COMPREHENSIVE GERIATRIC ASSESSMENT

WHAT IS A COMPREHENSIVE GERIATRIC ASSESSMENT?

• CGA is a complex process used to execute frail or vulnerable older adults.
• The CGA involves efficient evaluation beyond numerous realms, in order to identify treatable health and well-being related problems and improve health outcomes for older adults.

WHY IS COMPREHENSIVE GERIATRIC ASSESSMENT SIGNIFICANT FOR HIGH RISK OLDER ADULTS?

• CGA is the best practice for managing frailty.
• 22 research trials, 10,000 patients, 6 different countries.

PATIENTS WHO RECEIVE CGA ARE:

• More likely to remain living at home
• Less likely to be institutionalized
• Less likely experience deterioration
• More likely to experience improved cognition

Frailty Comorbidity Disability
-Impairments -Two or more -Difficulty
In multiple medical In daily
Systems that conditions. Living.
lead to a deadline.

WHO CAN PREFORM A CGA?

• The CGA can be in admitted by any member of the inter professional team.
• The team cooperates to review any data to create an integrated clinical picture.
• The clinical picture is further refined by physical assessment by a Physician, Nurse Practitioner, COE Physician or Geriatrician.

Screening & Assessment

GERIATRIC REVIEW OF SYSTEMS:

• Polypharmacy
• Cognition
• Falls
• Sleep
• Pain
• Nutrition
• Continence

PRIORITIZE PROBLEMS & FORMULATE

• Balance what Is most important to the patient/caregiver.
• The same problem may be more or less urgent, depending on the individual/situation.
• Utilize your resources.

ASSESSING OLDER ADULTS

• Medical *Mental
• -screening physical exam -cognitive status
• -medication review -emotional status
• -nutrition -spiritual status
• -dentition
• -hearing
• Vision
• Pain
• Urinary incontinence

ASSESSING OLDER ADULTS CONTD.

• Physical Evironment
• -Balance and Gait -social,financial status
• -Falls -environmental hazards
• -Functional status

CARE PREFERENCES

• Life sustaining measures
• Medical-screening physical exam
• Subjective specific to elders
• Family history
• Social history
• Review of systems
• Medicare wellness visits
• Family history
• List of current providers
• A written plan for screenings
• List of risk factors and conditions for which preventive interventions are being applied.

OBJECTIVE SPECIFIC TO ELDERS

• Orthostatic BP
• Visual and hearing
• Musculoskeletal
• Neurological

MEDICAL MEDICATION REVIEW

• De-prescribing
• -Look for and recognize opportunities to stops medication
• Do annual medication review
• Review all existing medications before starting another
• Harm outweighs benefit
• Minimal or limited effectiveness
• No documentation indication
• Not being taken or being taken inappropriately

MEDICAL-NUTRITION & DENTAL NUTRITION

• Inquire about recent weight loss
• Notice BMI
• When relevant, 24 hour recall
• Malnutrition assessment
• Dietician
• Ability to plan and prepare meals
• Depression screen

MEDICAL-NUTRITION & DENTAL NUTRITION CONTD.

• Dental
• -tooth decay or loss
• -poorly fitting dentures
• When relevant, dental referral

MEDICAL-HEARING AND VISION

• Whisper test
• Self-report hearing loss
• Weber and Rinne
• Ear exam
• When appropriate, ENT, audiologist

MEDICAL-HEARING & VISION CONTD.

• Self report vision change
• Eye exam
• Shellen chart
• Ophthalmology referral

MEDICAL-PAIN & URINARY INCONTINENCE

• Inquire about pain
• When appropriate:
• -pain inventory
• -coping patterns
• -falls

MEDICAL-PAIN & URINARY INCONTINENCE CONTD.

• Changes In bladder habits
• Inquire of lost urine>5 times in past year
• When appropriate:
• -prostate exam
• -vaginal exam
• -formal UI evaluation

MENTAL-COGNITIVE, EMOTIONAL & SPIRITUAL

• Cognitive status
• -self report of memory deficit
• -Mini-cognitive
• When appropriate:
• -MMSE
• -dementia evaluation
• -delirium evaluation
• -depression screen

MENTAL-COGNITIVE, EMOTIONAL & SPIRITUAL CONTD.

• Emotional
• -spiritual-recent change
• When appropriate:
• -In depth interview
• -Spiritual advisor
• -chaplain
• -Depression
• PHQ-2
• Geriatric presentation screen
• PHQ-9

PHYSICAL FUNCTIONAL, GAIT, FALLS

• Functional Gate and Balance
• Self Report of ADL and IADL
• When appropriate:
• -formal evaluation
• -referral to PT/OT
• -get up and go
• Gait speed
• Orthostatic BP

PHYSICAL FUNCTIONAL, GAIT, FALLS

• History of falls or trips
• When appropriate:
• - fall work-up
• PT evaluation

ENVIRONMENTAL & CARE PREFERENCES

• Social/Functional/Evironmental
• -inquire about living situation
• -assess risk factors for elder abuse
• -home safety checklist
• Care preferences
• -inquire about end life wishes/plans
• -legal documents

BIBLIOGRAPHY

• https://academic.oup.com/ageing/article/45/6/894/2499240
• https://www.americangeriatrics.org/geriatrics-profession/about-geriatrics
• https://www.healthinaging.org/a-z-topic/geriatrics