Comprehensive Geriatric Assessment

Comprehensive geriatric assessment (CGA) is a coordinated, multidimensional, and usually interdisciplinary process that evaluates an older adult's medical, functional, cognitive, psychological, and social domains and links the findings to an integrated plan of care. It is the central methodological framework of geriatric medicine for characterising frail and complex older patients.

Definition

Comprehensive geriatric assessment is a multidimensional, interdisciplinary diagnostic and management process that determines an older person's medical, functional, cognitive, psychological, and social capabilities and problems in order to develop a coordinated, integrated plan for care and follow-up.

Scope

This entry covers what distinguishes CGA from routine clinical evaluation, its constituent domains, the interdisciplinary process by which findings are integrated, and the controlled-trial and meta-analytic evidence that has examined its effects. It treats CGA as a methodological topic, not as treatment guidance.

Core questions

• What makes an assessment comprehensive rather than single-system?
• How are findings from separate domains integrated into one coordinated plan?
• What does controlled-trial and meta-analytic evidence show about CGA compared with usual care?

Key concepts

• Multidimensional evaluation
• Interdisciplinary team process
• Domain integration
• Coordinated care planning and follow-up
• Targeting of frail or complex older patients
• Geriatric evaluation and management

Mechanisms

CGA proceeds by appraising several domains — medical, functional, cognitive, psychological, and social — each with validated tools and clinical judgement, and then synthesising the results, typically through an interdisciplinary team, into a single coordinated plan with follow-up. Its proposed value over usual care is attributed to detecting problems that disease-focused evaluation overlooks, to explicit care coordination, and to follow-through on the assessment. Stuck and colleagues' 1993 meta-analysis pooled controlled trials of CGA across settings, and Ellis and colleagues (2011) synthesised randomised trials of CGA for hospitalised older adults.

Clinical relevance

CGA is the reference framework geriatric medicine uses to characterise complex older patients, and meta-analyses have examined its association with outcomes such as living at home. This entry describes the assessment process and how its evidence is generated; it is reference-educational and is not a basis for individual diagnostic or treatment decisions.

Epidemiology

CGA is applied to older populations marked by multimorbidity, functional impairment, and frailty, where single-diagnosis evaluation is insufficient. Trials and meta-analyses have evaluated CGA across community, hospital, and outpatient settings, with hospitalised older adults a particularly studied population.

History

Comprehensive geriatric assessment emerged from British geriatric medicine and was crystallised as a defined process in the later twentieth century. Stuck and colleagues' 1993 Lancet meta-analysis pooling controlled trials was a landmark that brought CGA to broad attention, and the 2011 BMJ meta-analysis by Ellis and colleagues extended the evidence base to acutely hospitalised older adults, while reviews such as Rubenstein and colleagues (1991) helped define geriatric evaluation and management programmes.

Debates

Which patients benefit most and in which settings?

Evidence has been examined across community, hospital, and outpatient settings, and questions remain about how best to target CGA to those likely to benefit and how setting and team composition shape its effects.

Key figures

• Laurence Z. Rubenstein
• Andreas E. Stuck
• Graham Ellis
• Peter Langhorne
• Desmond O'Neill

Seminal works

• stuck-1993
• ellis-2011

Frequently asked questions

What does the 'comprehensive' in comprehensive geriatric assessment mean?

It signals that the assessment is multidimensional and interdisciplinary, covering medical, functional, cognitive, psychological, and social domains together, rather than evaluating a single organ system or complaint in isolation.

Is comprehensive geriatric assessment just a checklist?

No. Beyond appraising domains, CGA is defined by integrating the findings into a coordinated, often team-based plan of care with follow-up, which is the part trials and meta-analyses have linked to its effects.