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</div></div> </div> </aside> <section id="content"> <div class="content-main"> <article id="node-315" class="node node-resource node-sticky node-content" about="/resources/2-cga-in-primary-care-settings-the-elements-of-the-cga-process" typeof="sioc:Item foaf:Document"> <div class="resource-header node-header"> <h1><div class="card-full-title"> 2. CGA in Primary Care Settings: The elements of the CGA process </div> </h1> <span property="dc:title" content="2. CGA in Primary Care Settings: The elements of the CGA process" class="rdf-meta element-hidden"></span><span property="sioc:num_replies" content="0" datatype="xsd:integer" class="rdf-meta element-hidden"></span> <div class="resource-header-details"> <div class="card-resource-type-i"> <div class="card-resource-type"> Good practice guide </div> <div class="resource-type-i-icon">i</div> <div class="resource-type-info-arrow"></div> </div> <div class="resource-type-info"><div class="resource-type-info-text">Good practices guides focus on providing information on a clinical topic.</div></div> </div> <div class="node-header-details"> <div class="card-authors-wrapper"><div class="label">Authors:</div><div class="author-details">British Geriatrics Society</div></div> <div class="card-topics-wrapper"><div class="label">Topics:</div><a href="/taxonomy/term/2935">Comprehensive Geriatric Assessment (CGA) in community settings</a>, <a href="/taxonomy/term/855">Integrated care</a></div> <div class="node-header-dates"> <div class="card-date-wrapper"><div class="label">Date Published:</div><div class="card-date"> <span class="date-display-single" property="dc:date" datatype="xsd:dateTime" content="2019-01-28T00:00:00+00:00">28 January 2019</span> </div> </div> <div class="card-date-updated"> <div class="label">Last updated: </div> <span class="date-display-single" property="dc:date" datatype="xsd:dateTime" content="2019-01-28T00:16:00+00:00">28 January 2019</span> </div> </div> </div> <div class="card-resource-summary"> <p>An overview of how Comprehensive Geriatric Assessment (CGA) is done in the primary care setting, and what to consider when conducting the assessment. Further guides in this series examine the functional assessment and psychological components of CGA.</p> <p>Comprehensive Geriatric Assessment comprises interdisciplinary and interagency working which places the patient and their supporters at the heart of care. </p> <p>Such an approach is usually proactive and is logically most relevant when it generates an individual problem list identifying issues and how they have changed over time in a number of domains:</p> <p>a. Physical assessment<br /> b. Functional, social and environmental assessment       <br /> c. Psychological components<br /> d. Medication review   </p> </div> </div> <div class="view view-sections view-id-sections view-display-id-main view-dom-id-ab4a7cf9a9bd915e3c3c939fc688c899"> <div class="view-content view-content-main"> <div class="views-row views-row-1 views-row-odd views-row-first section-row palette-default "> <div class="section-inner"> <div class="card-view-4"> <div class="view view-attachment view-id-attachment view-display-id-main view-dom-id-27f6fe7bce56a41807cd756938173fc0"> </div> </div> <div class="card-block"> <div class="item-list"><ul><li class="first last"><section class="block block-block infographic-block"> <svg xmlns="http://www.w3.org/2000/svg" width="780" height="700" viewBox="0 0 780 700"> <g fill="none" fill-rule="evenodd"> <g fill="#C8C9C7" fill-rule="nonzero" transform="translate(150 90)"> <path d="M153.600803,0.540598919 C153.302238,-0.232156358 153.686646,-1.10063266 154.459401,-1.3991972 C155.232156,-1.69776174 156.100633,-1.3133542 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class="top-box-link"><g transform="translate(230)"> <rect width="150" height="90" fill="#EFEFF0"/> <text fill="#C63663" font-family="SourceSansPro-Regular, Source Sans Pro" font-size="18"> <tspan x="35.171" y="50">Functional</tspan> </text> </g></a> <a xlink:href="/node/4171" class="top-box-link"><g transform="translate(60 70)"> <rect width="150" height="90" fill="#EFEFF0"/> <text fill="#C63663" font-family="SourceSansPro-Regular, Source Sans Pro" font-size="18"> <tspan x="14.444" y="37">Socioeconomic/</tspan> <tspan x="19.7" y="63">Environmental</tspan> </text> </g></a> <a xlink:href="/node/4503" class="top-box-link"><g transform="translate(0 180)"> <rect width="150" height="90" fill="#EFEFF0"/> <text fill="#C63663" font-family="SourceSansPro-Regular, Source Sans Pro" font-size="18"> <tspan x="44.225" y="50">Physical</tspan> </text> </g></a> <g transform="translate(50 310)"> <a xlink:href="/node/3354" class="bottom-box-link"><g transform="translate(400 290)"> <rect width="160" 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77.151063 241.5 76.3226359 241.5 75.651063 242.171573 75.651063 243L75.651063 258 75.651063 338.619387C75.651063 339.447815 76.3226359 340.119387 77.151063 340.119387L109.254879 340.119387C110.083306 340.119387 110.754879 339.447815 110.754879 338.619387 110.754879 337.79096 110.083306 337.119387 109.254879 337.119387z"/> </g> </g> </svg> </section></li> </ul></div> </div> </div> </div> <div class="views-row views-row-2 views-row-even views-row-last section-row palette-default "> <div class="section-inner"> <div class="card-body"> <p>It will then accommodate the individual’s own personal goals before documenting interventions and overall management strategies, as well as who will deliver these i.e. a comprehensive care plan.</p> <p>Depending on the goals/problem(s) identified, the intervention may consist of one or more actions to be delivered by a clinician - doctor and/or other relevant members of the multidisciplinary team (e.g. nurse, physiotherapist, occupational therapist etc), who are included as necessary. The key issue is the collaboration between patient/family/carers and the various members of the team throughout the process. The expectation is that the older person and their family will own this process and regard the resulting care plan as their own. Some of the actions/interventions may rely on activity by the older person themselves.</p> <p>The holistic nature of CGA covering physical, psychological, functional, social and environmental needs of older people may be confusing if not managed effectively. This is particularly true within the community setting where services are affected by local geography and availability- therefore CGA needs careful coordination.</p> <h2 class="sidebar-nav">Making CGA work</h2> <p>Key processes and structures which support implementation and maximise the impact of using CGA:</p> <ul> <li>Development of multi-professional teams</li> <li>Clear identification of a joint core level of competence in assessment between health and social care practitioners</li> <li>Clarity of when referral for specialist single professional assessment  is appropriate</li> <li>Single patient-held documentation</li> <li>Information sharing systems</li> <li>Regular multidisciplinary team (MDT) review meetings to share knowledge and develop team working</li> <li>Access to joint health and social care funding.</li> </ul> <h2 class="sidebar-nav">Time and financial constraints </h2> <p>Undertaking CGA takes time. To complete the process fully may take up to two hours. Such an undertaking is difficultfor individual GPs working in the current model of care where appointment times are short and time in the day very limited. We would envisage the assessment being contributed to by a number of health and social care professionals and there may be a role for the voluntary care sector to be involved. Some sections can be completed by the informal carer. The information would accumulate over time. Developing a model of proactive care for those Older Adults living with Frailty would enable a multidisciplinary approach to comprehensive assessment for those most at risk of unplanned hospital admissions.</p> <p>Developing a multidisciplinary approach to proactive care will require new models of care – enabling greater integration between primary care and community providers, social care and the voluntary care sector. In England, where commissioners and providers are split, this may be through closer alliances or through the creation of Multispecialty Community Providers – as described in the NHS Five Year Forward View. Enlightened commissioners are already investing in multidisciplinary community teams providing proactive models of care expecting that this will ultimately result in cost savings across the health economy. The fact that this will improve the quality of care for patients is likely to be the greater incentive for General Practice.</p> </div> <div class="card-view-4"> <div class="view view-attachment view-id-attachment view-display-id-main view-dom-id-de76ac19154af635566b132061853e21"> </div> </div> </div> </div> </div> </div> <div class="view view-sections view-id-sections view-display-id-additional view-dom-id-4f357d56c004f9cd9387ad47b19df6cb"> <div class="view-content view-content-main"> <div class="views-row views-row-1 views-row-odd views-row-first views-row-last section-row palette-default "> <div class="section-inner"> <div class="card-body"> <h2 class="sidebar-nav">Further information</h2> <p>The Rational Clinical Examination, Simel D and Rennie D.</p> <p>The entire book is excellent, delivered in short chapters asking a specific clinical question. Thereis no separate geriatric element however many of the issues are relevant to CGA.</p> <p>McLeod’s Clinical Diagnosis, Japp et al. Aimed primarily at trainee doctors. There is a short chapter on assessment of the older patient that expands on some of the themes raised here.</p> </div> </div> </div> </div> </div> </article> </div> <div class="content-additional"> <div id="block-webform-client-block-227" class="block block-webform"> <h2 class="resource-feedback-toggle">Feedback on this resource?</h2> <div class="content"> <div id="webform-ajax-wrapper-227"><form class="webform-client-form webform-client-form-227" action="/resources/2-cga-in-primary-care-settings-the-elements-of-the-cga-process" method="post" id="webform-client-form-227" accept-charset="UTF-8"><div><div class="webform-email form-item webform-component webform-component-email webform-component--email webform-container-inline"> <label for="edit-submitted-email">Email </label> <input class="email form-text form-email" type="email" id="edit-submitted-email" name="submitted[email]" size="60" /> <div class="description">If you鈥檇 like us to contact you, please leave your email</div> </div> <div class="webform-feedback form-item webform-component webform-component-textarea webform-component--comment webform-container-inline"> <label for="edit-submitted-comment">Your feedback <span class="form-required" title="This field is required.">*</span></label> <div class="form-textarea-wrapper"><textarea required="required" placeholder="(max 300 words)" id="edit-submitted-comment" name="submitted[comment]" cols="60" rows="3" class="form-textarea required"></textarea></div> </div> <input type="hidden" name="details[sid]" /> <input type="hidden" name="details[page_num]" value="1" /> <input type="hidden" name="details[page_count]" value="1" /> <input type="hidden" name="details[finished]" value="0" /> <input type="hidden" name="form_build_id" value="form-Gyx6CIxQ8Ncn-_rxbBtOtme5XR6Po2dBeESREHMplos" /> <input type="hidden" name="form_id" value="webform_client_form_227" /> <input type="hidden" name="webform_ajax_wrapper_id" value="webform-ajax-wrapper-227" /> <fieldset class="captcha form-wrapper"><legend><span class="fieldset-legend">CAPTCHA</span></legend><div class="fieldset-wrapper"><div class="fieldset-description">This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.</div><input type="hidden" name="captcha_sid" value="8293523" /> <input type="hidden" name="captcha_token" value="fc8380330290904e557f25848f27ccbb" /> <input type="hidden" name="captcha_response" value="Google no captcha" /> <div class="g-recaptcha" data-sitekey="6LdxcUsUAAAAABXmfqM-hujH0UGJIQjSzRbBKU2w" data-theme="light" data-type="image"></div></div></fieldset> <div class="form-actions"><input class="webform-submit button-primary form-submit" id="edit-webform-ajax-submit-227" type="submit" name="op" value="Send" /></div></div></form></div> </div> </div> </div> </section> <aside id="sidebar-second" role="complementary" class="sidebar"> <div class="sidebar-second-wrapper"> <section class="block block-views side-row resource-dl-block"> <h2 class="block-title">Download</h2> <div class="view view-resource-download view-id-resource_download view-display-id-download view-dom-id-dde80309f6cf9d25b536cda6622b2d68"> <div class="view-content view-content-main"> <div> <div> <div class="card-view-1"> <span><div class="view view-resource-download view-id-resource_download view-display-id-block_2 view-dom-id-b4d6d4209b71387f0304b996ce71ee35"> <div class="view-header"> <h5>Download documents from the complete series</h5> </div> <div class="view-content view-content-main"> <div> <div class="views-field views-field-nothing"> <span class="field-content"><a class="attachment-link download-resource" target="_blank" href="https://www.bgs.org.uk/sites/default/files/content/resources/files/2019-03-12/CGA%20Toolkit%20for%20Primary%20Care%20Practitioners_0.pdf"> <div class="file-icon file-type-pdf"><div class="file-name">CGA Toolkit for Primary Care Practitioners.pdf</div><div class="file-details"><div class="file-extension">pdf</div><div class="file-size">814.5 KB</div></div></div> </a></span> </div> </div> </div> </div></span> </div> </div> </div> </div> </div> </section> <section class="block block-views"> <div class="view view-sections view-id-sections view-display-id-sidebar view-dom-id-c9e34b758f59b84d1dbf9be45d4e8b02"> <div class="view-content view-content-main"> <div class="views-row views-row-1 views-row-odd views-row-first side-row "> <div class="section-inner"> <div class="card-title"> <h2 class="field-content">Section 1: CGA in Primary Care</h2> </div> <div class="side-row-wrapper"> <div class="card-body"> <p><a href="/resources/1-cga-in-primary-care-settings-introduction">Introduction</a><br /> <strong>The elements of CGA (you are here)</strong><br /> - <a href="/resources/3-cga-in-primary-care-settings-physical-assessment">Physical assessment</a><br /> - <a href="/resources/4-cga-in-primary-care-settings-functional-and-social-assessment">Functional, social and environmental assessment</a><br /> - <a href="/resources/5-cga-in-primary-care-settings-psychological-components">Psychological components</a><br /> - <a href="/resources/6-cga-in-primary-care-settings-medication-review">Medication review</a><br /> - <a href="/resources/7-cga-in-primary-care-settings-creating-a-problem-list">Creating a problem list</a><br /> <a href="/resources/8-cga-in-primary-care-settings-care-and-support-planning">Care and support planning</a><br /> <a href="/resources/9-cga-in-primary-care-settings-involving-social-services">Involving Social Services</a></p> </div> </div> </div> </div> <div class="views-row views-row-2 views-row-even views-row-last side-row "> <div class="section-inner"> <div class="card-title"> <h2 class="field-content">Section 2: Specific Presentations</h2> </div> <div class="side-row-wrapper"> <div class="card-body"> <p><a href="/resources/10-cga-in-primary-care-settings-patients-presenting-with-mobility-and-balance-issues">Mobility and balance</a><br /> <a href="/resources/11-cga-in-primary-care-settings-bone-health">Bone health</a><br /> <a href="/resources/12-cga-in-primary-care-settings-patients-at-risk-of-falls-and-fractures">Falls</a><br /> <a href="/resources/13-cga-in-primary-care-settings-patients-presenting-with-depression">Depression</a><br /> <a href="/resources/14-cga-in-primary-care-settings-patients-presenting-with-confusion-and-delirium">Confusion/delirium</a><br /> <a href="/resources/15-cga-in-primary-care-settings-mental-capacity-issues">Mental capacity</a><br /> <a href="/resources/16-cga-in-primary-care-settings-patients-presenting-with-urinary-incontinence">Urinary incontinence</a><br /> <a href="/resources/17-cga-in-primary-care-settings-weight-loss-and-nutrition-issues">Weight loss and nutrition</a><br /> <a href="/resources/18-cga-in-primary-care-settings-end-of-life-care-issues">End of life care</a></p> </div> </div> </div> </div> </div> </div> </section> </div> </aside> </div> </main> <section class="postscript-first"> <div class="postscript_first"> <section class="block block-views postscript-section-row-block"> <h2 class="block-title">Other resources in this series</h2> <div class="view view-resource-series view-id-resource_series view-display-id-block section-row row-max-4 view-card-default-palette view-dom-id-72f0e088a66ab2295e6574438c17c959"> <div class="view-content view-content-main"> <div class="views-row views-row-1 views-row-odd views-row-first"> <a class="card resource-card" href="/cgatoolkit"><div class="card-text"><div class="card-content"> <div class="card-title"> <h3>1. CGA in Primary Care Settings: Introduction</h3> </div> <div class="card-date-display-override"> <span class="date-display-single" property="dc:date" datatype="xsd:dateTime" content="2019-01-28T00:00:00+00:00">28 Jan 2019</span> </div> <div class="card-summary"> <div class="card-summary-wrapper"> <div class="card-summary"> An introduction to CGA in primary care settings. This toolkit was developed by the British Geriatrics Society and has been endorsed by the ANCD for Older People and Integrated Person-Centred Care and by the Council of British Geriatrics Society, Scotland. </div> </div> </div> </div><div class="card-footer"> <div class="card-resource-series"> In a series </div> <div class="card-resource-type"> Good practice guide </div> </div></div></a> </div> <div class="views-row views-row-2 views-row-even"> <a class="card resource-card" href="/resources/3-cga-in-primary-care-settings-physical-assessment"><div class="card-text"><div class="card-content"> <div class="card-title"> <h3>3. CGA in Primary Care Settings: Physical Assessment </h3> </div> <div class="card-date-display-override"> <span class="date-display-single" property="dc:date" datatype="xsd:dateTime" content="2019-01-28T00:00:00+00:00">28 Jan 2019</span> </div> <div class="card-summary"> <div class="card-summary-wrapper"> <div class="card-summary"> Examination of older patients incorporates all the typical aspects of clinical examination, although there are some general considerations and emphases that should be borne in mind, and specific examinations that may be more relevant in older people. </div> </div> </div> </div><div class="card-footer"> <div class="card-resource-series"> In a series </div> <div class="card-resource-type"> Good practice guide </div> </div></div></a> </div> <div class="views-row views-row-3 views-row-odd"> <a class="card resource-card" href="/resources/4-cga-in-primary-care-settings-functional-and-social-assessment"><div class="card-text"><div class="card-content"> <div class="card-title"> <h3>4. CGA in Primary Care Settings: Functional and social assessment</h3> </div> <div class="card-date-display-override"> <span class="date-display-single" property="dc:date" datatype="xsd:dateTime" content="2019-01-28T00:00:00+00:00">28 Jan 2019</span> </div> <div class="card-summary"> <div class="card-summary-wrapper"> <div class="card-summary"> Functional assessment examines factors like mobility and daily living activities, and social assessment looks at social circumstances. Asking what the older person does and what environment they live in adds context to any Comprehensive Geriatric Assessment. </div> </div> </div> </div><div class="card-footer"> <div class="card-resource-series"> In a series </div> <div class="card-resource-type"> Good practice guide </div> </div></div></a> </div> <div class="views-row views-row-4 views-row-even views-row-last"> <a class="card resource-card" href="/resources/5-cga-in-primary-care-settings-psychological-components"><div class="card-text"><div class="card-content"> <div class="card-title"> <h3>5. CGA in Primary Care Settings: Psychological components</h3> </div> <div class="card-date-display-override"> <span class="date-display-single" property="dc:date" datatype="xsd:dateTime" content="2019-01-28T00:00:00+00:00">28 Jan 2019</span> </div> <div class="card-summary"> <div class="card-summary-wrapper"> <div class="card-summary"> Depression among the over-65s is often under-recognised, so CGA is not complete without assessing mental health. The assessment conversation also offers an opportunity to identify cognitive dysfunction which may be a sign of dementia or delirium. </div> </div> </div> </div><div class="card-footer"> <div class="card-resource-series"> In a series </div> <div class="card-resource-type"> Good practice guide </div> </div></div></a> </div> </div> <div class="view-footer"> <div class="card-feed-link"><a href="/resources/resource-series/comprehensive-geriatric-assessment-toolkit-for-primary-care-practitioners">See all resources in this series</a></div> </div> </div> </section> </div> </section> <footer id="site-footer" role="contentinfo"> <section class="footer-first"> <div class="outer-wrapper"> <section class="block block-views"> <div class="view view-footer-sections view-id-footer_sections view-display-id-orgs view-display-grid view-dom-id-9ecd6675b226578fee50bb22524851eb"> <div class="view-header"> <script> if(jQuery('#Main.CRM_Contribute_Form_Contribution_Main').length > 0){ jQuery('#Main.CRM_Contribute_Form_Contribution_Main').on('submit',function(e){ setTimeout(function(){ e.preventDefault(); 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