When I tell a family that their elderly parent needs a Comprehensive Geriatric Assessment, the most common response is a blank look. Occasionally someone has heard the term before, but even then, most people are not clear on what it actually involves, how long it takes, or what comes out of it.
I have written this post because I think families deserve to know exactly what they are walking into — and exactly what they should expect to receive at the end.
What a CGA is — and what it is not
A Comprehensive Geriatric Assessment is not a series of tests. It is a structured clinical evaluation conducted by a trained geriatrician that assesses multiple domains simultaneously: physical function, cognition, nutrition, mood, medications, social support, and quality of life.
It is not a replacement for your parent’s existing investigations or doctors. It is the framework that makes sense of everything that has already been done — and that identifies what still needs to be addressed.
The gold standard for a CGA is a 45-minute to 60-minute encounter, preferably in the patient’s home or at a geriatric clinic, with a family member or caregiver present. The presence of someone who knows the patient well is important: certain parts of the assessment — particularly cognitive evaluation — require a family informant interview.
What we evaluate
Functional status is the starting point. Can your parent dress themselves? Manage their own medicines? Cook a meal? Use public transport? These are not lifestyle questions — they are clinical data points. Changes in functional ability are often the earliest sign of emerging disease in elderly patients.
Cognitive assessment uses validated tools. The Montreal Cognitive Assessment (MoCA) is a 10-minute test that evaluates memory, attention, language, visuospatial skills, and executive function. If there is concern, the Clinical Dementia Rating (CDR) provides a more detailed characterisation. Depression screening using the Geriatric Depression Scale (GDS-15) is always included — depression is the most under-diagnosed condition in elderly patients, and it profoundly affects every other aspect of health.
Nutritional assessment uses the Mini Nutritional Assessment (MNA) — a structured tool that goes beyond simple weight measurement to evaluate dietary intake, mobility, self-reported health status, and body composition. The MNA identifies patients at risk before they become malnourished, which is when intervention is most effective.
Falls and frailty assessment includes physical tests — the Timed Up and Go test, the 4-Stage Balance Test, the Fried Frailty Index. These are not subjective impressions. They are standardised measurements with normative values for age, and they predict future fall risk with reasonable accuracy. A home hazard checklist is part of this assessment when conducted in the patient’s residence.
Medication review applies STOPP/START criteria to the full medication list. Every drug is checked against every other drug, and against every diagnosis. The output is a written Medication Safety Letter to the patient’s treating doctors — specific, clinically referenced, and actionable.
What you receive at the end
Every family receives a written clinical summary on the day of the assessment. This is not a brief discharge note. It is a structured document that covers all domains assessed, identifies the key clinical concerns in order of priority, outlines the care plan with specific recommendations, lists any investigations needed, and coordinates referrals if required.
This document has a specific purpose: it should go to every doctor your parent sees. The cardiologist, the neurologist, the GP — all of them benefit from understanding the geriatric picture, and the written summary is how that information travels.
When to seek a CGA
Any elderly patient with multiple conditions, multiple medications, functional decline, cognitive changes, nutritional concerns, or recent falls will benefit from a CGA. In my practice, I recommend it as a baseline for any patient above 70, regardless of apparent health status — because the assessment often identifies problems that are not yet symptomatic but are developing.
A CGA is not a scary investigation. Most patients tell me it is the first time in years that someone has asked them how they are actually doing — across all dimensions of their life, not just the organ that most recently required attention.
That is what geriatric medicine is designed to do. And the CGA is where it begins.
Geriatric consultations at Manipal Hospital Broadway, Kolkata — and doctor-led home visits in Newtown, Rajarhat & Salt Lake through GeraVita.