Kerry Burrows

Frailty status is essential in CGA as it identifies individuals at increased risk of adverse outcomes like falls, hospitalisation, disability, and mortality.

The physical domain of CGA includes medical history, frailty syndromes, long term condition management, multi-morbidity, polypharmacy and structured medication reviews, nutrition, pain management, and falls risk. These aspects, combined with the other five domain areas, are essential for creating a comprehensive care plan. 

The functional domain of CGA focuses on mobility, activities of daily living (ADLs/IADLs), gait stability, and rehabilitation potential. Assessing Activities of Daily Living (ADLs) can provide insight into an individual’s functional status, independence, and care needs. These aspects, combined with the other five domain areas, are essential for creating a comprehensive care plan. 

The environmental domain examines home safety, accessibility, community services and technology aids. The living environment is an essential element of CGA as it directly impacts an older adult’s safety, independence, and quality of life.

The social domain of CGA explores social support, carer needs, isolation, spiritual/religious beliefs and financial concerns. These aspects, combined with the other five domain areas, are essential for creating a comprehensive care plan. 

Nutrition and hydration are essential elements of CGA as they impact on all body systems. Nutrition and hydration crossover with many other domains in CGA and identifying and managing poor nutrition and hydration is likely to support with the prevention and management of other health conditions, including frailty itself.

The effects of normal ageing have a detrimental effect on the integrity and function of skin, which can be further exacerbated by the presence of other comorbidities and frailty.

The psychological domain of CGA assesses cognition, mood, delirium risk, mental health conditions, and emotional wellbeing. These aspects, combined with the other five domain areas, are essential for creating a comprehensive care plan. 

Future wishes are an essential component of CGA, with the aim of encompassing information from all the domains of CGA to pre-empt potential deterioration in each of them, outlining how these should (or should not) be managed in line with the patients’ wishes, and their level of functioning/frailty. 

Pain should be considered in all patients as part of the process of CGA, and there are many tools available to facilitate the assessment of pain in individuals who may struggle to report it.

Sensory impairment is an important but often overlooked element of CGA. 

Issues with bladder and bowel function are common as we age, although it is important to remember they are not a ‘normal’ and inevitable part of ageing.

This page offers some real-world examples and experiences of CGA being implemented into older people's services. We invite BGS members and colleagues to share their success stories, tips, and learnings.

A detailed account of a person’s past medical and surgical history is an essential component of any physical health assessment. This is particularly important in geriatric medicine, given the close relationships between age, comorbidity, frailty and disability. 

Many older adults with frailty are prescribed multiple medicines for various health conditions, and careful management of this polypharmacy is crucial to ensure medicines are appropriate and safe.

Falls are a vital component of CGA, as they are common in older adults and strongly linked with increased morbidity, mortality, and loss of independence.