Conducting a comprehensive geriatric assessment

What is it?

Comprehensive geriatric assessment is ‘a multidimensional, interdisciplinary diagnostic process to determine the medical, psychological, and functional capabilities of a frail elderly person in order to develop a coordinated and integrated plan for treatment and long-term follow-up’.¹

It requires us to use a person centred approach to find out what matters to our older patients to maximise their strengths, functional independence and outcomes.

Why is it important?

Older people are the major users of hospitals, and often have longer stays, which increases their risk of functional decline.
Older people with frailty and multimorbidity as well as impaired cognition, poor mobility and incontinence will benefit from a comprehensive assessment.²
Information gained from a comprehensive geriatric assessment allows clinicians to implement a person-centred care plan which can reduce functional decline, support independence and improve quality of life.
An assessment can also facilitate discharge planning and reduce length of stay, medication use, and the need for admission to residential care.^2,3
A comprehensive geriatric assessment is a good time to encourage the older person and their family to consider advance care planning, identify their substitute decision maker and document their decisions.

How can you carry out a comprehensive geriatric assessment?

An initial risk screen of all older people in hospital aged over 70 years should identify those who would benefit from a comprehensive assessment. This need may change during the patient’s hospital stay, as indicated by ongoing monitoring of their health status.

What does a comprehensive geriatric assessment involve?

A specialist interdisciplinary team approach involving a geriatrician to undertake a comprehensive assessment.
Use of validated tools to gather a complete picture of the older person’s:
- medical health
- physical functioning
- psychological functioning
- social functioning.²
Collecting information through observation, open questioning of the older person and their family or carers, and reviewing their medical records to complement your assessment using the validated tools.

Involve the older person, their family and carers

Assume the patient is well placed to provide accurate information unless you suspect a medical condition is significantly affecting their ability to do so.
Consider the patient’s health literacy and their cultural and linguistic background. Check they have all their necessary aids such as hearing aids and glasses.
Communicate clearly with the patient, their family or carer and explain why you are collecting the information and how it will inform their care plan.
Screen the patient’s family or carer for carer stress and refer to appropriate inpatient and outpatient support services such as the Social Work team and Alzheimer’s Victoria and Carers Victoria.
Ask the person what matters to them and what they would like to see happen next.

What to do with the information

Communicate the outcomes of the comprehensive assessment to the person, their family, carers and all necessary staff.
Use the assessment information to inform both the person’s care plan and their discharge plan.
Monitor the older person’s health status and evaluate their care plan on an ongoing basis throughout their hospital stay.
Refer to your health service’s recommended template or validated tools to collect information during the assessment.

1. Wieland D & Hirth V 2003, ‘Comprehensive geriatric assessment’, Cancer Control 10(6):454-462.

2. Australian Institute of Health and Welfare 2013, Australian hospital statistics 2011–12,Australian Institute of Health and Welfare, Canberra.

3. Centre for Applied Gerontology, Bundoora Extended Care Centre, Northern Health 2004, A guide for assessing older people in hospitals. Report to the Australian Health Ministers' Advisory Council, Victoria.

4. Ellis G & Langhorne P 2004, ‘Comprehensive geriatric assessment for older hospital patients’, British Medical Bulletin 71(1):45-59