Domain | Question or instrument in CGA | Condition/ Disease |
---|---|---|
SOMATIC | ||
1. Mobility and stability | Have you been fallen once or more in the past six months? | Falls |
 | Do you experience dizziness? | Dizziness |
 | Have you ever had a fracture? | Osteoporosis risk |
2. Medication | Only if patients use medication Do you experience difficulties or side effect with medication use? | Medication safety and side effects |
 | Polypharmacy defined as the use or five or more different medications | Polypharmacy |
 | Medication adherence with the questionnaire of Aburuz [24] | Medication adherence |
3. Nutrition | Short Nutritional Assessment Questionnaire (SNAQ) [25] | Malnutrition |
 | Was the patient dehydrated at admission? | Dehydration |
 | Difficulties with swallowing? | Swallowing disturbance |
 |  | Obesity or underweight |
 | Body mass index | Oral hygiene |
 | Do you have pain in your mouth? |  |
4. Urine and fecal problems | Do you experience urine incontinence? Do you experience fecal incontinence | Incontinence |
 | Do you experience obstipation? | Obstipation |
 | Do you have an indwelling urinary catheter? Did you already have this at home? | Indwelling urinary catheter use |
5. Skin | Do you have pressure ulcer(s)? | Pressure ulcer |
6. Pain | Visual analogue scale for pain [26] | Pain |
7. Allergy | Are you allergic? | Allergy |
PSYCHOLOGICAL | Â | |
1. Delirium | Have you ever experienced a delirium? | Delirium |
 | Confusement Assessment Method [27] |  |
2. Depression | Depression | |
3. Cognition | Mini-Mental State Examination [30] | Cognitive impairement |
4. Anxiety | Do you feel anxious? | Anxiety |
5. Dependency | Do you smoke? | Alcohol, smoking and medication use |
 | Do you use alcohol |  |
 | Do you use benzodiazepines? |  |
FUNCTIONAL | Â | Â |
1. ADL functioning | Katz ADL index score [19] | ADL dependency |
2. IADL functioning | IADL questions of Lawton and Brody [31] | IADL dependency |
3. mobility difficulty | Are you using a walking aid? | Mobility difficulty |
4. Hearing | Do you experience difficulties with hearing, despite the use of a hearing aid? | Hearing impairment |
5. Visual | Do you experience difficulties with your vision, despite the use of glasses? | Visual impairment |
6. Sleep | Do you experience problems with sleeping? | Sleeping disorder |
 | Do you use sleeping medication? If yes, how often? |  |
SOCIAL | Â | Â |
1. Loneliness | De Jong Gierveld-questionnaire [32] | Loneliness |
2. Burden of care giver | Care giver extension of the Minimal Data set | Burden of care giver |
3. Health related quality of life | EQ-6 D [22] | Health related quality of life |