Comprehensive Geriatric Assessment

is a multidimensional and multidisciplinary process, which should include an evaluation of

• physical, medical, psychological, cultural and social.

• Independent process

• in order to arrive at a comprehensive plan for therapy and long-term follow-up.

• In the older patient with chronic, progressive and usually incurable disease, functional
status becomes an increasingly important indicator of quality of life.

• Thus, preventing functional decline has the highest priority and drives the process of
diagnostic and clinical decision-making.

Aims of CGA:

1- to recognize common geriatric disorders.

2- to plan an effective treatment program.

3- to improve overall health and function outcomes.

4- to reduce subsequent illness.

5- to improve quality of life.

Evaluation process of elderly patients is difficult due to the effects of the aging process and
multiple pathologies.

Evaluation process:

1- preparation.

2- expectation.

3- diagnostic initial interview.

1. Preparation
a) Setting: Quiet environment, large room space, doors (with free movement), Tables must
be adjustable, floor must be rough.

b) Tools: general evaluation form for initial evaluation and specific forms for evaluation of
body systems

c) Timing: Avoid immediately after large meals due to reduced blood flow to the brain.

2. Expectation: Older patients cannot tolerate history taking as younger patients, to

3. Diagnostic initial interview

a) Direct questions are key for a successful interview.

b) Therapist should review:

- Past medical history information.

- Current medication, indications.

- Current illnesses and functional impact.

c) Therapist may need to interview caregivers or family to collect all information.

5 Elements of geriatric Assessment:

1. Physical health

a) Musculoskeletal

b) Neurological

c) Cardiopulmonary

d) Circulatory

2. Functional status

3. Psychological (Cognitive & mental health)

4. Social & economic status

1. Physical health

In this process therapist should:

A. Provide subjective and objective data to monitor treatment program.

B. Relate physical findings to function.

C. Subdivide assessment process into several sessions.

1-Careful history:

Medications, habits, past medical history, family history & social history.

2-Physical examination:

A. General observation of Elderly:

• Body build (obesity, posture, nutritional status)

• Patient activity (mobility, balance & transfer)

• Facial expression (Pain, chronic disease)

• Patient orientation (time and place)

• Gait assessment

2. Function assessment:

Function has 4 main components:

1) Physical function: activities of daily living (ADLs) and instrumental activities of daily
living (IADLs), gait assessment

2) Mental function

3) Emotional function

4) Social function
N.B: Function assessment can give a relationship of function outcome to patient
independence.

There are two components of a functional assessment:

1- What can and what does the person actually do?

2- How recently has it changed?

Tools for functional assessment:

1- Barthel Index as a measure of function.

2- The Nottingham Extended Activities of Daily Living Scale.

3- The Timed Up and Go Test (TUGT).

Functional Performance Measures

1) Self-Report Measures:

a. Activities-Specific Balance Confidence Scale

b. Falls Efficacy Scale-International

Single-Test Mobility Measures:

a. Walking (Gait) Speed

b. Sit-to-Stand (Chair Stand) Test

c. Floor Transfer

d. Stair Climb Test

e. Timed Up and Go Test

f. Dual-Task Timed Up and Go

g. Distance Walk Tests

Multiactivity Mobility Measures:

b. Physical Performance Test

c. Modified Physical Performance Test

Sit-to-Stand (Chair Stand) Test (STS)

1. 30-Second STS Test:

• Measures: Number of stands completed in 30 seconds.

• Procedure:

- Sit in a 43 cm chair, arms folded across the chest.

- Stand up fully and sit back down repeatedly for 30 seconds.

- Score: Total number of completed repetitions.

Interpretation:

- 8 or fewer repetitions indicate a risk of mobility disability.

2. 5-Times STS Test (5TSTS):

• Measures: Time taken to complete 5 repetitions.

• Procedure:

- Sit in a 43 cm chair, arms folded across the chest.

- Stand up and sit down 5 times as quickly as possible.

- Score: Time in seconds.

Interpretation:

- ≥13 seconds suggests sarcopenia or prefrailty.

- ≥15 seconds correlates with multiple falls.

Importance of Floor Transfer:

• Emergency Situations

• Predictor of Injury

• Functional Indicator

• Risk Factors

Test Protocol:

1. Timing Options

2. Positioning

3. Nearby Support

4. Recording

Interpretation:

1. Performance Data

2. Clinical Relevance

3. Associated Difficulties

Stair Climb Test (SCT):

Purpose:

• Evaluates the ability to ascend and descend stairs.

• Serves as a measure of lower extremity power.

Psychological assessment:

1-Depression

2- Dementia or brain syndrome

1) Home safety: smoke detectors, carbon monoxide detectors, stairs, and elevators.

2) Home assessment: lighting, toilet, air conditioning, and clear visual clues.

Sarcopenia:

• Progressive and generalized loss of skeletal muscle mass and strength.

Criteria for the diagnosis of sarcopenia:

1. Low muscle mass

2. Low muscle strength

3. Low physical performance

Frailty Phenotype consists of five criteria:

1) Unintentional weight loss

2) Self-reported exhaustion

3) Weakness (poor grip strength)

4) Slow walking speed

5) Low physical activity

Sarcopenia assessment:

• Diagnosed via questionnaire or performance-based measures.

• The SARC-F questionnaire.

• Performance-based measures are preferred for accuracy.