What are the key components of a Comprehensive Geriatric Assessment (CGA)?

Key Components of a Comprehensive Geriatric Assessment (CGA)

A Comprehensive Geriatric Assessment (CGA) must include assessment of functional status, comorbidities, polypharmacy, nutritional status, cognitive function, psychological status, socioeconomic issues, and geriatric syndromes to effectively predict mortality risk and guide appropriate interventions in elderly patients. 1

Core Components of CGA

1. Functional Status Assessment

• Activities of Daily Living (ADLs) - Basic functions required to maintain independence at home 1
• Instrumental Activities of Daily Living (IADLs) - Complex skills necessary for maintaining independence in the community 1
• Physical Performance - Including gait speed assessment, which has been associated with survival in older adults 1

2. Medical Assessment

• Comorbidity Evaluation - Systematic assessment of medical conditions that may interfere with treatment 1
• Geriatric Syndromes - Identification of conditions like falls, incontinence, delirium, and pressure ulcers 1
• Polypharmacy Review - Comprehensive medication review to identify inappropriate medications and potential interactions 1

3. Nutritional Status

• Nutritional assessment has been independently associated with cancer treatment changes and survival outcomes 1
• Malnutrition is a significant predictor of mortality and morbidity in elderly patients 1

4. Cognitive Function

• Cognitive assessment is crucial as impairment may affect treatment decisions and compliance 1
• Even patients with good performance status may have undetected cognitive impairment 1

5. Psychological Status

• Assessment of depression, anxiety, and other emotional conditions 1
• Psychological factors significantly impact quality of life and treatment outcomes 1

6. Social Support and Socioeconomic Issues

• Evaluation of social network, caregiver availability, and financial resources 1
• Social support is critical for treatment adherence and post-treatment care 1

Implementation Approaches

Comprehensive vs. Abbreviated Assessment

• Full CGA is time-consuming but provides comprehensive evaluation 1
• Brief geriatric assessment tools have been developed that are largely self-administered and can identify patients who would benefit from a complete CGA 1
• Hurria et al. developed a brief but comprehensive geriatric assessment that can be completed by most older patients without assistance 1

Team-Based Approach

• CGA is optimally performed by a multidisciplinary team with specific gerontological expertise 2
• Key contributors include physicians, family members/caregivers, and social workers 2
• Additional expertise may come from physical therapists, occupational therapists, nurses, speech-language pathologists, dietitians, audiologists, and pharmacists 2

Clinical Impact of CGA

Treatment Decision-Making

• CGA components have been associated with cancer treatment decisions and survival in elderly patients 1
• Studies show that CGA results can change treatment recommendations in 40-50% of patients 1
• In the ELCAPA study, lower ADL scores and malnutrition were independently associated with cancer treatment changes 1

Mortality and Morbidity Prediction

• Women with 3 or more CGA deficits had approximately twice the all-cause and cancer-specific death rates at 5 and 10 years 1
• CGA can help stratify patients into varying risk groups for mortality 1

Practical Framework for Implementation

The Geriatric 5M's framework provides a systematic approach to CGA 2:

1. Mind - Cognitive assessment
2. Mobility - Physical function and fall risk
3. Medications - Medication review and polypharmacy assessment
4. Multicomplexity - Comorbidity evaluation
5. Matters most - Patient priorities and goals of care

Pitfalls and Caveats

• Chronological age alone is not reliable for estimating life expectancy, functional reserve, or treatment risk 1
• Screening tools alone have insufficient sensitivity and specificity for patient selection 1
• CGA should be linked to proper geriatric interventions to be effective in reducing rehospitalization and mortality 1
• Despite its benefits, CGA is not routinely used in clinical practice due to time and resource constraints 1

CGA is a powerful tool that goes beyond assessment to guide a holistic management plan with tangible interventions for elderly patients. When properly implemented, it can significantly improve care quality, reduce hospitalizations, and optimize treatment decisions based on individual patient characteristics rather than chronological age alone.