Comprehensive Geriatric Assessment: What to Expect

When a Regular Checkup Isn't Enough

A standard primary care visit covers blood pressure, lab work, and whatever the patient or caregiver brings up in 15 minutes. For an elderly parent dealing with multiple chronic conditions, cognitive changes, fall risk, medication complexity, and functional decline, that 15-minute window can't hold the whole picture.

A comprehensive geriatric assessment (CGA) is the clinical tool designed for exactly this situation. It's a structured, multi-domain evaluation conducted by a geriatrician or a geriatric assessment team — typically a physician, nurse, social worker, and sometimes a pharmacist, physical therapist, or psychologist working together. The assessment takes 1-3 hours and evaluates your parent across every dimension that affects their ability to live safely and independently.

What the Assessment Covers

A CGA evaluates seven clinical domains. Understanding what's tested helps you prepare and helps you interpret the results.

Cognition. Standardized screening tools — the Mini-Mental State Exam (MMSE), the Montreal Cognitive Assessment (MoCA), or the Mini-Cog — measure memory, attention, language, executive function, and spatial reasoning. The geriatrician is looking for patterns that distinguish normal aging from mild cognitive impairment from dementia.

Functional status. Two scales are used. Activities of Daily Living (ADLs) measure basic self-care: bathing, dressing, toileting, transferring (getting in and out of bed or a chair), continence, and eating. Instrumental Activities of Daily Living (IADLs) measure more complex tasks: managing medications, handling finances, using transportation, shopping, preparing meals, housekeeping, and using the phone. A decline in IADLs typically precedes a decline in ADLs and signals that your parent may need increasing support.

Mobility and fall risk. The Timed Up and Go (TUG) test — stand up from a chair, walk 10 feet, turn around, walk back, sit down — is the standard screening. The geriatrician also assesses gait, balance, lower extremity strength, and whether your parent uses assistive devices correctly. A history of falls in the past 12 months and the circumstances of each fall are critical data points.

Medication review. The full medication list — prescriptions, over-the-counter drugs, supplements — is reviewed for polypharmacy, drug interactions, potentially inappropriate medications (using the AGS Beers Criteria), and deprescribing opportunities. This review alone often identifies medications contributing to falls, confusion, or other symptoms the family has been attributing to aging.

Nutrition. Weight changes, appetite, ability to prepare and eat meals, hydration status, and screening for malnutrition. The Mini Nutritional Assessment (MNA) is commonly used. Unintentional weight loss of more than 5% in 6 months is a clinical red flag.

Mood and mental health. Depression screening using the Geriatric Depression Scale (GDS) or the PHQ-9. Depression in older adults frequently mimics cognitive decline — a condition geriatricians call "pseudodementia" — and it's treatable once identified. Anxiety, sleep disturbance, and social isolation are also assessed.

Social and environmental factors. Living situation, caregiver availability and caregiver stress, financial resources, safety of the home environment, advance care planning status (whether a healthcare power of attorney and advance directive are in place), and community support services. This domain connects the clinical assessment to the practical reality of your parent's daily life.

How to Request One

Start with your parent's primary care physician and say: "I'd like a referral for a comprehensive geriatric assessment." Specify why — cognitive changes, increasing falls, medication complexity, functional decline, or any combination. A clear clinical rationale strengthens the referral.

If the PCP doesn't make geriatric referrals routinely, contact your nearest academic medical center or VA hospital directly. Most have geriatric assessment programs that accept referrals. Wait times can be 2-3 months, so request the referral early rather than waiting for a crisis.

Medicare covers the CGA as a diagnostic evaluation and management service. Under Original Medicare, you'll pay the standard 20% coinsurance after the Part B deductible. Medicare Advantage plans cover it too, though some require prior authorization.

How to Prepare

Bring everything the assessment team will need:

• Complete medication list (prescriptions, OTC, supplements)
• Symptom journal from the past 2-4 weeks
• Fall history (dates, circumstances, injuries)
• Any prior cognitive test results
• List of all current providers and specialists
• Legal documents (healthcare POA, advance directive) — the social worker will ask about these
• A written description of your parent's typical day — what they can do independently and where they need help

Plan for the assessment to take 2-3 hours. Your parent may be tired by the end, so schedule it in the morning when energy and cognitive function are typically at their peak. Bring a snack and water.

What Happens After

The assessment team produces a comprehensive care plan that synthesizes findings across all seven domains. This plan may include:

• Medication changes (adding, adjusting, or discontinuing drugs)
• Referrals to specialists (neurologist, physical therapist, occupational therapist, psychiatrist)
• Home safety modifications
• Community service connections (Area Agency on Aging, adult day programs, meal delivery)
• Advance care planning recommendations
• Caregiver support resources

Ask for a written copy of the care plan and share it with every member of your parent's medical team. The CGA creates the unified baseline that all future care decisions should build from.

The Caregiver's Guide to Doctor Communication includes a geriatric assessment preparation worksheet and a post-assessment action plan template to help you implement the team's recommendations systematically.