Who needs CGA and when

CGA is most useful when complexity, vulnerability and service fragmentation interact. Learners need triggers without rigid score-based gatekeeping.

CGA is particularly useful when older people have frailty, multimorbidity, geriatric syndromes, functional decline, recurrent unplanned care, polypharmacy or complex transitions. Selection should remain clinical and service-dependent. Age alone is not an indication, and no single frailty score should function as a gatekeeper.

CGA can be reactive after a crisis, proactive in community or ambulatory care, or triggered by a transition such as discharge, care-home move, surgery or rehabilitation. A useful trigger is complexity plus risk of fragmentation: when several problems and services interact, a coordinated plan becomes more valuable.

NICE multimorbidity guidance supports person-centred care when treatment burden, multiple services, frailty, falls, polypharmacy or unplanned care make single-disease management inadequate.

Mrs Morgan’s fall is not an isolated event. She has acute illness, recent functional decline, polypharmacy and uncertainty about how safely she can return home. This combination makes CGA appropriate.

Trigger-point scenario carousel: acute ward, GP review, care home, perioperative clinic and discharge. Learner decides whether CGA is indicated and why.

• Document baseline as well as current state.
• Use collateral information when history is incomplete.
• Convert every important finding into an action or explicit decision not to act.
• State uncertainty rather than disguising it as a score.
• Name ownership and review whenever the plan crosses teams or settings.

Where in your service are older people most likely to need CGA but not receive coordinated assessment?