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Comprehensive geriatric assessment template

Long-Term Care Comprehensive Geriatric Assessment Form - cgjonline 2026

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The document is a Long-Term Care Comprehensive Geriatric Assessment Form designed to evaluate the cognitive, emotional, physical, and social status of elderly patients. It includes sections for assessing mobility, communication, nutrition, daily living activities (ADLs), and medical history. The form also addresses legal considerations such as advanced directives and code status, along with family stress levels and current medication adjustments. It aims to provide a thorough overview of the patient's health and care needs.

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Click ‘Get Form’ to open it in the editor.
Begin by filling in the 'Chief lifelong occupation' field to provide context about the individual's background.
Proceed to the 'Cognitive Status' section. Select from options like 'WNL', 'Dementia', or 'Other', and enter the MMSE score if applicable.
In the 'Mobility' section, assess balance and elimination needs, and fill out details regarding nutrition and activities of daily living (ADLs).
Complete the 'Emotional' section by indicating any mood disorders or anxiety present, selecting from provided options.
Evaluate communication abilities under 'Communication', noting any impairments in speech or hearing.
Fill out the 'Behaviours' section, marking any aggressive or non-aggressive behaviors observed.
Address health concerns such as infection control measures and footcare needs in their respective sections.
Finally, complete legal information including advanced directives and code status before saving your work.

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What are the four functional domains of geriatric syndromes?

Four shared risk factors have been identified across all of these geriatric syndromes, including older age, cognitive impairment, functional impairment, and impaired mobility.

What are the five major components of a comprehensive nursing assessment of an older patient?

This series discusses the comprehensive assessment of older peoples care needs, which should cover at least five domains: physical, psychological, functional, social and spiritual.

What is included in a comprehensive geriatric assessment?

It requires evaluation of multiple issues, including physical, cognitive, affective, social, financial, environmental, and spiritual components that influence an older adults health.

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How do you complete a CGA?

The four main dimensions covered in a CGA should include physical, functional, psychological and social assessment as follows: Physical assessment. Presenting complaint. Advanced directives. Functional assessment. Activities of daily living. Cognition and mood. Social assessment. Living arrangements.

What are the major components of comprehensive geriatric assessment?

It requires evaluation of multiple issues, including physical, cognitive, affective, social, financial, environmental, and spiritual components that influence an older adults health.

What are the four domains of comprehensive geriatric assessment?

Comprehensive geriatric assessment is a multidimensional process designed to assess the functional ability, health (physical, cognitive, and mental), and socioenvironmental situation of older people.

What are the 4 domains of comprehensive geriatric assessment?

The main geriatric domains to be assessed in CGA are functional status (FS), fatigue, comorbidity, cognition, mental health, social support, nutrition and geriatric syndromes (e.g. dementia, delirium, falls, incontinence, osteoporosis or spontaneous fractures, neglect or abuse, failure to thrive, constipation,

What are the domains of CGA?

Results: The CKD-CGA included 16 domains: cardiovascular disease, diabetes, five frailty phenotype components, depressive symptoms, cognition, five kidney disease quality-of-life components, health literacy, and medication use.