**2. Comprehensive geriatric assessment (CGA) as basic tool of modern geriatry**

Clinical gerontology emphasises an individual approach to old patients (Harari et al., 2007; Soriano et al., 2007). The method of operation is **comprehensive geriatric assessment - CGA**  (Gupta, 2008; Gurcharan & Mulley, 2007; Williams, 2008). Apart from somatic aspects of the health status there are significant items to be underlined: self-sufficiency evaluation, knowledge and evaluation of psychic state and social conditions (see tab. 1).

Much of what has been written on evaluation of the older patient is simply attention to the details of careful clinical assessment. Contemporary emphasis on efficiency and effectiveness of clinical care requires thoughtfulness about any extension of the already lengthy evaluation of complex chronic medical problems that commonly cluster in older persons. Brief screening questions rather than elaborate instruments are appropriate for the first encounters (Stuck, 1995); more detailed assessment should be reserved for patients with demonstrated deficits (Applegate et al., 1990).


Table 1. Comprehensive geriatric assessment

In its multidisciplinary context the geriatry does not substitute other clinical medical branches in care of an old person but completes them with application of **specific geriatric regimen**, which aims to reinforce the independence and improve self-sufficiency of the older patients (Williams, 2008). Following methods are based on principles of **specific geriatric regimen**.


• Social work creating conditions enabling patients to return to home environment (incl. home-care)

Main target of these efforts is improvement in independence and self-sufficiency improvement in older patients (Zavazalova et al., 2007). Geriatric regimen brings benefits especially for patients aged 75+ or even 80+ who are endangered with following risks typical for this age:


38 Pulmonary Embolism

mostly consequences of simultaneously on-going diseases (Goldmann et al., 2000; Fauci et al., 2008). The target of new **interventional gerontology** is extension of active life period and

Information about function can be used in a number of ways: as baseline information, as a measure of the patient's need for support services or placement, (Tallis & Fillit, 2003) as an indicator of possible caregiver stress, (Asplund et al., 2000) as a potential marker of specific disease activity, to determine the need for therapeutic interventions, and to indicate prognosis.

Clinical gerontology emphasises an individual approach to old patients (Harari et al., 2007; Soriano et al., 2007). The method of operation is **comprehensive geriatric assessment - CGA**  (Gupta, 2008; Gurcharan & Mulley, 2007; Williams, 2008). Apart from somatic aspects of the health status there are significant items to be underlined: self-sufficiency evaluation,

Much of what has been written on evaluation of the older patient is simply attention to the details of careful clinical assessment. Contemporary emphasis on efficiency and effectiveness of clinical care requires thoughtfulness about any extension of the already lengthy evaluation of complex chronic medical problems that commonly cluster in older persons. Brief screening questions rather than elaborate instruments are appropriate for the first encounters (Stuck, 1995); more detailed assessment should be reserved for patients with

Somatic status Somatic examination, posture, mobility, continence,

Self-sufficiency ADL- test, ability to keep own household, IADL- test

Mental status cognitive function – MMSE- test, Clock test; depression

Social status social contacts, people available to summon help,

In its multidisciplinary context the geriatry does not substitute other clinical medical branches in care of an old person but completes them with application of **specific geriatric regimen**, which aims to reinforce the independence and improve self-sufficiency of the older patients (Williams, 2008). Following methods are based on principles of **specific** 

• Considerate tailor-made diagnostics and treatment aimed at improvement of life

• Multi-disciplinary team active approach aimed at improvement of self-sufficiency

nutrition, sight, hearing, geriatric syndromes, etc.

scale according Yesavage, etc.

bereavement, removal, dwelling and loneliness risks

**2. Comprehensive geriatric assessment (CGA) as basic tool of modern** 

knowledge and evaluation of psychic state and social conditions (see tab. 1).

Subject of assessment Way of evaluation

sustaining functional abilities for maximum time.

demonstrated deficits (Applegate et al., 1990).

Table 1. Comprehensive geriatric assessment

and/or prevention of dependence

**geriatric regimen**.

quality

• Follow up physiotherapy

**geriatry** 


Evaluation of the older patient can be time-consuming (Topinkova, 2005), even when it is tailored to the problem. Yet, such initial investment can reduce subsequent morbidity and resource utilization and enhance both patient's and physician's satisfaction. Additionally, the assessment can often be accomplished over several visits. Moreover, much can be gleaned from questionnaires filled out by the patient or caregiver in advance as well as from observation.
