Comprehensive Geriatric Assessment (CGA)
What is it?
Comprehensive Geriatric Assessment (CGA) is a process of care comprising a number of steps. Initially, a multidimensional holistic assessment of an older person considers health and wellbeing and leads to the formulation of a plan to address issues which are of concern to the older person (and their family and carers when relevant). Interventions are then arranged in support of the plan. Progress is reviewed and the original plan reassessed at appropriate intervals with the interventions reconsidered accordingly.
Why is it done?
Evidence shows that CGA is effective in reducing mortality and improving independence (still living at home) for older people admitted to hospital as an emergency compared to those receiving usual medical care.
In community settings, the evidence shows that complex interventions in people with frailty can reduce hospital admission and can reduce the risk of readmission in those recently discharged.
CGA is also a vital part of the management strategy for older people suspected of having frailty in order to identify areas for improvement and support to reduce the impact of frailty.
A recent study showed that comprehensive assessment and individualised care planning can reverse the progression of frailty.
- Physical Symptoms
- Mental Health symptoms
- Level of function in daily activity for personal care and life functions
- Social support networks currently available (formal and informal)
- Living environment
- Level of participation and individual concerns/anxieties – what is important to them
- Compensatory mechanisms and resourcefulness the individual uses to respond to having frailty. Outcomes of a CGA
- Formulation of a patient-centred list of needs and issues to tackle including medication review (an action plan)
- Individualised care and support plan
- Recommendation for frequency of review.
Outcome
The outcome of the CGA process is the formulation of a patient-centred list of needs and issues to tackle (an action plan) and an individualised care and support plan and a recommendation for frequency of review.
Gloucestershire CGA template in development
A CGA Template is being developed in Gloucestershire. The Gloucestershire CGA project group reviewed existing Ardens templates and found them lacking in several areas. Having multiple templates led to inconsistencies and duplication of effort across practices.
In response, the Gloucestershire team initiated the development of a new, unified CGA template that would:
- Combine the best elements of the existing templates
- Eliminate duplication (e.g. CGA write-ups being typed twice)
- Support consistent data capture and coding
- Integrate with digital care planning systems
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