Comprehensive Geriatric Assessment (CGA), Frailty & Function

AANPCB Adult-Gerontology Primary Care Nurse Practitioner A-GNP

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1 Exam Structure, APRN Foundations & Geriatric Assessment

A-GNP Exam Logistics, Blueprint & Scoring Structure APRN Scope of Practice, Consensus Model & Interprofessional Collaboration Comprehensive Health History & Subjective Assessment Across Adult Lifespan Comprehensive Physical Examination & Clinical Assessment Skills

2 Health Assessment, Diagnostic Reasoning & Clinical Procedures

Diagnostic Reasoning, Test Interpretation & Clinical Decision-Making Screening Guidelines & Evidence-Based Health Promotion (USPSTF) Comprehensive Geriatric Assessment (CGA), Frailty & Function In-Office Clinical Procedures, ECG Interpretation & Minor Surgical Skills

3 Cardiovascular & Peripheral Vascular Disorders

Essential Hypertension & Hypertensive Urgency/Emergency Management Coronary Artery Disease, Acute Coronary Syndromes & Post-MI Care Heart Failure (HFrEF & HFpEF) Diagnosis, Staging & 4-Pillar GDMT Arrhythmias (Atrial Fibrillation), Valvular Heart Disease & PAD

4 Respiratory, HEENT & Dermatological Disorders

Asthma Management across the Adult Lifespan (GINA Guidelines) Chronic Obstructive Pulmonary Disease (COPD) Staging & Management (GOLD Guidelines) Community-Acquired Pneumonia & Lower Respiratory Tract Infections Common HEENT Disorders: Otitis, Sinusitis, Pharyngitis, Glaucoma & Macular Degeneration

5 Endocrine, Metabolic & Renal/Genitourinary Disorders

Type 2 Diabetes Mellitus Management Thyroid Disorders: Hypothyroidism, Hyperthyroidism & Subclinical Disease Chronic Kidney Disease (CKD) Staging & Diabetic/Hypertensive Nephropathy Genitourinary Disorders: BPH, Urinary Incontinence, UTIs & Prostatitis

6 Gastrointestinal, Hematologic & Immunologic Disorders

Upper Gastrointestinal Disorders: Dyspepsia, GERD, PUD & H. pylori Lower Gastrointestinal Disorders: IBS, IBD, Diverticulitis & Colorectal Screening Liver, Biliary & Pancreatic Disorders: NAFLD/MASLD, Cirrhosis & Cholecystitis Hematologic & Immunologic Disorders: Anemias, Anticoagulation & Immunizations

7 Neurological, Cognitive & Psychiatric Disorders

Cognitive Assessment: Delirium, Dementia & Mild Cognitive Impairment Neurological Disorders: Stroke, TIA, Parkinson's Disease & Headache Syndromes Major Depressive Disorder & Anxiety Disorders in Adults & Older Adults Sleep Disorders, Insomnia & Restless Legs Syndrome

8 Geriatric Syndromes, Polypharmacy & Deprescribing

The Beers Criteria & STOPP/START Criteria for Potentially Inappropriate Medication Use Polypharmacy Management, Pharmacokinetics/Pharmacodynamics in Aging & Deprescribing Protocols Fall Risk Assessment (CDC STEADI), Gait/Balance & Mobility Impairments Pressure Injury Prevention/Staging, Urinary/Fecal Incontinence & Frailty Assessment

9 APRN Professional Practice, Ethics, Quality & Healthcare Policy

Musculoskeletal Disorders: Osteoarthritis, Osteoporosis, Gout & Back Pain Dermatological Disorders: Lesions, Skin Cancers, Infections & Rash Evaluation Palliative Care, Advance Care Planning, Pain Management & End-of-Life APRN Professional Practice, Quality Improvement, Ethics & Healthcare Policy

Comprehensive Geriatric Assessment (CGA), Frailty & Function

Key Takeaways Explain This Topic AI

The Comprehensive Geriatric Assessment evaluates five core domains: medical, functional, cognitive, psychological, and environmental/social factors.

Basic ADLs assess self-care independence (Katz Index), while Instrumental ADLs (Lawton Scale) evaluate complex community living tasks sensitive to early executive cognitive decline.

The Fried Frailty Phenotype identifies frailty based on 3+ criteria: unintentional weight loss, exhaustion, low physical activity, slow gait speed, and weak grip strength.

The CDC STEADI framework standardizes fall screening, mobility assessment (TUG >12s), orthostatic hypotension management, and multifactorial fall prevention.

Last updated: July 2026

Comprehensive Geriatric Assessment (CGA), Frailty & Function
Principles of Comprehensive Geriatric Assessment (CGA)

Geriatric care requires shifting from a disease-centric diagnostic model to a holistic, functional paradigm. The Comprehensive Geriatric Assessment (CGA) is a multidimensional diagnostic process evaluating an older adult's functional capability, physical health, cognitive/psychological well-being, and social/environmental support. The CGA formulates an integrated plan for therapy, rehabilitation, and long-term follow-up.

The Five Core Domains of CGA

Medical Domain: Evaluates chronic disease burden, multimorbidity, polypharmacy (utilizing the AGS Beers Criteria 2023 update), sensory impairments, nutritional status, and geriatric syndromes (incontinence, pain).

Functional Domain: Evaluates basic self-care capabilities and complex instrumental tasks necessary for independent living.

Cognitive Domain: Assesses executive function, memory, attention, and screens for dementia, mild cognitive impairment (MCI), and delirium.

Psychological Domain: Evaluates mood disorders, late-life depression, anxiety, and coping mechanisms.

Environmental and Social Domain: Assesses home safety, architectural hazards, financial security, caregiver stress, and community support.

Functional Assessment: ADLs, IADLs & Physical Performance

Functional status is the most powerful predictor of health outcomes, hospitalization, and mortality in older adults. Functional decline is often the initial presentation of an acute medical illness.

Basic Activities of Daily Living (ADLs) & The Katz Index

ADLs represent basic physical self-care tasks. The Katz Index of Independence in Activities of Daily Living assesses 6 core functions:

Bathing: Washing oneself independently in tub or shower.

Dressing: Selecting clothing and dressing independently.

Toileting: Getting to/from toilet, cleaning oneself, adjusting clothes.

Transferring: Moving independently into and out of bed or chair.

Continence: Complete voluntary bowel and bladder control.

Feeding: Getting food from plate to mouth independently.

Scoring: 1 point per independent task (0 to 6). Score 6 = full independence; 4 = moderate impairment; ≤ 2 \le 2 ≤ 2 = severe dependency.

Instrumental Activities of Daily Living (IADLs) & The Lawton Scale

IADLs involve complex cognitive skills required for independent community living. The Lawton Instrumental Activities of Daily Living Scale evaluates 8 domains:

Telephone Use: Dialing numbers and answering calls.

Shopping: Purchasing food and necessities independently.

Food Preparation: Planning, cooking, and serving meals.

Housekeeping: Maintaining a clean home.

Laundry: Washing and drying clothing.

Transportation: Driving or navigating public transit.

Medication Management: Taking correct doses at scheduled times.

Financial Management: Budgeting, writing checks, paying bills.

Clinical Pearl: Loss of IADLs precedes loss of ADLs. Because tasks like managing medications or finances require high-level executive functioning, a decline on the Lawton Scale is often the earliest indicator of mild cognitive impairment or early dementia.

Performance-Based Mobility Measures

Timed Up and Go (TUG) Test: The patient rises from a chair, walks 3 meters (10 feet), turns, walks back, and sits down.

Interpretation: Completion time > 12 > 12 > 12 seconds identifies high fall risk.

4-Meter Gait Speed Test: Gait speed < 0.8 m/s < 0.8\text{ m/s} < 0.8 m/s indicates physical frailty, mobility limitation, and increased mortality risk.

Short Physical Performance Battery (SPPB): Combines balance, gait speed, and chair stands. Score < 10 < 10 < 10 indicates vulnerability.

Frailty Syndromes, Sarcopenia & Clinical Stratification

Frailty is a biological syndrome of decreased physiological reserve resulting from multi-system dysregulation.

The Fried Frailty Phenotype

Diagnoses frailty based on the presence of 3 or more of 5 criteria:

Unintentional Weight Loss: Loss of ≥ 10 \ge 10 ≥ 10 lbs (or ≥ 5 % \ge 5\% ≥ 5% ) in the past year.

Self-Reported Exhaustion: Increased effort required for daily tasks.

Low Physical Activity: Low weekly energy expenditure.

Slowness: Slow walking speed over 15 feet.

Weakness: Low handgrip strength measured via dynamometer.

Categorization: 0 criteria = Robust ; 1-2 = Pre-Frail ; ≥ 3 \ge 3 ≥ 3 = Frail .

Sarcopenia Assessment

Sarcopenia is the progressive loss of skeletal muscle mass and strength. Screening utilizes the SARC-F questionnaire . Confirmation involves grip strength ( < 27 kg < 27\text{ kg} < 27 kg in men, < 16 kg < 16\text{ kg} < 16 kg in women) and DXA scan for appendicular lean muscle mass.

Cognitive & Psychological Screening Tools
Mini-Cog Screening Tool

A 3-minute screening instrument combining:

Three-Item Recall: Clinician presents 3 non-related words.

Clock Drawing Test (CDT): Patient draws clock face, numbers, and hands set to 10 past 11.

Recall Verification: Patient recalls the 3 words.

Scoring: 1 point per recalled word (0-3); CDT rated Normal (2 points) or Abnormal (0 points). Score 0 to 2 indicates high likelihood of cognitive impairment.

Montreal Cognitive Assessment (MoCA)

A 30-point screening tool sensitive for Mild Cognitive Impairment (MCI). Score < 26 / 30 < 26 / 30 < 26/30 suggests cognitive impairment (add 1 point if education ≤ 12 \le 12 ≤ 12 years).

Geriatric Depression Scale (GDS-15)

A 15-item self-report tool excluding somatic symptoms. Score ≥ 5 \ge 5 ≥ 5 indicates clinical depression.

CDC STEADI Fall Prevention & Elder Abuse Screening
CDC STEADI Framework

Screening (Three Key Questions):

"Have you fallen in the past year?"
"Do you feel unsteady when standing or walking?"
"Do you worry about falling?"

Multifactorial Assessment & Interventions:

Medication Reconciliation: Deprescribe psychoactive medications.

Orthostatic Blood Pressure: Check BP supine and at 1 and 3 min standing. Systolic drop ≥ 20 mmHg \ge 20\text{ mmHg} ≥ 20 mmHg or Diastolic drop ≥ 10 mmHg \ge 10\text{ mmHg} ≥ 10 mmHg defines orthostatic hypotension .

Home Safety & Physical Therapy: Refer to occupational therapy for home safety and physical therapy for gait/balance training (Tai Chi).

Vitamin D: Recommend 800-1000 IU daily for deficient older adults at fall risk.

Elder Maltreatment & Caregiver Strain

APRNs are mandatory reporters for suspected elder abuse (physical, emotional, sexual, financial exploitation, neglect). Assess caregiver stress using the Zarit Burden Interview (ZBI) to prevent caregiver burnout and elder neglect.