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Senior Citizen's Guide to Cleveland

Why a Comprehensive Geriatric Assessment?

Elderly patients often present with numerous medical complaints, sometimes leading to under-diagnosis of some medical conditions and over-treatment of others. Many factors affect their well-being and quality of life, including social, psychological, environmental and physical conditions. Seniors require an individualized, interdisciplinary approach to address these complex factors. A Comprehensive Geriatric Assessment (CGA) team — a nurse, social worker and physician — evaluates an older person’s physical, psychological and cognitive health. The process identifies the effects of acute problems overlying chronic medical illnesses, mood disorders and cognitive deficits taking into account the psychological, emotional, social and environmental factors that may affect the patient’s independence, sense of well-being, and physical and mental health.

Family members, patients and other physicians may refer patients for CGA. Most often it is due to concerns about memory problems. However, geriatric assessments are also beneficial to older patients with multiple medical problems. The patient receives a complete physical assessment, medication review, testing and referrals as indicated. The team will also assess the patient’s home safety and ability to carry out the activities of daily living. A variety of screening tests are used to validate the assessment.

Numerous challenges present when assessing someone for cognitive decline, including subtle early signs and difficulty establishing a time-line of cognitive changes, family dynamics, family members’ respect for patient autonomy and often emotional factors related to a loved one’s loss of function.

The primary goal of a comprehensive geriatric assessment is to improve patient functioning and quality of life by 1) identifying reversible problems (i.e. polypharmacy, vitamin deficiencies, deconditioning); 2) emphasizing ways to improve or maintain health; and 3) establishing a diagnosis, often for memory loss, to help patients and families develop a course of action to slow health decline and make appropriate plans with a strong emphasis on safety and increasing social and physical activity.

During a Summary Conference — the second part of the CGA, which is held about one month after the initial assessment — the interdisciplinary team helps patients and families establish a plan of care by reviewing the initial assessment, establishing diagnoses and providing recommendations. Families and patients receive the opportunity to ask questions regarding diagnosis, prognosis, treatment and care options. The team will provide referrals, as needed, for counseling, legal issues, and financial matters.

Today’s older adults can reasonably expect to remain active and independent longer than past generations. Comprehensive Geriatric Assessment attempts to redirect focus away from debilitation and toward the health, well-being and safety of older individuals.

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