Synopsis
Use comprehensive geriatric assessment to convert medical, functional, psychological, medication, social and personal-priority findings into one coordinated plan that treats acute disease, protects independence and names accountable follow-up.
- CGA is a multidimensional, interdisciplinary diagnostic and planning process with implementation and review; a long clerking or screening form alone is not CGA.
- First priority remains diagnosis and treatment of acute illness. Build CGA alongside emergency care and revise it as delirium, pain and physiology improve.
- Establish baseline about two weeks before the acute illness from the person and collateral sources: mobility, ADLs, IADLs, cognition, mood, continence, nutrition and support.
- Cover medical problems and prognosis, medicines and adherence, function and falls, cognition and mood, vision and hearing, social network, housing, safeguarding and personal goals.
- Ask permission for collateral where the person has capacity; when they lack capacity, use necessary and proportionate information in their best interests and document reasoning.
- Name treatment burden: appointments, monitoring, administration complexity, adverse effects, travel, cost to daily life and the work transferred to family carers.
- Translate every important finding into an action, owner and review point. Unowned problem lists and vague recommendations do not improve outcomes.
- The MDT may include geriatric medicine, nursing, pharmacy, physiotherapy, occupational therapy, social work, dietetics, speech and language therapy and mental-health expertise.
- Goals and advance plans guide proportional care but do not remove the duty to assess reversible illness, relieve symptoms or revisit decisions when circumstances change.
- CGA is iterative: compare progress with baseline, test the discharge environment, reconcile medicines and communicate a single plan across settings.
Key red flags
New confusion, reduced alertness or behaviour change is delirium until assessed and requires a cause search rather than attribution to dementia or old age.
A sudden loss of walking, transfers, continence, eating or self-care often represents acute disease even when fever, pain and laboratory inflammation are muted.
Repeated falls, unexplained bruising, missed medicines, weight loss, self-neglect, unsafe housing or fear of a carer requires proportionate safeguarding assessment.
Carer exhaustion, inability to continue care or conflict about discharge can make an apparently medically stable plan immediately unsafe.
A proposed discharge without reliable mobility, cognition, medicine administration, nutrition, toileting and overnight support needs a same-day multidisciplinary review.
Do not accept a frailty label as an explanation for focal neurology, chest pain equivalent, hypoxia, abdominal catastrophe, sepsis or acute kidney injury.
Falls, delirium, immobility, incontinence or poor intake may be the first expression of infection, stroke, medicine toxicity, pain or organ failure.
Carer strain, missed visits, environmental hazards, financial difficulty or safeguarding concern can invalidate an otherwise reasonable medical plan.
Investigation priorities
Identify time-critical and reversible disease before attributing change to frailty.
Management branches
An older adult presents with acute illness, functional decline or complex discharge needs.
- Treat immediate physiological threats and obtain essential collateral, baseline function and medicine information in parallel.
- Assess medical, functional, psychological, sensory, social and personal-priority domains with the relevant MDT members.
- Create one prioritised plan in which every action has an owner, timeframe, outcome and escalation trigger.