Evidence Supporting Comprehensive Geriatric Assessment (CGA)
Comprehensive Geriatric Assessment (CGA) significantly improves clinical outcomes for older adults by identifying vulnerabilities not captured in routine assessments, reducing hospital admissions, and increasing the likelihood of patients remaining in their own homes. 1
What is Comprehensive Geriatric Assessment?
CGA is a multidimensional, multidisciplinary diagnostic and treatment process that:
- Identifies medical, psychosocial, and functional capabilities of older adults
- Develops a coordinated plan to maximize overall health with aging
- Addresses impairments through appropriate interventions, counseling, and/or referrals
Strong Evidence Supporting CGA
Impact on Mortality and Independence
- CGA increases the likelihood that patients will be alive and in their own homes at 3-12 months follow-up (high-certainty evidence) 2
- Home-based CGA reduces mortality at 36 months and improves functional status at 6-24 months 3
- CGA may decrease the risk of unplanned hospital admissions (low-certainty evidence) 4
Impact on Healthcare Utilization
- CGA reduces early re-hospitalization when linked to proper geriatric interventions 1
- CGA decreases the likelihood of nursing home admission at 3-12 months follow-up (high-certainty evidence) 2
- A CGA-based approach for elderly NSCLC patients leads to better tailored treatment and improved outcomes 1
Essential Domains of CGA
According to the 2023 ASCO guidelines, a comprehensive geriatric assessment should include these high-priority domains 1:
- Physical function
- Cognitive function
- Emotional health
- Comorbid conditions
- Polypharmacy
- Nutrition
- Social support
Settings Where CGA Is Most Effective
The effectiveness of CGA varies by setting:
- Hospital-based CGA shows consistent benefits for health outcomes 5
- Home-based CGA improves functional status and health-related quality of life 3
- CGA in primary care settings shows variable outcome benefits but is widely accepted 6
Specific Applications of CGA
Surgical Setting
- Patients over 65 years should be assessed and co-managed by a physician with expertise in care of older surgical patients as early as possible postoperatively 1
- Preoperative frailty assessment using validated tools is recommended for patients over 60 years 7
Cancer Care
- All patients with cancer age 65 years and over with GA-identified impairments should have GA-guided management included in their care plan 1
- CGA can estimate life expectancy of older cancer patients, which is crucial when planning therapeutic strategy 1
- CGA domains can predict the risk of chemotherapy toxicity 1
Implementation Considerations
Practical Application
- Clinical adaptation of CGA based on patient population, resources, and time is appropriate 1
- Brief, primarily self-administered geriatric assessment tools have been developed for settings with time constraints 1
- Abbreviated screening tools (e.g., VES-13, G8, GFI) can identify patients who require a full CGA, though sensitivity and specificity may be insufficient 1
Common Pitfalls to Avoid
- Underestimating frailty, which is a stronger predictor of surgical complications than age 7
- Failing to link CGA findings to appropriate interventions (CGA is most effective when followed by targeted interventions) 1
- Inadequate attention to implementation barriers, as guidelines typically provide limited guidance on execution 1
Cost-Effectiveness
- CGA may lead to a slight increase in healthcare costs but is potentially cost-effective 2
- CGA-based approaches for frail patients may decrease overall costs of care 1
In conclusion, comprehensive geriatric assessment represents a well-established, evidence-based approach to improving outcomes for older adults across various healthcare settings. The strongest evidence supports its use in hospital and home-based settings, with emerging evidence for its application in primary care and specialized contexts like oncology and surgery.