Comprehensive Geriatric Assessment

Question 1

What is a comprehensive geriatric assessment?

Answer 1

A comprehensive, multidisciplinary process to determine the medical, psychological, functional, and social/environmental capacity of the elderly patient in order to develop a plan for treatment and follow up

Question 2

Who should get CGA?

Answer 2

Frail elders who are at risk of or are experiencing adverse events

Question 3

What are the geriatric syndrome?

Answer 3

Immobility
Instability
Incontinence
Iatrogenesis
Intellectual decline
Functional decline
Chronic wounds

Question 4

Who usually makes up the team involved in a CGA?

Answer 4

Medical doctor (geriatrician usually)
Nurses
OT
Physiotherapist
Social worker
Primary carer

Question 5

Practically, list the domains that are assessed in a GCA?

Answer 5

Standard Medical Hx
Functional
Social
Cognitive and Psychological

Question 6

Which specific conditions should be assessed in the medical aspect of the GCA?

Answer 6

Incontinence
Osteoporosis
Falls
Nutrition
Vision
Hearing
Polypharmacy

Question 7

What are some tools for assessing functional capacity?

Answer 7

ADLs - personal, domestic, community
Barthel
Timed up and go (TUG)
FIM score

Question 8

What is the Barthel index? Briefly outline its structure

Answer 8

An assessment of ADLs which includes 10 domains

• Bowel
• Bladder
• Toiletting
• Feeding
• Dressing
• Mobility
• Grooming
• Transfer
• Stairs
• Bathing

Question 9

Outline how a timed up and go (TUG) is performed and how it is interpreted

Answer 9

• Patient is seated in a standard arm chair with their mobility aid nearby
• Patient is required to rise from the chair, walk 3m, turn around, and sit down again, at their normal walking pace
• The patient is timed

0-10s normal
11-20s within the normal limit for a frail or disabled patient
21-30 person needs assistance outside and further assessment
30+ patient is prone to falls

Question 10

What is the FIM scale?

Answer 10

Functional independence measure
Tests 18 domains of function, including physical and cognitive
Each domain is given a score of 1-7

Question 11

What tools can be used to assess cognition and psychological status?

Answer 11

MMSE
RUDAS
AMTS
Geriatric depression scale
CLUX

Question 12

What is the geriatric depression scale?

Answer 12

A series of Y/N questions that screen for depression

Question 13

Outline the sequence of the RUDAS? What is it scored out of?

Answer 13

1. Repeat 4 shopping items (tea, cooking oil, eggs, and soap) and remember them
2. Visuospatial orientation: identify 5 body parts (/5)
3. Praxis: fist/palm movements (/2)
4. Draw the cube (/3)
5. Judgement: crossing the road (/4)
6. Recall the 4 objects (/8)
7. Language: name 8 animals (/8)

/30

Question 14

What do you elicit in the social aspect of the CGA?

Answer 14

Living circumstances
Familial/Social Support
Carer issues