Skip to main content

Comprehensive Geriatric Assessment (CGA) in general practice: Results from a pilot study in Vorarlberg, Austria



Most comprehensive geriatric assessment (CGA) programs refer to hospital-based settings. However the body of geriatric healthcare is provided by general practitioners in their office. Structured geriatric problem detection by means of assessment instruments is crucial for efficient geriatric care giving in the community.


We developed and pilot tested a German language geriatric assessment instrument adapted for general practice. Nine general practices in a rural region of Austria participated in this cross-sectional study and consecutively enrolled 115 persons aged over 75 years. The prevalence of specific geriatric problems was assessed, as well as the frequency of initiated procedures following positive and negative tests. Whether findings were new to the physician was studied exemplarily for the items visual and hearing impairment and depression. The acceptability was recorded by means of self-administered questionnaires.


On average, each patient reported 6.4 of 14 possible geriatric problems and further consequences resulted in 43.7% (27.5% to 59.8%) of each problem.

The items with either the highest prevalence and/or the highest number of initiated actions by the GPs were osteoporosis risk, urinary incontinence, decreased hearing acuity, missing pneumococcal vaccination and fall risk. Visual impairment was newly detected in only 18% whereas hearing impairment and depression was new to the physician in 74.1% and 76.5%, respectively.

A substantial number of interventions were initiated not only following positive tests (43.7% per item; 95% CI 27.5% to 59.8%), but also as a consequence of negative test results (11.3% per item; 95% CI 1.7% to 20.9%).

The mean time expenditure to accomplish the assessment was 31 minutes (SD 10 min). Patients (89%) and all physicians confirmed the CGA to provide new information in general on the patient's health status. All physicians judged the CGA to be feasible in everyday practice.


This adapted CGA was feasible and well accepted in the general practice sample. High frequencies of geriatric problems were detected prompting high numbers of problem-solving initiatives. But a substantial number of actions of the physicians following negative tests point to the risks of too aggressive treatment of elderly patients with possibly subsequent negative effects.

Peer Review reports


In the Austrian health care system, general practitioners provide care for more than 90% of the population aged over 75 years. For general practitioners in rural as well as urban regions, effective support strategies for geriatric patient problems are indispensable.

From studies several decades ago it is known that high numbers of undetected problems exist in elderly people, highlighting the need for a systematic approach to geriatric problem detection [1, 2]. Subsumed as comprehensive geriatric assessment (CGA) many initiatives have been started within the last years [35]. Today evidence from randomised controlled trials or systematic reviews on CGA is increasingly available, supporting the use of hospital-based programs with extended ambulatory follow-up [6] and preventive home visits based on CGA with multiple follow-up [7, 8]. The study samples refer to hospital-based and long term multidimensional care settings, performed by groups of geriatricians, geriatric nurses or other specialised health care providers. But working conditions in the general practitioners' offices and the characteristics of a community dwelling geriatric population differ from the settings providing the main evidence up to now.

Therefore, for the implementation of such an instrument in general practice, it is important to recognize the special requirements of the primary care setting. Limited consultation time and small office staffs can cause problems for the adoption of the CGA. Thus, for the use in primary care, the CGA should be concise, easy to perform and take no more than 30 minutes [9, 10].

The aim of our study was to adapt and pilot a CGA instrument in German Language, to measure the prevalence of specific geriatric socio-medical problems in the Austrian senior population and to analyse the subsequent management applied by the primary care physicians. The instrument was to be tested regarding its applicability in daily practice and its acceptability for patients and physicians.


Study design and participants

We performed a cross-sectional study in nine general practices in Vorarlberg, a rural area of Austria. All general practitioners recruited built a convenience sample from a management quality circle.

Patients were equally recruited from all practices. Eligibility criteria were: age over 75 years and the capability to attend the GPs office. We excluded persons with a terminal illness or with a known pre-existing diagnosis of severe dementia. These criteria focused on elderly patients who would most likely benefit from CGA [8]. Patients were assigned prospectively and consecutively to the study, which took place between December 2001 and April 2002. All patients gave written informed consent and agreed to schedule an appointment in the next days for fasting laboratory tests and for the assessment.

Screening instrument

The screening instrument was developed by reviewing the literature with focus on the most common socio-medical geriatric health problems regarding epidemiology and treatment options [5, 7, 9, 11]. Table 1 shows the assessment checklist with the covered areas. For each category we gave pre-specified answers with cut-off values for positive and negative screening tests. For the subsequent management of positive findings, we proposed common-practice problem solving strategies.

Table 1 Geriatric assessment chart

We collected information from the physicians on whether a finding was new to them in an exemplary subset of the variables visual acuity, hearing acuity and depression. We did not collect data on new diagnoses for all clinical domains, because our primary aim was a systematic inventory taking of geriatric problems and its feasibility in the primary care setting.

Prior to the start of the study we gave an introduction of 6 hours to all participating GPs' on the use of the assessment instrument.

Physicians' acceptability

All physicians recorded their time expenditure to complete the screening assessment. Any further actions invoked within the assessment were not part of the time measurement. We recorded the acceptability of the CGA by the practitioners with a self-administered questionnaire. Physicians specified whether the CGA revealed new information about their patients, whether they had any suggestions for improving the CGA and whether they perceived the CGA to be suitable for the general practice setting.

Patients' acceptability

We collected data on the patients' perception of the CGA equally by means of a self-administered questionnaire. Patients specified 1. whether they received new information on their health status 2. whether they considered annual follow-ups of the CGA to be beneficial for their well-being 3. The willingness to pay personally for the health assessment 4. whether they felt embarrassed about the detailed assessment 5. whether the CGA missed any important health issues.

Data on patient acceptability were collected during and after performance of the CGA and either returned to the GP directly or sent to the study coordinator by post. Data were collected only once, follow-up data are not available.

Data analysis

Disease prevalence of this descriptive analysis is estimated by the number of people with a positive screening test out of those examined. Further, any diagnostic or treatment efforts taken by the primary care physicians were analysed in relation to positive or negative screening results by means of 2 × 2 contingency tables for each screening item.

We supposed that screening items which are practically relevant for the physicians might either have a high prevalence and/or might be followed by a high frequency of diagnostic or treatment efforts initiated by the GPs. To therefore generate a rank order of more or less relevant items, we calculated the product of the prevalence times the total proportion of diagnostic or treatment actions initiated by the physician for each item. Items with a high prevalence and/or a high frequency of consequences taken by the GPs reached high product scores and were ranked in descending order in Table 4.

We assessed associations between age (by year), sex (female sex) and the risk for a positive screening test fitting logistic regression models, accounting for the effect of clustering.

Since observations on individuals within the same general practice may be correlated, all analyses took account of the clustering effect in the variance estimation. All analyses were performed using STATA 8.0. We used the survey method of STATA for analysis. The general practice was the primary sampling unit.


Demographic data

The study took place between December 2001 and April 2002. Nine general practitioners volunteered to take part in the study. Their general practice experience varied between 7 and 22 years. Three of nine were female doctors.

124 patients were consecutively enrolled in the study; the data from nine patients had to be excluded because of incomplete data collection. The patients' baseline characteristics are shown in Table 2.

Table 2 Patients baseline characteristics as recorded in the CGA chart (n = 115)

Geriatric assessment

Table 3 shows the prevalence of each screened problem. The frequency of any actions taken by the physicians – as a consequence of a positive test result or following negative test results – are shown in table 4. The items in table 4 are listed in a descending rank order according to the decreasing product score of practical relevance. The detailed management actions undertaken by the physicians irrespective of the screening result are specified in table 5.

Table 3 Prevalence of positive assessment test results
Table 4 Number of disease management actions undertaken by the GPs following positive or negative test results.
Table 5 Frequencies of detailed management actions undertaken by the physicians following positive or negative screening tests.

On average, each patient reported 6.4 of 14 possible problems. Overall diagnostic or therapeutic consequences were taken in 23.9% per patient and test item (95% CI 13.0% to 34.7%) and in 43.7% (95% CI 27.5% to 59.8%) following positive test results.

The test items with either the highest prevalence or the highest proportions of actions undertaken by the GPs were osteoporosis risk, urinary incontinence, decreased hearing acuity, missing pneumococcal vaccination and increased fall risk.

The items hyperlipidemia, hypertension, and hyperglycemia had a fairly high prevalence, but general practitioners initiated further work-up's only in 1.8% to 7.9% of all of cases.

The investigation of whether a detected problem was a new finding for the practitioner was exemplarily done for visual acuity, hearing acuity and depression. In only 6 of 33 cases (18.2%) visual impairment was new to the physician whereas for hearing impairment and depression this information was new in 43 of 58 (74.1%) and 26 of 34 (76.5%) cases, respectively.

In contrast, in a substantial number of 10.7% (95% CI 0.3% to 21.0%) of all cases per item diagnostic or therapeutic procedures were initiated by the physicians despite negative results in the screening. Considerable variability existed in the number of actions following negative tests over the different items, most important concerning osteoporosis risk, fall risk and the immunisation interventions (Table 4).

Significant associations between sex, age and the particular screening item are illustrated in Table 6, non-significant associations are omitted. For every significant association, female patients were clearly at higher risk, after controlling for age. This finding was most obvious for depression.

Table 6 Independent significant associations of risk of the particular screening item by age and sex

Physicians' acceptability of geriatric assessment

The mean time expenditure to solely accomplish the entire geriatric assessment was 31 minutes (SD 10 min), with a minimal requirement of 18 minutes to a maximum of 45 minutes.

All nine physicians confirmed that the geriatric assessment provided new information in general on their patients' health status and that it was feasible in everyday practice. By comments, three of the nine practitioners mentioned that the screening of dementia by means of the MAC-Q Test is inadequate.

Patients' acceptability of geriatric assessment

All but four patients returned the self-administered questionnaire. 99 (89%) of 111 patients estimated the CGA to be potentially supportive for their health condition and well-being; the remaining 11% were sceptical or negative. In 55%, patients stated the CGA to provide new information on their health status, mainly in the area of sensomotory dysfunction (vision, hearing), cognitive impairment and osteoporosis risk. 103 of 111 (93%) wished to attend regular CGA follow-up assessments and 62 of 111 (56%) confirmed the willingness to pay personally for it. The most commonly mentioned missing topics from the patients' point of view were dental health, sexuality, tremor and joint affections. Only a minority of four patients felt embarrassed by the examination.


We have presented the results of a Pilot-Initiative to implement a multidimensional geriatric assessment instrument in a general-practice population in Vorarlberg, Austria. This German-Language instrument was tailored for the use in the GP's office.

Six out of 14 geriatric health problems were identified on average in each patient and nearly half of the positive test items led the physician to take further actions. However initiatives taken by the physicians strongly depend on whether patient problems were previously known or not. We did not systematically score new findings as such throughout the assessment because the primary goal was to test feasibility and focused on initial problem inventory taking. Exemplarily we investigated the gain of new information for the items vision, hearing and depression and found considerable variation ranging from a proportion of only 18% of new cases for low vision up to 76% for depression. Junius [1214] reported that less than half of registered health problems in a CGA were known to the GP's.

Osteoporosis risk, urinary incontinence, reduced hearing acuity, missing pneumococcal vaccination and fall risk were the problems with either the highest prevalence or highest frequency of initiated steps by the physicians. Mainly items on functional impairment and prevention resulted in high number of initiatives taken by the doctors. We suggest that these aspects of the assessment yielded new information on patient problems because these aspects are not usually covered in routine visits to the GP. In contrast, few diagnostic or therapeutic consequences were initiated after GPs detected hyperlipidemia, hypertension or hyperglycemia, despite considerable prevalence rates. We are not able to specify on the basis of our data why a certain discrepancy was found between higher proportions of actions taken after the detection of functional impairment or missing preventive measures (e.g. vaccination) than after measuring pathologic values of plasma lipids, blood pressure or blood glucose. We suggest that physicians have a rather critical attitude towards interventions aiming to increase life expectancy. In addition caution towards risks of multiple medication use or over-treatment might have been an important reason for the restricted use of for example lipid lowering agents [15]. Also a single elevated blood pressure value or elevated fasting blood glucose measurement was not considered to justify an immediate drug therapy in every case and may explain the limited initiatives of the GPs' towards these positive test findings. Nevertheless, the study population consisted of a rather fit group of independent community-dwelling elderly and in certain cases starting treatment can be justified (e.g. combination of cardiovascular risk factors) [16].

We found a high number of actions taken to further assess and treat osteoporosis. In two thirds of all participants DEXA bone measurements were initiated, mainly in women and in singular cases of men at risk (e.g. corticosteroid treatment). But the proportion of DEXA orders varied considerably between physicians. According to the SCORE [17, 18] and ORAI [18, 19] decision rules, elderly female patients within the CGA basically qualify for BMD measurements, but no clear recommendations exist for men [20]. This high number of performed BMD tests during the assessment may reflect a study effect rather than the real attitude of primary care physicians towards BMD-tests. The between-physician variation in the frequency of testing for osteoporosis points towards the problems among family physicians on the management of osteoporosis and on the educational needs on osteoporosis management in primary care [21].

Pneumococcal and influenza vaccinations are widely recommended preventive actions in the elderly population in many European countries and the USA [2224]. The level of vaccination in our population considerably differed between the flu shot (54%) and pneumococcal vaccination (18%). The data are similar to other German-speaking countries [25], but are low compared to US rates [26, 27]. The difference in the coverage between influenza and pneumococcal vaccination in our population reflects the lower acceptance for the pneumococcal vaccine. Promotion for pneumococcal vaccination was being performed only recently [28].

For cognitive impairment patients were referred to specialists in 19% of positive results. For most patients physicians ordered a follow-up after six months although in the protocol a simple follow-up was proposed only for borderline cases (MAC-Q 22–24 points). Participating GPs reported to refrain from undertaking further steps because of limited treatment options [29].

Fall risk was prevalent in nearly half of all patients and was followed in nearly half of all positive cases. Patients' low compliance for exercise programs and hip protectors was the reason for low treatment rates [30].

Hearing was more commonly impaired than vision [31, 32]. Vision was tested with corrective lenses in most cases whereas acoustically impaired patients were equipped with hearing aids only rarely.

Positive testing for depression was identified in up to one third of the senior population and it was strongly associated with the female sex, but not age. We incorporated the GDS-4, a short version of the GDS-15 in the CGA. With a sensitivity of 89% and specificity 65% most patients are identifiable, depending on the severity of the condition [33]. Within the study setting physicians were aware not to miss this treatable condition and judged further efforts necessary in about 60% of positively screened cases. This exceeds the generally low number for referral or treatment for depression in general practice [34].

Compared to other prevalence studies in the elderly 75+ primary care population in Europe [35] we saw broadly about twofold higher prevalences of common problems in our setting, although we assume to have assessed a rather fit elderly population. Not population differences but rather the sensitivity and specificity of the different screening tests might explain the discrepancy. Within the framework of the geriatric screening, the instrument should be simple and easy to handle in general practice, but at the expense of perhaps a substantial number of false positive results leading to over-diagnosis and the risk of over-treatment.

A considerable proportion of diagnostic or therapeutic consequences were initiated even though negative test results had been recorded. In fact for the items osteoporosis risk, fall risk, lack of influenza or pneumococcal vaccination and low vision consequences following negative results were ascertained in 10% up to 62%. Hence some physicians have expanded their efforts after negative tests what might reflect some lack of trust of the GPs' in CGA although impeccable scores of acceptability were quoted in the questionnaire. In addition, patients might have complained about symptoms outside the protocol leading to further interventions. Generally this finding points to a risk that through the accomplishment of CGAs some physicians tend towards over-treatment of elderly patients with potential negative side-effects.

In our population of relatively fit seniors, CGA was welcomed by most patients and physicians as a part of regular health checks. CGA, requiring about half an hour of consultation time was judged to be feasible in daily practice routine. But the time expenditure to initiate further, especially complex work-up is not accounted for in this half an hour. According to patients, we missed important screening items like dental health, sexuality, tremor and joint affections.

Further research should focus on the effectiveness of systematic screening as well as on potential negative effects like over-diagnosis, labelling and over-treatment of geriatric patients through CGAs. The MRC-Trial of assessment and management of older people in the community addresses these questions of effectiveness and its results will bring further clarity [36]. The validation of a German instrument should include effectiveness and practical relevance, as pointed out in this study.


Cognitive impairment was found in 55% of all participants screened and restrictions apply either to the MAC-Q test with a high false-positive rate or test results requiring intellectual or memory capacities must be interpreted with caution.

Statements on the physicians' acceptability might be generalised only with restriction, because the participating physicians are a convenience sample of physicians with a higher than average interest in geriatric health care problems.

We performed no follow-up assessments. Repeated measurements of the score of patient consent and physicians' acceptability during follow-up would add import information. Patients experiencing side effects of over-eager doctors, of embarrassing diagnostic procedures or limited therapeutic possibilities might criticize the CGA later resulting in decreasing patient consent.


Our pilot study showed that an adapted version of a CGA detects a high prevalence of geriatric problems prompting a high number of consecutive diagnostic and therapeutic interventions mainly in the field of functional impairment and prevention. It is applicable in general practice and shows good acceptability. Physicians ostensibly appreciate being guided by the CGA but in some aspects preserve autonomy for decision making.

The CGA should not be seen as an isolated screening instrument, but rather as a clinical checklist to approach elderly patients in general practice. There might be a positive impact on quality of life, but on the same time it carries the risk of side effects of over-diagnosis and too aggressive treatment.


  1. Williams EI, Bennett FM, Nixon JV, Nicholson MR, Gabert J: Sociomedical study of patients over 75 in general practice. Br Med J. 1972, 2: 445-448.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Thomas P: Experiences of two preventive clinics for the elderly. Br Med J. 1968, 2: 357-360.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Rubenstein LZ, Goodwin M, Hadley E, Patten SK, Rempusheski VF, Reuben D, Winograd CH: Working group recommendations: targeting criteria for geriatric evaluation and management research. J Am Geriatr Soc. 1991, 39: 37S-41S.

    Article  CAS  PubMed  Google Scholar 

  4. Rubenstein LZ, Stuck AE, Siu AL, Wieland D: Impacts of geriatric evaluation and management programs on defined outcomes: overview of the evidence. J Am Geriatr Soc. 1991, 39: 8S-16S.

    Article  CAS  PubMed  Google Scholar 

  5. Rubenstein LZ, Josephson KR, Wieland GD, English PA, Sayre JA, Kane RL: Effectiveness of a geriatric evaluation unit. A randomized clinical trial. N Engl J Med. 1984, 311: 1664-1670.

    Article  CAS  PubMed  Google Scholar 

  6. Stuck AE, Siu AL, Wieland GD, Adams J, Rubenstein LZ: Comprehensive geriatric assessment: a meta-analysis of controlled trials. Lancet. 1993, 342: 1032-1036. 10.1016/0140-6736(93)92884-V.

    Article  CAS  PubMed  Google Scholar 

  7. Stuck AE, Aronow HU, Steiner A, Alessi CA, Bula CJ, Gold MN, Yuhas KE, Nisenbaum R, Rubenstein LZ, Beck JC: A trial of annual in-home comprehensive geriatric assessments for elderly people living in the community. N Engl J Med. 1995, 333: 1184-1189. 10.1056/NEJM199511023331805.

    Article  CAS  PubMed  Google Scholar 

  8. Stuck AE, Egger M, Hammer A, Minder CE, Beck JC: Home visits to prevent nursing home admission and functional decline in elderly people: systematic review and meta-regression analysis. JAMA. 2002, 287: 1022-1028. 10.1001/jama.287.8.1022.

    Article  PubMed  Google Scholar 

  9. Lachs MS, Feinstein AR, Cooney L.M.,Jr., Drickamer MA, Marottoli RA, Pannill FC, Tinetti ME: A simple procedure for general screening for functional disability in elderly patients. Ann Intern Med. 1990, 112: 699-706.

    Article  CAS  PubMed  Google Scholar 

  10. Barber JH, Wallis JB: The effects of a system of geriatric screening and assessment on general practice workload. Health Bull (Edinb ). 1982, 40: 125-132.

    CAS  Google Scholar 

  11. Epstein AM, Hall JA, Besdine R, Jr Cumella E, Feldstein M, McNeil BJ, Rowe JW: The emergence of geriatric assessment units. The "new technology of geriatrics". Ann Intern Med. 1987, 106: 299-303.

    Article  CAS  PubMed  Google Scholar 

  12. Junius U, Kania H, Fischer GC: [Ambulatory geriatric screening (AGES) in general practice. 2: Physician assistant questionnaire--medical examination]. Fortschr Med. 1996, 114: 279-280.

    CAS  PubMed  Google Scholar 

  13. Junius U, Kania H, Fischer GC: [Ambulatory Geriatric Screening (AGES) in general practice. 1: Patient questionnaire]. Fortschr Med. 1996, 114: 262-265.

    CAS  PubMed  Google Scholar 

  14. Junius U, Kania H, Fischer GC: [A prevention program for health problems in the elderly. Ambulatory Geriatric Screening (AGES) for use in general practice]. Fortschr Med. 1996, 114: 259-261.

    CAS  PubMed  Google Scholar 

  15. Borchelt M, Horgas AL: Screening an elderly population for verifiable adverse drug reactions. Methodological approach and initial data of the Berlin Aging Study (BASE). Ann N Y Acad Sci. 1994, 717: 270-281.

    Article  CAS  PubMed  Google Scholar 

  16. Shepherd J, Blauw GJ, Murphy MB, Bollen EL, Buckley BM, Cobbe SM, Ford I, Gaw A, Hyland M, Jukema JW, Kamper AM, Macfarlane PW, Meinders AE, Norrie J, Packard CJ, Perry IJ, Stott DJ, Sweeney BJ, Twomey C, Westendorp RG: Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial. Lancet. 2002, 360: 1623-1630. 10.1016/S0140-6736(02)11600-X.

    Article  CAS  PubMed  Google Scholar 

  17. Lydick E, Cook K, Turpin J, Melton M, Stine R, Byrnes C: Development and validation of a simple questionnaire to facilitate identification of women likely to have low bone density. Am J Manag Care. 1998, 4: 37-48.

    CAS  PubMed  Google Scholar 

  18. Cadarette SM, Jaglal SB, Murray TM, McIsaac WJ, Joseph L, Brown JP: Evaluation of decision rules for referring women for bone densitometry by dual-energy x-ray absorptiometry. JAMA. 2001, 286: 57-63. 10.1001/jama.286.1.57.

    Article  CAS  PubMed  Google Scholar 

  19. Cadarette SM, Jaglal SB, Kreiger N, McIsaac WJ, Darlington GA, Tu JV: Development and validation of the Osteoporosis Risk Assessment Instrument to facilitate selection of women for bone densitometry. CMAJ. 2000, 162: 1289-1294.

    CAS  PubMed  PubMed Central  Google Scholar 

  20. Cummings SR, Bates D, Black DM: Clinical use of bone densitometry: scientific review. JAMA. 2002, 288: 1889-1897. 10.1001/jama.288.15.1889.

    Article  PubMed  Google Scholar 

  21. Jaglal SB, Carroll J, Hawker G, McIsaac WJ, Jaakkimainen L, Cadarette SM, Cameron C, Davis D: How are family physicians managing osteoporosis? Qualitative study of their experiences and educational needs. Can Fam Physician. 2003, 49: 462-468.

    PubMed  PubMed Central  Google Scholar 

  22. Ambrosch F, Fedson DS: Influenza vaccination in 29 countries. An update to 1997. Pharmacoeconomics. 1999, 16 Suppl 1: 47-54.

    Article  CAS  PubMed  Google Scholar 

  23. Bridges CB, Fukuda K, Uyeki TM, Cox NJ, Singleton JA: Prevention and control of influenza. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2002, 51: 1-31.

    PubMed  Google Scholar 

  24. Bridges CB, Fukuda K, Cox NJ, Singleton JA: Prevention and control of influenza. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2001, 50: 1-44.

    CAS  PubMed  Google Scholar 

  25. Bovier PA, Chamot E, Bouvier Gallacchi M., Loutan L: Importance of patients' perceptions and general practitioners' recommendations in understanding missed opportunities for immunisations in Swiss adults. Vaccine. 2001, 19: 4760-4767. 10.1016/S0264-410X(01)00223-7.

    Article  CAS  PubMed  Google Scholar 

  26. From the Centers for Disease Control and Prevention. Influenza and pneumococcal vaccination levels among persons aged >/= 65 years--United States, 1999. JAMA. 2001, 286: 413-414.

  27. From the Centers for Disease Control and Prevention. Influenza and pneumococcal vaccination levels among persons aged > or = 65 years--United States, 2001. JAMA. 2002, 288: 2815-2817.

  28. Nichol KL, Zimmerman R: Generalist and subspecialist physicians' knowledge, attitudes, and practices regarding influenza and pneumococcal vaccinations for elderly and other high-risk patients: a nationwide survey. Arch Intern Med. 2001, 161: 2702-2708. 10.1001/archinte.161.22.2702.

    Article  CAS  PubMed  Google Scholar 

  29. Valcour VG, Masaki KH, Curb JD, Blanchette PL: The detection of dementia in the primary care setting. Arch Intern Med. 2000, 160: 2964-2968. 10.1001/archinte.160.19.2964.

    Article  CAS  PubMed  Google Scholar 

  30. van Schoor NM, Smit JH, Twisk JW, Bouter LM, Lips P: Prevention of hip fractures by external hip protectors: a randomized controlled trial. JAMA. 2003, 289: 1957-1962. 10.1001/jama.289.15.1957.

    Article  PubMed  Google Scholar 

  31. Keller BK, Morton JL, Thomas VS, Potter JF: The effect of visual and hearing impairments on functional status. J Am Geriatr Soc. 1999, 47: 1319-1325.

    Article  CAS  PubMed  Google Scholar 

  32. Moore AA, Siu A, Partridge JM, Hays RD, Adams J: A randomized trial of office-based screening for common problems in older persons. Am J Med. 1997, 102: 371-378. 10.1016/S0002-9343(97)00089-2.

    Article  CAS  PubMed  Google Scholar 

  33. D'Ath P, Katona P, Mullan E, Evans S, Katona C: Screening, detection and management of depression in elderly primary care attenders. I: The acceptability and performance of the 15 item Geriatric Depression Scale (GDS15) and the development of short versions. Fam Pract. 1994, 11: 260-266.

    Article  PubMed  Google Scholar 

  34. MacDonald AJ: Do general practitioners "miss" depression in elderly patients?. Br Med J (Clin Res Ed). 1986, 292: 1365-1367.

    Article  CAS  Google Scholar 

  35. van Weel C, Michels J: Dying, not old age, to blame for costs of health care. Lancet. 1997, 350: 1159-1160. 10.1016/S0140-6736(97)08312-8.

    Article  CAS  PubMed  Google Scholar 

  36. Fletcher A, Jones D, Bulpitt C, Tulloch A: The MRC trial of assessment and management of older people in the community: objectives, design and interventions [ISRCTN23494848]. BMC Health Serv Res. 2002, 2: 21-10.1186/1472-6963-2-21.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Linksz A: The development of visual standards: Snellen, Jaeger, and Giraud-Teulon. Bull N Y Acad Med. 1975, 51: 277-285.

    CAS  PubMed  PubMed Central  Google Scholar 

  38. Macphee GJ, Crowther JA, McAlpine CH: Screening for impaired hearing in the elderly. JAMA. 1988, 260: 3589-3590. 10.1001/jama.260.24.3589.

    Article  CAS  PubMed  Google Scholar 

  39. Grob D, Six P, Bopp I, Ongaro G, Behrendt U, Husmann C, Zbinden N: Waid-Guide - Agenda für geriatisches Screening und Assessment. Teil 1: Testsfür die multidimensionale Abklärung. 2000, Eigenverlag.:

    Google Scholar 

  40. Crook TH,III, Feher EP, Larrabee GJ: Assessment of memory complaint in age-associated memory impairment: the MAC-Q. Int Psychogeriatr. 1992, 4: 165-176. 10.1017/S1041610292000991.

    Article  PubMed  Google Scholar 

  41. Katz S, Downs TD, Cash HR, Grotz RC: Progress in development of the index of ADL. Gerontologist. 1970, 10: 20-30.

    Article  CAS  PubMed  Google Scholar 

  42. Lawton MP, Brody EM: Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969, 9: 179-186.

    Article  CAS  PubMed  Google Scholar 

  43. Hofmann W, Nikolaus T, Pientka L, Stuck AE: [The "Geriatric Assessment" Study Group (AGAST): recommendations for the use of assessment procedures]. Z Gerontol Geriatr. 1995, 28: 29-34.

    CAS  PubMed  Google Scholar 

  44. [No authors listed]. Prevention of pneumococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 1997, 46: 1-24.

  45. Podsiadlo D, Richardson S: The timed "Up & Go": a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991, 39: 142-148.

    Article  CAS  PubMed  Google Scholar 

  46. Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, Scherr PA, Wallace RB: A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994, 49: M85-M94.

    Article  CAS  PubMed  Google Scholar 

  47. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001, 285: 2486-2497.

  48. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001, 285: 2486-2497.

  49. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001, 285: 2486-2497.

  50. Mulrow CD, Cornell JA, Herrera CR, Kadri A, Farnett L, Aguilar C: Hypertension in the elderly. Implications and generalizability of randomized trials. JAMA. 1994, 272: 1932-1938. 10.1001/jama.272.24.1932.

    Article  CAS  PubMed  Google Scholar 

  51. Meneilly GS, Tessier D: Diabetes in elderly adults. J Gerontol A Biol Sci Med Sci. 2001, 56: M5-13.

    Article  CAS  PubMed  Google Scholar 

  52. Grob D, Six P, Bopp I, Ongaro G, Behrendt U, Husmann C, Zbinden N: Waid-Guide - Agenda für geriatisches Screening und Assessment. Teil 2: Tests für die klinische Geriatrie. 2000, Eigenverlag.:

    Google Scholar 

  53. Osteoporosis prevention, diagnosis, and therapy. JAMA. 2001, 285: 785-795.

Pre-publication history

Download references


Drs. Erich Rüdisser, Thomas Jungblut, Klaus König, Elisabeth Brändle, Siegfried Hartmann, Annemarie und Christian Bergmeister, Peter Pircher, Michael Oberzinner for collecting the data.

Dr. Klaus Eichler for critically reviewing the manuscript.

Funding: Private initiative "Geriatrics in General Practice" supported by "Caritatis Stiftung Liechtenstein".

Author information

Authors and Affiliations


Corresponding author

Correspondence to Michael Koller.

Additional information

Competing interests

None declared.

Authors' contributions

EM and CM designed the study. MTK analysed the data. All authors participated in the interpretation of the results and the writing of the paper. EM and MTK are guarantors for the paper.

All authors read and approved the final manuscript.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mann, E., Koller, M., Mann, C. et al. Comprehensive Geriatric Assessment (CGA) in general practice: Results from a pilot study in Vorarlberg, Austria. BMC Geriatr 4, 4 (2004).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: