CGA Flashcards
What does CGA stand for?
Comprehensive Geriatric Assessment
What is a CGA?
CGA is a process of care comprising a number of
steps. Initially, a multidimensional holistic assessment of an older person considers health
and wellbeing and leads to the formulation of a plan to address issues which are of concern
to the older person (and their family and carers when relevant). Interventions are then
arranged in support of the plan. Progress is reviewed and the original plan reassessed at
appropriate intervals with the interventions reconsidered accordingly.
Why is the role of a CGA?
- CGA is effective in reducing mortality and improving independence in the elderly.
- Reduce hospital admission and can reduce admission in those recently
discharged and can reduce the risk of readmission in those recently discharged. - Identify areas for improvement and support to reduce the impact of frailty.
Who can perform a GCA?
- Any member of the health and social care team.
- In many cases this will be the patient’s GP, a geriatrician working in a community setting
could be involved in, or even lead, CGA. - Often nurses and pharmacists are involved.
When should a GCA be performed?
CGA should be considered appropriate in a number of circumstances, all of which reflect
frailty in an individual:
- When an older person presents to their GP with one or more obvious frailty
syndromes – i.e. falls, confusion, reduced mobility and increasing incontinence even
if these appear to be due to a reversible cause – such as a new medication or minor
infection or if the ambulance service has already been called. - When an older person has been discharged from hospital after presenting with a
frailty syndrome (fall, reduced mobility, delirium etc). - In care homes.
Where does a CGA take place?
Since the process of CGA can be performed anywhere, either in the older person’s home, in the GP surgery or in a special clinic set up for the purpose in a leisure centre, day centre or hospital outpatient department.
What are the 4 parameters of a CGA?
- Physical
- Functional
- Psychological
- Socioeconomic and environmental
What parameters are examined in the physical assessment of the CGA?
- Participation
- Posture
- Assessment of the non-concordant patient (e.g. dementia, delirium or mental illness)
- Gait and balance
- Sensory loss
- Feet and footwear
- Lying and standing BP
- Cognition and mood
- Functional ability (e.g. choice of clothes and hygiene)
- Pain and joints
- Weight and nutrition
- PR and genitalia
- Normal ‘age’ related changes
What parameters are examined in the functional assessment of the CGA?
- Mobility
- Activities of daily living
- Ability to interact with technologies used for
telecare
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How are social and environmental parameters assessed in the CGA?
- GPs are constrained by time and may
not be the best people to collate social and
financial information about a patient. - This can easily be done by the patient themselves, a wellinformed carer, a nurse or health care assistant or indeed a social worker working as part of the multidisciplinary team
What parameters are assessed in the social assessment of the CGA?
- Does the patient live alone?
- What support does the patient have?
- Does the patient get out and about?
- Is the patient a carer?
- Does the patient have any pets?
- Are there any safeguarding issues?
What parameters are assessed in the environment assessment of the CGA?
- What is the nature of the home environment?
- Does the home have stairs?
- Availability of bathroom and toilet facilities
- How is the home accessed?
- Is there a telephone?
- Availability of cooking facilities
- Is there damp?
What parameters are examined in the psychological assessment of the CGA?
- Mood
- Cognition
What are the 6 steps in the medication review of the CGA?
- Obtain full medical history
- Review medication use
- Review full drug list for pharmacological interactions or common side effects
- Obtain sufficient medical history
- Review each medication
- List and prioritise
