1. Comprehensive geriatric assessment (CGA)
Dr. Rehab F. Gwada

2. Comprehensive geriatric assessment (CGA)
is a multidimensional, interdisciplinary diagnostic process to determine the medical, psychological, and functional capabilities of a frail elderly person in order to develop a coordinated and integrated plan for treatment and long-term follow-up.
to optimize quality of life
frail elderly person = at risk of loss of homeostasis and incident disability

3. Comprehensive geriatric assessment
the hallmarks of CGA are the employment of interdisciplinary teams and the use of any number of standardized instruments to evaluate aspects of patient functioning, impairments, and social supports.
Geriatric assessment is complex and time consuming
It is important to ensure that patient is not exhausted
Sample geriatric screening instruments have been used for simple, quicker and efficient assessment

4. the objectives of CGA Improve diagnostic accuracy.
Optimize medical treatment and health outcomes.
Improve function and quality of life.
Reduce the use of unnecessary formal services.
Improve long-term care management.

5. The team for CGA physicians, Physical therapists
Occupational therapists
Speech therapists
Psychologist
Dentist
Audiologist
nurses
social workers
Dietician
that assess and plan care addressing the multiple needs of older adults.

6. Components of Comprehensive Geriatric Assessment
 medical, psychological, social, and environmental components, as well as functional components (at the level of activities of daily living [ADLs] and instrumental activities of daily living [IADLs]).

7. . Components of Comprehensive Geriatric Assessment
Elements
Medical assessment
History taking
Problem list Co morbid conditions and disease severity Medication review Nutritional status
Physical examination
Assessment of functioning
Basic activities of daily living Instrumental activities of daily living Gait and balance
Psychological assessment
Mental status (cognitive) testing Mood/depression testing
Social assessment
Informal support needs Care resource eligibility/financial assessment
Environmental assessment
Home safety Transportation

8. Rationale
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
Palmer RM, Med Clin North Am, 1999

9. Components of Comprehensive Geriatric Assessment
History taking: include
Subjective &personal history , chief complain, present &previous physical illness, medication, nutritional& family history

10. Guidelines regarding history taking
Remember, the elderly have age related changes
Keep the pace slow
Introduce yourself at the beginning
Address each individual with his or her preference
(adopt effective way of communication)Eye contact , loud voice
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.

11. Components of Comprehensive Geriatric Assessment
Physical examination may include :
Height , weight,
orthostatic hypotension, pulse ,
edema, skin integrity, pallor
ROM, Muscle strength , sensory status, coordination,
vision ,hearing,
oral cavity(no or lose of teeth)

12. Components of Comprehensive Geriatric Assessment
Function status: This is vital component
Information collect from it can be used as baseline to measure the future decline in function & to plane treatment strategy to improve QoL. including
ADLs{including bathing, dressing, toileting, eating, ambulating, and continence}
Instrumental activities of daily living (IADLs) are the more complex tasks people need for independent living. include being able to shop, cook, manage finances, manage transportation, do housework and manage medications.
3. Balance
4. Gait

13. Components of Comprehensive Geriatric Assessment
Mental status:
Because altered cognitive status is one of the more commonly occurring symptoms of disease among older adults, cognitive assessment is an essential skill to be acquired by physiotherapist for the older population.
One screening tool that has been used successfully to screen for the development of changes in cognitive function symptomatic of dementia is the Mini-Cog assessment instrument

14. The Mini-Cog Components Abnormal Mini-Cog scoring
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 ≤2 AND CDT abnormal
What is mini-cog? There are two parts. First part, 3 item recall from MMSE, uncued ,give 3 items and ask to repeat; divert with something for short period of time and asking if he/she remembered the 3 items. The second part is CDT, many ways of scoring but what these authors determined.
Abnl mini-cog ---- if recall is zero or if recall>0, then look at CDT
Borson S. et al Int J Geriatr Psychiatry 2000;15:

15. Clock Drawing Test Instructions
Subjects told to
Draw a large circle
Fill in the numbers on a clock face
Set the hands at 8:20
No time limit given
Scoring (subjective):
0 (normal)
1 (mildly abnormal)
2 (moderately abnormal)
3 (severely abnormal) 12 11 1 2 10 9 3 8 4 5 7 6
Borson S. et al Int J Geriatr Psychiatry 2000;15:

16. Components of Comprehensive Geriatric Assessment
Emotional status:
Depression is the most common psychological problem among elderly
10% of >65 y/o with depressive symptoms
1% with major depressive disorder
Associated with physical decline of community-dwelling adults and hospitalized patients
Geriatric depression scale (GDS) is used to assess depression in elderly.

17. Q
Ture or false: 1- Comprehensive geriatric assessment is a diagnostic process to determine the medical, psychological, functional, social domains. 2- Information collect from emotional status can be used as baseline to measure the future decline in function & to plane treatment strategy 3- Depression Associated with physical decline. 4- Clock Drawing Test composed of 3 item recall test and The Mini-Cog test.

18. Any Q?