Comprehensive Geriatric Assessment

A Comprehensive Geriatric Assessment (CGA) is a structured evaluation carried out by a specialist in older-adult care to build a complete picture of an elderly person's health, physical ability, mental state, and social situation.

Rather than focusing on a single illness, the CGA looks at the whole person. A team of healthcare professionals — which may include a geriatrician (a doctor specialising in the care of older adults), a nurse, a physiotherapist, and a social worker — works together to identify problems that routine check-ups often miss, such as hidden memory changes, fall risk, malnutrition (poor nutrition), and difficulties managing daily life. The findings are then used to create a personalised care plan.

The CGA is recommended when an older adult's situation is complex — meaning they have multiple health problems, are taking several medications, or are showing signs that everyday functioning is becoming harder. It is especially useful when a doctor suspects that standard tests alone will not capture the full picture.

• Multiple long-term conditions occurring at the same time, such as diabetes, heart disease, and arthritis (joint inflammation) together
• Frailty (a state of reduced strength and resilience that makes the body less able to recover from illness or stress)
• Unexplained or repeated falls
• Memory concerns or early signs of dementia (a decline in memory and thinking that affects daily life)
• Unintentional weight loss or signs of poor nutrition
• Difficulty managing medications safely
• Decline in the ability to perform daily tasks such as bathing, dressing, or cooking
• Depression (persistent low mood) or anxiety in older age
• Planning before a major surgery or cancer treatment to assess whether the patient can tolerate it
• Decisions about living arrangements, such as whether home-based care or a care facility is more appropriate

A CGA may be less relevant when an older adult is in excellent overall health with no complex problems, or when urgent emergency treatment takes priority. Your doctor will decide whether the timing and circumstances are right for this type of in-depth assessment.

A Comprehensive Geriatric Assessment is a non-invasive (no cuts, needles, or instruments entering the body) diagnostic process, so it carries no physical risks in itself.

• Fatigue: the assessment involves several interviews and tasks, which some older adults may find tiring; sessions are usually paced to allow for rest
• Emotional discomfort: questions about memory, independence, and social circumstances can feel sensitive or distressing for some patients
• Incidental findings: the thorough nature of the assessment may uncover previously unknown health issues, which can cause temporary anxiety while further investigation is arranged

Because the CGA is a non-invasive assessment with no procedures involving anaesthesia (medication to block sensation or induce sleep), there is usually no need to fast or to stop eating and drinking beforehand. However, the preparation that does matter is gathering information — arriving well-prepared helps the team make the most of the time available.

Before the appointment, it is helpful to collect the following:

• A complete list of all current medications, including vitamins and herbal supplements, with their doses written down
• A summary of past medical history, including previous operations and known allergies
• Records of recent blood tests, imaging results, or specialist letters if available
• The name and contact details of the family doctor or any other specialists currently involved in care
• A trusted family member or caregiver who can attend alongside the patient, since they may provide important observations about day-to-day functioning

Additional tests are often arranged as part of or alongside the CGA. These may include:

• Blood tests to check nutrition, kidney function, thyroid function (a gland that regulates body energy), and other markers
• An EKG (electrocardiogram — a recording of the heart's electrical activity)
• Bone density scanning if osteoporosis (thinning of the bones) is suspected
• Brain imaging such as CT or MRI if memory or neurological (nerve and brain) concerns are present

The assessment itself typically unfolds across one or more sessions. The usual sequence is:

• 1. A detailed medical interview covering current symptoms, past illnesses, medications, and family history
• 2. Physical examination, including checks of blood pressure, heart rate, vision, hearing, and nutritional status
• 3. Functional assessment — the patient is asked to perform simple tasks such as walking a short distance, rising from a chair, and gripping an object, to measure strength and balance
• 4. Cognitive screening (testing of memory and thinking) using standardised questionnaires that the patient answers verbally or in writing
• 5. Mood and psychological assessment to identify depression or anxiety
• 6. Social and environmental review — questions about living conditions, family support, financial situation, and ability to manage at home
• 7. Team discussion to bring all findings together and agree on a care plan

Because the CGA involves no surgical procedure or sedation (medication to cause drowsiness or light sleep), there is no physical recovery period. The patient can usually return home immediately after the session. The most important 'aftercare' is engaging with the care plan that the geriatric team puts in place.

• A written summary of findings and recommendations is usually provided; keep this and share it with all other doctors involved in your care
• Follow-up appointments may be scheduled to monitor progress and adjust the care plan as the patient's condition changes over time
• Specialist referrals may be arranged — for example, to a physiotherapist for balance exercises, a dietitian for nutrition guidance, or a psychologist for mood support
• Medication reviews may result in changes to the current medication list; a pharmacist or doctor will explain any adjustments
• Home safety modifications may be recommended, such as grab rails or removing trip hazards, to reduce fall risk
• Family members or caregivers are usually encouraged to be involved in follow-up discussions, as their support is a key part of the care plan
• Repeat assessments may be suggested after several months to track whether the interventions are working