Comprehensive Geriatric Assessment

Darryl Wieland, PhD, MPH; Victor Hirth, MD, MHA

Disclosures

Cancer Control. 2003;10(6) 

In This Article

Definition and Role of Comprehensive Geriatric Assessment

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 coordinated and integrated plan for treatment and long-term follow-up.[1,2,3] While integrating standard medical diagnostic evaluation, CGA emphasizes quality of life and functional status, prognosis, and outcome that entails a workup of more depth and breadth. Thus, the hallmarks of CGA are the employment of interdisciplinary teams[4] and the use of any number of standardized instruments to evaluate aspects of patient functioning, impairments, and social supports.[5,6]

A CGA in some configuration has been performed in many different institutional and community settings. In its most extensive forms, it underpins care in hospital geriatric units and can play a key role in community-based services such as the Chronic Care Model for ill and impaired adults[7] and the Program of All-Inclusive Care for the Elderly for the frail and disabled.[8] It can also be performed as an adjunct to standard medical evaluations in primary care settings. A multidimensional geriatric assessment -- an abbreviated form of CGA but one that also covers medical, functional, psychological, and social domains -- is performed in screening by community health professionals and primary care providers who can use the results to refer patients to geriatric specialty programs for more comprehensive evaluation and management. In the clinical context, CGA is used to identify the functional problems and disabilities of older patients with the aim of providing care and arranging longer-term follow-up.

The focus of the more extensive forms of CGA is the elderly who are frail (ie, at risk of loss of homeostasis and incident disability) or disabled or both. Frailty is a clinically recognized syndrome that is common in older adults.[9] Using recently developed criteria, the prevalence of marked frailty is less than 10% in community-dwelling adults 65 years and older,[10] with high risk of mortality over 3 and 7 years. While the prevalence of disability appears to be declining somewhat,[11] approximately 1 in 5 older Americans lives with some established disability.[12,13] Given increases in the older population, particularly in the oldest old, the number of frail and disabled Americans has likely increased in the past decade and will continue to grow.[11,14]

From the inception of geriatric medicine, it was recognized that frail and disabled older adults were those at highest risk for adverse outcomes and were also most likely to benefit from geriatric care. Much subsequent health services and clinical research has sought to define the healthcare delivery modalities as well as specific interventions that would mitigate or even prevent frailty and its outcomes. The CGA has been central to the approach and has the objectives of improving diagnostic accuracy, optimizing medical treatment and health outcomes, improving function and quality of life, extending community tenure, reducing use of unnecessary formal services, and instituting or improving long-term care management.[1]

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