Introduction

Comprehensive Geriatric Assessment (CGA) is a multidimensional, interdisciplinary process designed to evaluate the medical, psychological, and functional capabilities of older adults. The primary goal of CGA is to develop a coordinated and integrated plan for treatment and long-term follow-up. CGA tools help healthcare professionals identify and address a wide range of issues that affect the health and well-being of older adults, ensuring that care is tailored to meet the unique needs of each individual.

Key Components of Comprehensive Geriatric Assessment

1. Medical Assessment

   • Focuses on diagnosing and managing chronic and acute medical conditions.
   • Involves a thorough review of the patient’s medical history, current medications, and existing health issues.
   • Tools used include Charlson Comorbidity Index and Cumulative Illness Rating Scale (CIRS).

2. Functional Assessment

   • Evaluates the patient’s ability to perform activities of daily living (ADLs) and instrumental activities of daily living (IADLs).
   • Tools include Katz Index of Independence in Activities of Daily Living and Lawton-Brody Instrumental Activities of Daily Living Scale.
   • Helps identify needs for assistance with daily tasks and determine the level of independence.

3. Cognitive Assessment

   • Assesses cognitive function to identify conditions such as dementia, delirium, and mild cognitive impairment.
   • Common tools include Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Clock Drawing Test.
   • Early identification of cognitive decline allows for timely intervention and planning.

4. Psychological Assessment

   • Focuses on identifying mental health issues, such as depression, anxiety, and loneliness.
   • Tools include Geriatric Depression Scale (GDS), Hospital Anxiety and Depression Scale (HADS), and Cornell Scale for Depression in Dementia.
   • Psychological well-being is crucial for overall health and quality of life in older adults.

5. Social Assessment

   • Evaluates the patient’s social support network, living conditions, and access to community resources.
   • Tools like the Lubben Social Network Scale (LSNS) assess the size and frequency of social interactions, which are critical for preventing social isolation.
   • Identifies potential risks such as elder abuse or neglect and helps connect patients with necessary social services.

6. Nutritional Assessment

   • Assesses the patient’s nutritional status and risk of malnutrition, which is common in older adults.
   • Tools include Mini Nutritional Assessment (MNA) and Malnutrition Universal Screening Tool (MUST).
   • Nutritional interventions are essential for preventing frailty and improving overall health.

7. Polypharmacy and Medication Management

   • Reviews all medications the patient is taking to identify potential drug interactions, side effects, and adherence issues.
   • Tools like the Beers Criteria and STOPP/START Criteria are used to evaluate the appropriateness of prescribed medications.
   • Reducing polypharmacy and optimizing medication regimens can significantly improve health outcomes.

8. Environmental Assessment

   • Examines the safety of the patient’s home environment, including potential fall hazards and accessibility issues.
   • Tools include the Home Safety Checklist and Falls Risk Assessment Tool (FRAT).
   • Modifying the home environment can prevent injuries and promote independence.

Detailed Overview of Key Assessment Tools

1. Mini-Mental State Examination (MMSE)

   • Purpose: Screens for cognitive impairment.
   • Description: The MMSE is a 30-point questionnaire used extensively in clinical and research settings to measure cognitive function. It assesses areas such as orientation, memory, attention, language, and visuospatial skills.
   • Scoring: Scores range from 0 to 30, with lower scores indicating more severe cognitive impairment. A score of 24 or above generally indicates normal cognition, while a score below 24 suggests cognitive impairment.

2. Geriatric Depression Scale (GDS)

   • Purpose: Screens for depression in older adults.
   • Description: The GDS is a self-report questionnaire designed to identify symptoms of depression in the elderly. The most common version is the 15-item scale, which asks simple yes/no questions related to mood and behavior.
   • Scoring: Scores range from 0 to 15, with higher scores indicating more severe depressive symptoms. A score of 5 or above suggests the presence of depression.

3. Katz Index of Independence in Activities of Daily Living (ADL)

   • Purpose: Assesses the patient’s ability to perform basic activities of daily living.
   • Description: The Katz Index evaluates six functions: bathing, dressing, toileting, transferring, continence, and feeding. Each function is scored based on the level of independence.
   • Scoring: Scores range from 0 to 6, with higher scores indicating greater independence. A score of 6 indicates full function, while a score of 0 indicates severe functional impairment.

4. Lawton-Brody Instrumental Activities of Daily Living (IADL) Scale

   • Purpose: Assesses more complex activities that are necessary for living independently in the community.
   • Description: The IADL scale evaluates abilities such as using the telephone, managing finances, shopping, housekeeping, and medication management.
   • Scoring: Scores range from 0 to 8 for women and 0 to 5 for men, with higher scores indicating greater independence. The difference in scoring reflects gender roles that were prevalent when the scale was developed.

5. Mini Nutritional Assessment (MNA)

   • Purpose: Assesses the nutritional status of older adults.
   • Description: The MNA includes 18 items divided into two parts: a screening section and an assessment section. It evaluates factors such as BMI, weight loss, dietary intake, and mobility.
   • Scoring: Scores range from 0 to 30, with scores above 24 indicating normal nutritional status, 17-23.5 indicating risk of malnutrition, and below 17 indicating malnutrition.

6. Beers Criteria

   • Purpose: Identifies potentially inappropriate medications in older adults.
   • Description: The Beers Criteria is a guideline developed by the American Geriatrics Society to help healthcare providers avoid prescribing medications that may pose more risks than benefits for older adults.
   • Use: The criteria list medications that should be avoided or used with caution in older adults, particularly those with specific health conditions.

Case Studies

1. Case Study 1: Cognitive Assessment in an Older Adult Patient: Mr. J, a 78-year-old man, presents with memory complaints. His family has noticed he often forgets recent conversations and appointments.

   Assessment: Mr. J undergoes the MMSE and scores 22/30, indicating mild cognitive impairment. Further evaluation with the MoCA and neuroimaging is recommended to differentiate between normal aging, mild cognitive impairment, and early dementia.

2. Case Study 2: Functional Assessment in a Frail Older Adult Patient: Mrs. H, an 85-year-old woman, lives alone and has difficulty with daily activities, particularly dressing and bathing.

   Assessment: The Katz Index reveals that Mrs. H has moderate functional impairment, with a score of 3/6. Based on this assessment, home care services are arranged to assist her with ADLs, and a referral to occupational therapy is made to improve her functional abilities.

End of Topic Quiz

1. Which tool is most commonly used to screen for cognitive impairment in older adults?

   • a) Katz Index
   • b) Geriatric Depression Scale
   • c) Mini-Mental State Examination
   • d) Lawton-Brody IADL Scale

   Answer: c) Mini-Mental State Examination

2. The Katz Index of Independence in Activities of Daily Living assesses which of the following?

   • a) Cognitive function
   • b) Basic activities of daily living
   • c) Nutritional status
   • d) Depression

   Answer: b) Basic activities of daily living

3. A score of 5 or higher on the Geriatric Depression Scale suggests what?

   • a) Normal mood
   • b) Mild cognitive impairment
   • c) Depression
   • d) High nutritional status

   Answer: c) Depression

4. Which of the following is a tool used to assess the nutritional status of older adults?

   • a) Lawton-Brody IADL Scale
   • b) Mini Nutritional Assessment
   • c) Beers Criteria
   • d) MoCA

   Answer: b) Mini Nutritional Assessment

5. The Beers Criteria is primarily used to evaluate what?

   • a) Functional status
   • b) Cognitive impairment
   • c) Appropriateness of medications
   • d) Social support networks

   Answer: c) Appropriateness of medications

Curated Online Resources

1. American Geriatrics Society (AGS) – Beers Criteria

   • AGS Website
   • A comprehensive resource for understanding and applying the Beers Criteria in clinical practice.

2. Alzheimer’s Association – Cognitive Assessment Tools

   • Alzheimer’s Association Website
   • Provides guidelines and tools for cognitive assessments, including the MMSE and MoCA.

3. Geriatric Depression Scale (GDS)

   • GDS Website
   • Offers the Geriatric Depression Scale in multiple languages, along with scoring instructions and interpretation.

4. Mini Nutritional Assessment (MNA)

   • MNA Website
   • Provides the MNA tool, scoring guidelines, and additional resources on nutritional assessment in older adults.

Summary

Comprehensive Geriatric Assessment (CGA) is an essential tool in geriatric care, providing a holistic view of an older adult’s health and well-being. The use of various assessment tools, such as the Mini-Mental State Examination for cognitive function, the Katz Index for functional abilities, and the Mini Nutritional Assessment for nutritional status, allows healthcare providers to tailor care plans to meet the specific needs of older adults. Effective use of these tools can significantly improve health outcomes, enhance quality of life, and ensure that older adults receive the care and support they need. By integrating these assessments into routine practice, healthcare providers can better address the complex and multidimensional aspects of aging.