Comprehensive geriatric assessment is a multidimensional process designed to assess the functional ability, health (physical, cognitive, and mental), and socioenvironmental situation of older adults.
The comprehensive geriatric assessment specifically and thoroughly evaluates functional and cognitive abilities, social support, financial status, and environmental factors, as well as physical and mental health. Ideally, a regular examination of older patients incorporates many aspects of the comprehensive geriatric assessment, making the 2 approaches very similar. Assessment results are coupled with sustained, individually tailored interventions (eg, rehabilitation, education, counseling, supportive services).
The cost of geriatric assessment limits its use. Thus, this assessment may be used best mainly in high-risk older patients, such as the frail or chronically ill (eg, identified via mailed health questionnaires or interviews in the home or meeting places). Family members may also request a referral for geriatric assessment. However, in the United States, the Annual Wellness Examination is offered as a covered benefit under Medicare and includes the main components of a comprehensive geriatric assessment and provides a detailed health risk assessment and personalized prevention plan.
Assessment can have the following benefits:
Increased identification of conditions
Improved functional and mental status (1)
Decreased use of nursing homes and acute care hospitals (2)
Greater satisfaction with care
If older patients are relatively healthy, a standard medical evaluation may be appropriate.
Comprehensive geriatric assessment is most successful when done by a geriatric interdisciplinary team (typically, a geriatrician, nurse, social worker, and pharmacist). Usually, assessments are done in an outpatient setting. However, patients with physical or mental impairments and chronically ill patients may require inpatient assessment.
A Geriatric Assessment Instrument
Domain (1) | Item |
|---|---|
Degree of difficulty eating, dressing, bathing, transferring between bed and chair, using the toilet, and controlling bladder and bowel Degree of difficulty preparing meals, doing housework, taking medications, going on errands (eg, shopping), managing finances, and using the telephone | |
Assistive devices | Use of personal devices (eg, cane, walker, wheelchair, oxygen) Use of environmental devices (eg, grab bars, shower bench, hospital bed) |
Caregivers | Use of paid caregivers (eg, nurses, aides) Use of unpaid caregivers (eg, family members, friends, volunteers) |
Medications | Name of prescription medications used Name of nonprescription medications used |
Nutrition | Height, weight Stability of weight (eg, "Has the patient lost 4.54 kg [10 lb] in the past 6 months without trying?") |
Preventive measures | Regularity of blood pressure measurements, guaiac test for occult blood in stool, sigmoidoscopy or colonoscopy, immunizations (influenza, pneumococcal, tetanus), thyroid-stimulating hormone assessment, and dental care Regularity of exercise Use of smoke detectors |
Cognition | Ability to remember 3 objects after 1 minute and draw a clock face (Mini-Cog©) |
Affect | Feelings of sadness, depression, or hopelessness Lack of interest or pleasure in doing things |
Advance directives | Possession of a living will Establishment of durable power of attorney for health care |
Substance abuse/misuse | |
Gait and balance | Number of falls in the past 6 months Time required to rise from a chair, walk 3.05 meters (10 feet), turn around, return, and sit down Extent of maximal forward reach while standing |
Sensory function | Ability to report 3 numbers whispered 0.61 meters (2 feet) behind the head Ability to read Snellen chart at 20/40 or better (with corrective lenses, if needed) |
Upper extremity mobility | Ability to clasp hands behind the head and back |
General references
1. Huss A, Stuck AE, Rubenstein LZ, et al: Multidimensional preventive home visit programs for community-dwelling older adults: A systematic review and meta-analysis of randomized controlled trials. J Gerontol A Biol Sci Med Sci 63 (3):298–307, 2008. doi: 10.1093/gerona/63.3.298
2. Ellis G, Gardner M, Tsiachristas A, et al: Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane Database Syst Rev 9 (9):CD006211, 2017. doi: 10.1002/14651858.CD006211.pub3
Assessment Domains
The principal domains assessed are
Functional ability: Ability to do activities of daily living (ADLs) and instrumental ADLs (IADLs) are assessed. ADLs include eating, dressing, bathing, transferring between the bed and a chair, using the toilet, and controlling bladder and bowel. IADLs enable people to live independently and include preparing meals, doing housework, taking medications, going on errands, managing finances, and using a telephone.
Physical health: History and physical examination should include problems common among older adults (eg, problems with vision, hearing, continence, gait, and balance).
Cognition and mental health: Several validated screening tests for cognitive dysfunction (eg, mental status examination) and for depression (eg, Geriatric Depression Scale, Hamilton Depression Scale) can be used.
Socioenvironmental situation: The patient’s social interaction network, available social support resources, special needs, and the safety and convenience of the patient’s environment are determined, often by a nurse or social worker. Such factors influence the treatment approach used. A checklist can be used to assess home safety.
Standardized instruments make evaluation of these domains more reliable and efficient (see table A Geriatric Assessment Instrument). They also facilitate communication of clinical information among health care professionals and monitoring of changes in the patient’s condition over time.
Geriatric Depression Scale (Short Form)
Question | Response | |
|---|---|---|
1. Are you basically satisfied with your life? | Yes | No |
2. Have you dropped many of your activities and interests? | Yes | No |
3. Do you feel that life is empty? | Yes | No |
4. Do you often get bored? | Yes | No |
5. Are you in good spirits most of the time? | Yes | No |
6. Are you afraid that something bad is going to happen to you? | Yes | No |
7. Do you feel happy most of the time? | Yes | No |
8. Do you often feel helpless? | Yes | No |
9. Do you prefer to stay at home rather than go out and do new things? | Yes | No |
10. Do you feel you have more problems with memory than most? | Yes | No |
11. Do you think it is wonderful to be alive now? | Yes | No |
12. Do you feel pretty worthless the way you are now? | Yes | No |
13. Do you feel full of energy? | Yes | No |
14. Do you feel that your situation is hopeless? | Yes | No |
15. Do you think that most people are better off than you are? | Yes | No |
Score: One point for “No” to questions 1, 5, 7, 11, 13. One point for “Yes” to other questions.
> 5 points suggests depression and warrants a follow-up evaluation. ≥ 10 points almost always indicates depression. | ||
Adapted from Sheikh JI, Yesavage JA: Geriatric depression scale (GDS): Recent evidence and development of a shorter version. In Clinical Gerontology: A Guide to Assessment and Intervention, edited by TL Brink. Binghamton, NY, Haworth Press, 1986, pp. 165–173. © by The Haworth Press, Inc. All rights reserved. Reprinted with permission. | ||
More Information
The following English-language resource may be useful. Please note that THE MANUAL is not responsible for the content of this resource.
Medicare: Annual Wellness Examination (AWE): This US resource includes the main components of a comprehensive geriatric assessment and provides a detailed health risk assessment and personalized prevention plan.
