CGA

Question 1

What is a COMPREHENSIVE GERIATRIC ASSESSMENT?

Answer 1

CGA
= multidisciplinary, multidimensional assessment with the aim of of developing a comprehensive Mx/care plan
• for maintenance and improvement of a patient’s medical, functional, cognitive ( incl psychological), social and environmental domains.
• not a “once off” review - involves regular review if circumstances change

NB: good opportunity to discuss ACP
- substitute decision makers
- wishes in the event of deteriorating health & an
inability to communicate

Question 2

What is the PURPOSE/IMPORTANCE of a CGA?

Answer 2

Older people are at increased risk of adverse outcomes especially at times of acute illness and hospitalization
b. Frail older people and those with multiple comorbidities are at particularly high risk
c. These adverse outcomes include prolonged hospital stay, functional decline, need for residential care and death
Numerous studies have confirmed the advantage of CGA compared with standard care

Question 3

TARGET: What population should receive a CGA?

Answer 3

frail elderly who are at risk of or are experiencing adverse events (especially at times of acute illness and hospitalisation).

These adverse outcomes include:
• prolonged hospital stay
• functional decline
• need for residential care
• death

Pts identified by:

1) PRESENTING PROBLEM: multiple issues/co-morbidities or geriatric syndromes
2) PT CHARACTERISTICS: older pt / cognitive impairment / live alone / disabled / frail
3) LOCATION: present to ED or acute hospital ward

Question 4

OUTCOMES of CGA

Answer 4

a. Identification of missed diagnoses
b. ↓ medication use
c. Improved and sustained functional status
d. ↓ healthcare utilization, including hospital admission
e. ↓ residential care admission
f. ↑likelihood of living at home
g. Some have reported reduced mortality

Question 5

WHO should be assessed for a CGA?

Answer 5

NOT ALL OLDER PT WILL BENEFIT FROM CGA!

Target populations include:

- Age >75
- Living alone
- Pre-existing cognitive impairment
- Dependence in at least one personal ADL and 2 community or domestic ADL's
- Multiple health problems
- Reports of not managing well at home
- Carer stress
- Multiple hospital admissions
- Polypharmacy (>4 medications)

Question 6

Who PERFORMS the CGA?

Answer 6

MULTIDISCIPLINARY TEAM: depends on the concerns raised (e.g.: cognition → neuropsychologist vs falls risk → physic/OT )

Usually involves the following disciplines:
    - Medical (usually geriatrician)
           → GP should be involved also
    - Nursing
    - Physiotherapy
    - Occupational Therapy
    - Social work
    - Carer

• Other health professionals that may be involved include:

- Dietetics
- Speech pathology
- Neuropsychology
- Clinical psychology
- Clinical Pharmacist

NB: may be undertaken by a single health professional, but ideally involves multidisciplinary assessments and discussion.

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