Introduction

A multidimensional process designed to assess an elderly person's functional ability, physical health, cognitive and mental health, and socioenvironmental situation.

Comprehensive geriatric assessment differs from a standard medical evaluation by including nonmedical domains, by emphasizing functional ability and quality of life, and, often, by relying on interdisciplinary teams. This assessment aids in the diagnosis of health-related problems, development of plans for treatment and follow-up, coordination of care, determination of the need for and the site of long-term care, and optimal use of health care resources.

Geriatric assessment programs vary widely in purpose, comprehensiveness, staffing, organization, and structural and functional components. Most attempt to target their services to high-risk elderly persons and to couple their assessment results with sustained individually tailored interventions (eg, rehabilitation, education, counseling, supportive services).

Comprehensive geriatric assessment of frail or chronically ill patients can improve their care and clinical outcomes. The possible benefits include greater diagnostic accuracy, improved functional and mental status, reduced mortality, decreased use of nursing homes and acute care hospitals, and greater satisfaction with care. However, the cost of comprehensive geriatric assessment programs has limited their use. Although some cost-effectiveness evaluations suggest that these programs can save money, few programs operate in integrated care systems that can track these savings. Wide use of comprehensive geriatric assessment programs has thus been slow to develop. An alternative approach is to conduct less extensive assessments in primary care offices or emergency departments.

An assessment instrument designed to help primary care physicians, nurses, and other health care practitioners perform practical, efficient assessment is shown in Table 4-1. It includes elements from an instrument recommended by the American College of Physicians and from instruments validated and field-tested in randomized clinical trials.

To identify elderly persons who might benefit from assessment (in a special comprehensive geriatric assessment unit or in a primary care setting), some health care organizations mail multidimensional self-administered health questionnaires to elderly populations. Responses are scored according to defined algorithms, and reports of high-risk conditions and behaviors are sent to the patients and their primary care physicians to stimulate more detailed follow-up evaluation and treatment. Other organizations identify candidates for assessment by interviewing elderly persons in their homes or meeting places (eg, meal sites, senior centers, places of worship). Family members who are concerned about an elderly relative's health or functional abilities may also arrange referrals for geriatric assessment.