Comprehensive Geriatric Assesment

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Geriatric conditions such as functional impairment and dementia are common and frequently unrecognized or inadequately addressed in older adults. Identifying geriatric conditions by performing a geriatric assessment can help clinicians manage these conditions and prevent or delay their complications. Although the geriatric assessment is a diagnostic process, the term is often used to include both evaluation and management. Geriatric assessment is sometimes used to refer to evaluation by the individual clinician (usually a primary care clinician or a geriatrician) and at other times is used to refer to a more intensive multidisciplinary program, also known as a comprehensive geriatric assessment (CGA). This topic will review the indications for CGA, as well as its major components and evidence of its efficacy. General issues of geriatric health maintenance and the assessment of specific geriatric populations are discussed elsewhere. (See "Geriatric health maintenance" and "Comprehensive geriatric assessment for patients with cancer" and "Failure to thrive in elderly adults: Evaluation".) BACKGROUND — Comprehensive geriatric assessment (CGA) is defined as a multidisciplinary diagnostic and treatment process that identifies medical, psychosocial, and functional limitations of a frail older person in order to develop a coordinated plan to maximize overall health with aging [1,2]. The health care of an older adult extends beyond the traditional medical management of illness. It requires evaluation of multiple issues including physical, cognitive, affective, social, financial, environmental, and spiritual components that influence an older adult's health. CGA is based on the premise that a systematic evaluation of frail, older persons by a team of health professionals may identify a variety of treatable health problems and lead to better health outcomes. CGA programs are usually initiated through a referral by the primary care clinician or by a clinician caring for a patient in the hospital setting. The content of the assessment varies depending on different settings of care (eg, home, clinic, hospital, nursing home). CGA is not available in all settings, due to issues related to the time required for evaluation, need for coordination of multidisciplinary specialties, and lack of reimbursement for some components (eg, outpatient social work, pharmacy, and nutrition). INDICATIONS FOR REFERRAL — The best evidence for comprehensive geriatric assessment (CGA) is based on identifying appropriate patients (ie, excluding patients who are either too well or are too sick to derive benefit). No criteria have been validated to readily identify patients who are likely to benefit from CGA. Specific criteria used by CGA programs to identify patients include: Age

Medical comorbidities such as heart failure or cancer
Psychosocial disorders such as depression or isolation
Specific geriatric conditions such as dementia, falls, or functional disability Previous or predicted high health care utilization
Consideration of change in living situation (eg, from independent living to assisted living, nursing home, or in-home caregivers) One outpatient approach would be to refer patients for CGA who are found to have problems in multiple areas during geriatric assessment screens. Major illnesses (eg, those requiring hospitalization or increased home resources to manage medical and functional needs) should also prompt referral for CGA, particularly for functional status, fall risk, cognitive problems, and mood disorders. (See "Geriatric health maintenance" and 'Major components' below.) An inpatient approach would be to refer older patients admitted for a specific medical or surgical reason (eg, fractures, failure to thrive, recurrent pneumonia, pressure sores). Another approach would be to have all patients above a certain age (eg, 85 years) receive preliminary screening to determine whether a full multidisciplinary evaluation is needed....
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