/her own heart beating fast
or pounding)
June 4, 2025
23

You will look for:
 Swelling of feet/hands
 Fast breathing at rest (>20 breaths in a minute)
You will measure:
 BP
 Pulse rate
 Non-Communicable disease management: managed
under supervision of Medical Officer at PHC.
June 4, 2025
24

June 4, 2025
25
Cardiovascular
WHO/ ISH Charts
 The tool predicts risk by including domains of
 age more than 40 years,
 Sex,
 Systolic Blood pressure,
 Smoking status,
 Status of Diabetic Mellitus and
 Blood cholesterol levels.

June 4, 2025
26
Cardiovascular
WHO/ ISH Charts - Interpretation
 The patients under high risk of CVD risk prediction
should be referred to Medical officer at HWC-PHC and
 Patient is followed up for cardiovascular investigations
and treatment status. pressure, blood cholesterol and
blood sugar.
 The risk prediction charts are a simple way of
calculating the approximate combined risk due to all
these risk factors. It is expressed as a 10-year risk of
developing a heart attack or stroke.

June 4, 2025
27
 Using these new risk prediction charts, an individual can be classified in a
category of
 high risk (maroon and red),
 medium risk (orange and yellow),
 or low risk (green) for heart attack or stroke in the following ten years.
 If an individual has high cardiovascular risk, the guidelines recommend
more intensive treatment, often including drugs -- this is because the
individual's risk has to be lowered urgently to prevent a heart attack or
stroke.
 On the other hand, if the risk is low, the interventions may be more
conservative ones like counselling for change in behavior e.g. smoking
cessation or increased physical activity

June 4, 2025
28
 WHO/ISH have devised two sets of risk prediction charts—
with and without blood cholesterol.
 The former requires data on sex (male/female),
 age (measured in single years),
 systolic blood pressure (in mmHg),
 total serum cholesterol (in mmol/l),
 current smoking status (yes/no) and
 diabetes status (yes/no)
 For individuals with missing cholesterol data we used the
no-cholesterol charts

CARDIOVASCULAR RISK ASSESSMENT:
(WHO/ISH)- Risk level
<10% 2. 10-19% 3. 20-29% 4. 30-39% 5. ≥40%
June 4, 2025
29

June 4, 2025
30

June 4, 2025
31

June 4, 2025
32

June 4, 2025
33
How to implement the tool:
 Charts are useful for stratifying risk for people with blood pressure
<160/100 mm Hg or blood cholesterol < 8 mmol/l or
uncomplicated diabetes.

 For example, by using the charts, person X and person Y, who have
similar blood pressures and blood cholesterol levels, can be
correctly assessed for their risk of developing a heart attack or a
stroke as follows:

June 4, 2025
34
Person Y needs intensive lifestyle interventions and drug treatment to
prevent a heart attack or stroke.
Person X needs lifestyle interventions and may need drug treatment if
risk persists at follow up.

3. Mental Health Assessment:
a. Assessment of depression-
 Depression is assessed by ‘’Geriatric Depression Scale (GDS)-
15 item”.
 The patients will be categorized into Normal, mild, moderate or
severe depressives based on the scores obtained.
 Elder Abuse- suspected with the standard questionnaire “EASI-
Elder Abuse Suspicion Index”.
June 4, 2025
35

June 4, 2025
37
Interpretation of GDS
 Of the 15 items, 10 indicated the presence of depression when
answered positively, while
 the rest (question numbers 1, 5, 7, 11, 13) indicated depression
when answered negatively.
 Scores of 0-4 are considered normal,
 depending on age, education, and complaints;
 5-8 indicate mild depression;
 9-11 indicate moderate depression; and 12-15 indicate severe
depression.

b. Cognitive assessment-
 Cognitive function may decline as a result of certain risk factors
(e.g. hypertension, elevated cholesterol, cardiac arrhythmias).
 Adversely impact the physical functioning and quality of life of
older adults.
June 4, 2025
38

Role of ASHA in addressing Depression, Anxiety and
memory problems in elderly:
1. Forming elderly support groups where elderly would get to
interact with their peers.
2. Conducting wellness activities for the support groups or
encouraging them for conducting wellness activities
themselves.
3. Communicating with the elderly about how they feel and how
they have been for the past few days during the home visits.
4. Completing the individual assessment (Part D: PHQ2). *If the
total score is more than 3, CHO should be informed.
June 4, 2025
39

4. Nutritional Assessment:
 Assessed using Mini Nutritional Assessment Scale (MNA)
 Based on food intake, weight loss, mobility, neurological
problems, stress, Body Mass Index (BMI) and calf
circumference.
 Blood Haemoglobin is also checked in addition to this scale to
correlate with the Nutritional status.
June 4, 2025
40

NUTRITIONAL ASSESSMENT:
(MINI NUTRITIONAL ASSESSMENT SCALE)
June 4, 2025
41
A. Has food intake declined over the past 3 months
due to loss of appetite, digestive problems, chewing
or swallowing difficulties?
 0 = severe decrease in food intake
 1 = moderate decrease in food intake
 2 = no decrease in food intake

June 4, 2025
42
B. Weight loss during the last 3 months
 0 = weight loss greater than 3kg (6.6lbs)
 1 = does not know
 2 = weight loss between 1 and 3kg (2.2 and 6.6 lbs)
 3 = no weight loss

June 4, 2025
43
C. Mobility
 0 = bed or chair bound
 1 = able to get out of bed / chair but does not go out
 2 = goes out
D. Has suffered psychological stress or acute disease
in the past 3 months? 0 = yes 2 = no

June 4, 2025
44
E. Neuropsychological problems
0 = severe dementia or depression
1 = mild dementia
2 = no psychological problems

June 4, 2025
45
F1. Body Mass Index (BMI) = weight in kg / (height in m)2
 0 = BMI less than 19
 1 = BMI 19 to less than 21
 2 = BMI 21 to less than 23
 3 = BMI 23 or greater
 IF BMI IS NOT AVAILABLE, REPLACE QUESTION F1 WITH
QUESTION F2.
 DO NOT ANSWER QUESTION F2 IF QUESTION F1 IS
ALREADY COMPLETED.

June 4, 2025
46
F2. Calf circumference (CC) in cm
 0 = CC less than 31,
 3 = CC 31 or greater
Note:
 Malnutrition Indicator Score - 12-14 points: Normal
nutritional status;
 8-11 points: At risk of malnutrition;
 0-7 points: Malnourished

Role of ASHA in addressing Nutrition in elderly:
1. Notify the CHO if malnutrition is suspected in elderly individual.
2. Utilize patient support groups for discussing nutritional
provisions for the elderly. Exchange of recipes of local foods
suitable for elderly can be facilitated on these groups.
3. Suggest the family and caregivers about soft, chewable foods
for the elderly.
4. Talking to the elderly about lack of appetite being normal,
listening to them compassionately about changed food habits.
June 4, 2025
47

June 4, 2025
48
 What is role of CHO/ Staff nurse?

Video –WHO
Integrated Care
https://youtu.be/q2SdjlFQn3I

June 4, 2025
50
Group Work
 Participants are divided in five groups
 Each group is allocated one case study
 They discuss role of HWC team (including
CHO, staff nurse, ANM, ASHA) based on
identified problem areas in case/ family
 Discuss possible assessments- CGA
 Time allocated is five minutes for discussion
 One participant per group discuss the group
activity

June 4, 2025
51
Case Scenario 1
 Mr. Radhey sham , 70 year old, assessed at a point of
care by a CHO at HWC. He is non smoker, weighs 49
kg and is 162.5 cm tall. He was put earlier on oral
hypoglycaemics, but is non adherent to medicines.
 He had two consecutive 5minute BP readings 137/87
mm Hg and 138/84 mm Hg.
 He went earlier to DH for his blood investigations- RBS –
250 mg/dl, Total CHL- 221 mg/ dl, LDL- 204 mg/dl, HDL-
30 mg/dl, TGL- 208 mg/dl
 Serum Creatinine- 2.2 mg/dl
 Hb 9.8 mg/dl
 Discuss care plan and role of CHO in this case. Do
appropriate risk assessment in this case.

June 4, 2025
52
Case Scenario 2
 Mrs. Savithri, 68 years had a major abdomen surgery four months
back in view of a cancer in gall bladder. She was very active
before that but after surgery, prefers to be in bed. She can get up
out of her bed but remains confined to her room. She worries that
she will not be able to recover and lacks will to do any work. She
stays with her son’s family and maintain good relationships. They
are concerned about her.
 She has reduced appetite and has been reducing weight more
than 3 kgs in last three months. On oral examination she has teeth,
though had carries in few teeth and has poor oral hygiene.
 On examination- her weight was 40 kg, height 150 cm, Pulse 85/
min, afebrile, BP 98/62 mm of Hg, GDS score – 7
 As a CHO/ Staff nurse, do a nutritional assessment, and
comprehensively assess the situation, based on scenario
presented.

Case Scenario 3
 An 85 year retired old school teacher Mr. Ganesh, presented
with complaints of pain in his right knee since 8 years. He said
that 2 years back while he was visiting a temple with his family
he suddenly lost consciousness and had to be taken to an
emergency room at district hospital. After evaluation ,he was
told , to have no major problem and was sent home. He said
that he hasn’t gone out of his house for the past 2 years, as he
felt dizzy and felt he might fall and lose consciousness again.
He is a smoker, diabetic and on oral hypoglycaemics.
 He said his wife expired , 1 year back and he said he was
waiting for his time to come. His children were well settled. He
was living with his eldest son and their family.
 His BP was 124/88 mm of Hg.
 Discuss role of HWC team in this case

June 4, 2025
54
Case Scenario 4
 On a visit to houses in the village, MPW (F) Susheela
talked to Mrs. Shakuntala, 73 year old woman having
hypertension and hypothyroidism . She was taking
medicines, but was found to be worried.
 Her husband Mr. Suresh, was chronically ill with cancer
and had difficulty in walking. He used to fall frequently ,
and while taking care of him, Mr. Suresh fell down on
her.
 Her right ankle and foot was paining too much. There
was swelling also and Mrs. Shakuntala had difficulty in
walking. Nobody else lived with them.
 Discuss the role of HWC team in this case

June 4, 2025
55
Case Scenario 5
 Sohan lives in Nawabganj village with his wife Parwati, his only son Ramu and
Ramu’s wife Radha. He is 72 years of age and in good health. He runs a local shop
and quite popular in his village. He was living happily with his family but then
suddenly he lost his wife in an accident. After that his life has changed a lot, now
he has no interest in life. Though the behaviour of his son and daughter in law
towards him is good but still he feels lonely and prefers staying home. He has also
lost interest in many activities which he used to enjoy earlier. At times he feels
emptiness in his life and gets bored.
 Ramu thinks his father is sad due to his mother's death and things will be better
after sometime. Meanwhile ASHA informs you about Sohan, You visit his home
and assess Sohan for depression .
 Discuss role of HWC team in this case. Apply GDS and comment on whether
depression exists or not

Comprehensive Geriatric Assessment Sumit. CHOpptx.pptx

More Related Content

Similar to Comprehensive Geriatric Assessment Sumit. CHOpptx.pptx

Recently uploaded

Comprehensive Geriatric Assessment Sumit. CHOpptx.pptx