Comprehensive
geriatric assessment
(CGA)
‫‪Names‬‬
‫‪ -1‬محمود مجدى على الصباغ ( ‪)200789‬‬
‫‪ -2‬محمد أحمد شحاته الهدهد (‪)200669‬‬
‫‪ -3‬محمود محمد طه السرسى (‪)200792‬‬
‫‪ -4‬محمود مدحت أحمد عثمان (‪)200793‬‬
‫‪ -5‬محمود مصطفى محمد دياب (‪)200794‬‬
‫‪ -6‬مصطفى محمد أبوالحسن (‪)200853‬‬
‫‪ -7‬محمود هشام عثمان (‪)200797‬‬
ILOS
• Define comprehensive geriatric assessment
(CGA)
• Describe CGA dimensions
• Appreciate the role of family physician in CGA
Definition
• is a multidimensional, interdisciplinary
diagnostic process to older person's medical
problems, mental wellbeing, functional ability,
and social circumstances.
• Its goal is to create and execute a wellcoordinated and integrated care, recovery,
assistance, and long-term follow-up plan
Rational
• Early detection of risk factors for functional
decline when linked to specific interventions
may help reduce the incidence of functional
disability and dependency for older patients
Benefits of CGA:
• Improves diagnostic accuracy.
• Optimizes medical and rehabilitation treatment
• Enhances health and functional outcomes.
• Informs the development of individualized care plans
• Assists in avoiding the potential complications of
hospitalization.
• Facilitates effective discharge planning.
Dimensions
of CGA:
• Medical assessment.
• Functional assessment
• Psychological assessment
• Socio-Environmental functioning
Medical assessment
• History taking
• Physical examination
• Medication review
• Nutritional status
1-History taking
The following should be considered:
• Sensory deficits: Dentures, eyeglasses, or hearing aids
• Underreporting of symptoms: Older patients may not
• report symptoms that they consider part of normal aging (eg,
dyspnea, hearing or vision deficits, memory problems,
incontinence, gait disturbance, constipation, dizziness, falls
• Functional decline as the only manifestation
• Difficulty recalling
• Fear: Older adults may be reluctant to report symptoms because
they fear hospitalization, which they may associate with dying.
Guidelines regarding history taking
• Remember, the elderly have age related changes
• Keep the place slow
• Introduce yourself at the beginning
• Address each individual with his or her preference
• (adopt effective way of communication)Eye contact, loud
• Ensure that pt. can hear what is said
• Provide glasses if needed
• Speak at eye level, facing the elderly
• Never treat the elderly as a child
• Respect the elderly as an individual
2- Physical
Clinical
examination
involves
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Vital signs
Neurological
(fecal & urinary continence)
Respiratory
Vision
GIT
Hearing
Musculoskeletal
Foot
Oral Health
(MSK)
Skin/Nodes
CVS / Thyroid
• Using Snellen chart and Jaeger card in
examination
• loss of central vision (presbyopia)
:common with age
Visual
Impairment
• loss of car vision (presbyopia) :common
with age
• Loss of peripheral vision : glaucoma,
stroke
• Glare from lights at night : Cataracts
• Eye pain : glaucoma, temporal arteritis.
Hearing
Impairment
• Doing Whisper Test
• using Audioscope :A handheld otoscope
with a built-in audiometer
• Obtain full medication history.
• Review medication use in general and for
3Medication
review
each medication.
• Review full drug list for pharmacological
interactions or common side effects Get
enough history.
• Review each medication.
• List and prioritize.
• Amount of Unintentional Weight Loss in
the Past 6 Months
4nutritional
assessment
• Reduced Food Intake (how long?)
• Hydration
• Swallowing
• BMI
• Use Mini Nutritional Assessment – Short
Form
Def : The capacity to perform tasks that
are required or desirable in everyday life
• Activities of daily living - including basic
Functional
assessment:
activities of daily living (ADLs) e.g.,
bathing, dressing
• Instrumental or intermediate activities of
daily living (IADLs) e.g., shopping,
telephoning, taking medicine.
• Advanced activities of daily living
(AADLs) e.g., being able to partake in
social activities.
Gait and balance Gait observation
• Timed up and go, number of steps to turn 180 degrees
(180 degree turn test),
• Chair stand test.
Psychological assessment
• Cognitive Decline
• Delirium
• Dementia
• Depression
Psychological assessment
1- The Mini-Cog Components
•
3 item recall test: give 3 unrelated words, ask to repeat, divert and
recall after CDT
• Clock Drawing Test (CDT)
Normal (0): all numbers present in correct sequence and position
and hands readably displayed the represented time
its advantages: less time consuming, needs no special equipment,
useful for poorly educated people.
• Abnormal Mini-Cog scoring
• • Recall -0, or
• Recall s2 AND CDT abnormal
• 2-MMSE : mini mental status examination
Subjects told to Draw a large circle
Fill in the numbers on a clock face
Clock
Drawing
Test
Instructions
Set the hands at 8:20
No time limit given
Scoring (subjective):
• 0 (normal)
• 1 (mildly abnormal)
• 2 (moderately abnormal)
• 3 (severely abnormal)
Socioenvironmental assessment
• Housing and environment
• Caregiver
• Financial management