Geriatric assessment

Comprehensive geriatric assessment

Overview and approach

CGA is multidimensional assessment with a coordinated plan for older adults with complex needs.

  • CGA is a multidisciplinary, multidimensional process that identifies medical, functional, psychological, social and environmental needs and then develops an integrated, goal-based care plan (1)(2).
  • The RACGP Silver Book supports this through the Geriatric 5Ms (Mind, Mobility, Medications, Multicomplexity, Matters Most) and multidisciplinary team care (3)(4).
  • In Australia, the My Aged Care Integrated Assessment Tool covers medical, physical and frailty, social, cognitive, behavioural, psychological, home-safety and support domains; complex needs are referred for comprehensive assessment. ACAT has been replaced by the Single Assessment System (5).
Assessment and clinical features

Cover medical problems, medications, cognition/mood, function, mobility, nutrition, continence, sensory loss, supports and goals.

  • Domains: medical problems and multimorbidity; medicines (including anticholinergic burden and deprescribing); cognition, mood and sleep; function (basic and instrumental ADLs); mobility, falls and gait; nutrition and swallowing; continence; vision and hearing; skin; social supports, carers and home safety; and the person's goals (1)(3).
  • Ask what matters most and use it to prioritise problems (3).
Differentials and investigations

Use collateral baseline, validated tools where useful and targeted investigations for reversible decline.

  • Obtain collateral history for baseline function and cognition; use validated tools where helpful (frailty scale, cognitive screen, depression scale, delirium screen, falls and nutrition screens).
  • Investigate reversible causes of decline (infection, metabolic, medicines, anaemia, thyroid, B12), directed by the findings.
Management and follow-up

Agree priorities with the person and carers, assign actions to the multidisciplinary team and plan follow-up/discharge.

  • Agree priorities with the person and carers; assign actions to the team (geriatrician, GP, nursing, physiotherapy, OT, speech pathology, dietitian, pharmacist, social work); and set review dates (1)(4).
  • Link to community and aged care supports, advance care planning and carer support.
Red flags and clinical pearls

Chronological age alone is not a treatment plan. Acute deterioration should not be dismissed as frailty.

  • Acute change in function or cognition should prompt a search for a reversible cause rather than attribution to ageing or frailty.
  • Treatment decisions should be based on function, frailty, goals and prognosis, not age alone.
References
  1. Comprehensive geriatric assessment - a guide for the non-specialist (PMC)
  2. UQ report: Survey and evaluation of CGA systems for residential and community aged care
  3. RACGP Silver Book Part B: Geriatric syndromes
  4. RACGP Silver Book Part B: Collaboration and multidisciplinary team-based care
  5. My Aged Care Assessment Manual v7.3

Last updated from Sen’s notes on 9 October 2026.