Comprehensive Geriatric Assessment Explained

What is a comprehensive geriatric assessment?

It is a structured, multi-part review of an older person's: - Medical conditions and how well they are controlled. - Medicines and their combined effect. - Physical function: walking, balance, daily activities. - Thinking and memory. - Mood and emotional wellbeing. - Nutrition and swallowing. - Senses: vision, hearing. - Continence. - Social situation and carer support. - Home environment and safety. - The person's own goals, values and preferences.

The findings lead to a shared care plan that sets priorities, treatments, referrals, supports and follow-up.

Who can benefit

CGA is most helpful for older adults, often over seventy-five but not defined by age alone, who have: - Several long-term conditions and many medicines; see living with several conditions at once: building one plan. - Frailty: weakness, slowness, weight loss, exhaustion; see frailty in older adults: what it means and what helps. - Falls or fear of falling, dizziness or balance problems; see falls risk assessment at home. - Memory or thinking changes, confusion or delirium; see mild cognitive impairment: what it is and what families can do and delirium in older adults. - Recent hospital admission or a sudden decline. - Unplanned weight loss, poor appetite; see malnutrition in older adults: signs and prevention. - Difficulty with daily tasks such as bathing, dressing or cooking; see activities of daily living explained. - Incontinence; see incontinence in older adults explained. - Low mood, loneliness or caregiver strain. - Questions about whether to have surgery, move home or change care arrangements.

It is not a test that a person can pass or fail, and it does not remove anyone's independence. It is meant to support it.

What happens during the assessment

It may take one long visit or several shorter ones, and may happen in a clinic, hospital ward, day hospital or at home. Components often include:

1. Conversation and history. Your parent's story, what has changed, what troubles them most, what a good day looks like, and their goals. The team also listens to the family's observations.

2. Medicine review. Every medicine, supplement and herbal product is listed and checked: Is each one needed? Are there duplicates, interactions, side effects, or unsafe combinations? Can the list be simplified? Doses may be adjusted or medicines stopped only by the doctor; see polypharmacy and deprescribing: taking fewer, better medicines and medicine side effects families should watch for.

3. Examination and tests. Blood pressure sitting and standing (to detect drops on standing), pulse, weight, a heart, lung and nerve examination, and blood or urine tests as needed; see dizziness when standing: postural hypotension in older adults.

4. Function and mobility. Simple tests such as walking speed, standing up from a chair, balance and grip strength; questions on bathing, dressing, eating, toileting, managing money, medicines, shopping and phone use; see physiotherapist gait assessment and strength after 60: how much is enough.

5. Thinking and memory. Short screening tests of memory, attention and planning, often with a family member's account; tests do not diagnose by themselves and are interpreted with the full picture; see dementia stages and what each needs.

6. Mood. Questions about sleep, interest, worry and hopelessness. If your parent is very low, the team will discuss help; see depression in older adults and anxiety in older adults.

7. Nutrition and swallowing. Weight, appetite, teeth, food choices, and swallowing; see dental health and eating and swallowing problems (dysphagia) in older adults.

8. Vision and hearing. Simple checks and referral for correctable problems such as cataract or wax; see hearing and vision checkup schedule.

9. Continence and bowel. Gentle questions about bladder and bowels; see when to see a doctor about bladder or bowel changes.

10. Feet, skin and pain. Foot problems, pressure areas, pain control; see chronic pain in older adults: a whole-person approach.

11. Social and home assessment. Who lives with the person, who helps, carer strain, money worries, safety, stairs, bathroom, kitchen; see occupational therapy home assessment and home safety for seniors living alone.

12. Goals and preferences. What matters, what the person wants and does not want, and who should help decide if they cannot; see advance care planning in India: wishes, documents and conversations.

How to prepare

• Bring the medicine list and packs, including all supplements and herbal products; see preparing for a doctor's visit with a parent.
• Bring records: recent reports, discharge summaries, vaccination record, and a one-page summary; see keeping a health record at home.
• Write down concerns: falls, memory, mood, weight, sleep, continence, appetite, pain, daily tasks, and how the carer is coping.
• Bring glasses, hearing aids, dentures and walking aids, because the team needs to see how your parent functions normally.
• Come with someone who knows your parent well, to give the history, especially if memory or hearing is poor.
• Prepare your parent: explain that the visit is to help them stay independent and well, not to take decisions away. Reassure and let them express worries.
• Plan for time: the assessment can be tiring; bring water, a snack and rest breaks; see travel with an elderly parent: checklist.
• Bring a list of your own questions; see below.

Questions families can ask

• What are the most important problems, and which can be improved?
• Are all the current medicines necessary, and can anything be simplified? (The doctor decides; do not stop anything yourself.)
• How is my parent's thinking and mood, and what can we do?
• What is the risk of falls, and how do we reduce it?
• What equipment, exercises or home changes would help?
• What supports are available (nurses, therapists, day care, attendants)?
• What should we watch for, and whom do we call?
• How will the plan fit my parent's wishes?
• When should we come back?

After the assessment: the care plan

The team will usually discuss findings and give a written plan. It may include: - Medicine changes or monitoring. - Treatment of specific problems, such as anaemia, thyroid disease, low vitamin levels, low blood pressure, urinary problems or pain. - Referrals: physiotherapy, occupational therapy, speech and language therapy, dietician, eye, ear, dental, memory clinic, counselling. - Exercise and nutrition plan; see exercise at home for seniors: a starter guide and how much protein do older adults need. - Vaccinations; see vaccines for older adults in India: a practical schedule. - Home changes and equipment, and help with daily tasks; see ageing in place: room by room and daily living aids starter guide. - Carer support and respite; see caregiver burnout signs and prevention. - Goals and care preferences recorded. - Follow-up: often at one to three months, and after any hospital stay.

Ask for the plan in writing, ask who is responsible for each item, and keep it with the health file.

Where to find geriatric services in India

Some medical colleges, large private and public hospitals, and specialised centres have geriatric departments or clinics. Some offer home visits or teleconsultations, and some voluntary organisations run senior health camps. Ask your family doctor for a referral, check hospital websites, and ask about cost and the team involved. If a full CGA is not available, a family doctor can still do parts of it: a medicine review, falls check, memory screen, mood screen and home safety review; see managing chronic disease with regular teleconsults and government schemes for senior citizens.

Limits and cautions

• CGA is a method, not a promise of results; benefits depend on acting on the plan.
• Not every older adult needs one; it is most useful when problems are complex.
• Findings should be discussed respectfully with your parent; they decide what they want.
• A short test of memory does not equal a diagnosis of dementia.
• If a recommendation worries you, ask for explanation or a second opinion.

Red flags: do not wait for an assessment

Call 112 for chest pain, severe breathlessness, stroke signs, fainting, a serious fall, sudden severe confusion or heavy bleeding. See a doctor promptly for new confusion, rapid decline, repeated falls, unexplained weight loss, severe low mood or talk of ending life; Tele-MANAS (14416) is India's national mental health helpline (check the current number); see knowing when to call the doctor.

When to ask a professional

Ask your family doctor whether a geriatric assessment would help, or ask directly at a hospital with a geriatric clinic. Ask a pharmacist about medicine reviews and a social worker about services.