Brief Geriatric Assessment (BGA): An evidence-based tool for improving care of older adults

Summary

The Brief Geriatric Assessment is an approach for rapidly identifying high-risk older adults and guiding timely interventions in busy clinical settings. Unlike the Comprehensive Geriatric Assessment, albeit the gold standard, which is resource-intensive, the Brief Geriatric Assessment offers a scalable alternative by using validated, time-efficient tools to screen for common geriatric syndromes. This narrative state-of-the-art review synthesizes the evidence and best practices regarding the concept, structure, and clinical application of the Brief Geriatric Assessment. It compares the Brief Geriatric Assessment and Comprehensive Geriatric Assessment from theoretical and practical perspectives and outlines how the former can be integrated into healthcare settings, with a focus on its potential utility within the Saudi healthcare system in the context of population aging and health system transformation. The review findings suggest that the Brief Geriatric Assessment should be more broadly adopted to improve the quality and efficiency of care for older adults.

Introduction

The global population is aging rapidly, with projections indicating that by 2050, 1 in 6 people worldwide will be aged ≥65 years [1]. In Saudi Arabia, the proportion of older adults is expected to triple over the next 2 decades, presenting new challenges for healthcare systems that are unaccustomed to managing the complexities of aging [2]. Older patients often have multiple comorbidities, atypical symptoms, polypharmacy, functional decline, and psychosocial vulnerabilities [3]. These factors necessitate a holistic and multidimensional approach to assessment and care planning.

The Comprehensive Geriatric Assessment (CGA) is widely recognized as the gold standard for evaluating older adults [4]. It systematically addresses the medical, functional, cognitive, psychological, and social domains to guide personalized interventions. However, its implementation in routine clinical practice remains limited owing to time constraints, lack of trained personnel, and logistical burdens, especially in fast-paced environments such as primary care clinics or emergency departments [5].

In response to these limitations, the Brief Geriatric Assessment (BGA) has emerged as a pragmatic alternative. The BGA aims to quickly identify high-risk older adults using validated, time-efficient screening tools that can be administered by a range of healthcare professionals [6]. Unlike CGA, the application of which typically requires a multidisciplinary team and a duration of 45–90 min, BGA can be completed in <15 min and serves as a frontline filter to determine which patients require full CGA or specialized referrals.

This review provides a state-of-the-art synthesis of the BGA concept and highlights its theoretical foundations, toolsets, implementation strategies, and advantages, compared to the CGA and aims to summarize and critically appraise the existing literature on BGA as an alternative or complementary approach to the CGA. Additionally, it examines how the BGA fits within the broader landscape of geriatric care in Saudi Arabia, aligning with national priorities under Vision 2030 to promote healthy aging, reduce avoidable hospitalizations, and enhance the efficiency of health services.

Methods

A targeted literature search was performed using PubMed, Scopus, and Google Scholar from January 2014 to May 2025. The following keywords and Boolean operators were used: “Brief Geriatric Assessment” OR “Rapid Geriatric Assessment” OR “Screening Tools” AND “Older Adults” AND “Comprehensive Geriatric Assessment.” Additional references were retrieved by scanning the bibliographies of the relevant review articles and clinical guidelines.

The following inclusion criteria were considered: 1) peer-reviewed articles published in English; 2) original studies, reviews, and guidelines focusing on geriatric screening, BGA tools, or comparisons with CGA; and 3) publications with clinical relevance to primary care, acute care, or transitional settings. Articles were excluded if they did not directly address BGA concepts or tools or if they were purely theoretical without clinical application. Preference was given to studies aligned with the guidelines of international geriatric societies, including the American Geriatrics Society, National Institute for Health and Care Excellence, and World Health Organization.

Data regarding the BGA domains, tool validity, time efficiency, and clinical utility were extracted. The findings were qualitatively synthesized to highlight the comparative advantages and practical applications of the BGA in contemporary healthcare systems, including the Saudi context.

CGA vs. BGA: conceptual and practical comparison

The CGA is a multidimensional, interdisciplinary process designed to evaluate the medical, functional, psychological, and social capabilities of older persons aged 60 years and older, and to develop a coordinated care plan. Numerous studies and guidelines endorse the CGA as the gold standard for geriatric evaluation, especially in inpatient or long-term care settings [4,7]. Despite its proven benefits, the CGA is resource-intensive and often underutilized in fast-paced environments, such as primary care, emergency departments, and transitional clinics [5].

To address these limitations, the BGA emerged as a pragmatic alternative. The BGA uses brief, validated tools to assess core geriatric syndromes, such as frailty, functional impairment, cognitive decline, and fall risk, with a focus on rapid administration and decision-making [6,8]. Table 1 provides a brief comparison between CGA and BGA. BGA is particularly relevant in health systems that aim to scale geriatric screening without the full infrastructure required for CGA. It acts as a frontline filter to prioritize patients who require the complete CGA, referral to specialized services, or proactive care interventions [9,10]. In Saudi Arabia, where population aging and primary care enhancement are key pillars of Vision 2030, implementing the BGA can play a crucial role in improving health outcomes in older adults [11].

Table 1.

Comparison of the comprehensive geriatric assessment and brief geriatric assessment.

Feature	Comprehensive geriatric assessment	Brief geriatric assessment
Purpose	In-depth multidimensional evaluation of older adults	Rapid identification of risk and care needs
Domains	Medical, functional, cognitive, psychosocial, nutritional	Frailty, cognition, mobility, mood, function
Completion time	45–90 min	5–15 min
Personnel required	Multidisciplinary team (geriatrician, nurse, physical therapist, and social worker)	Generalist provider or trained nurse
Common settings	Geriatric clinics, hospitals, rehabilitation centers	Primary care, emergency department, community
Tool examples	Full cognitive batteries, Instrumental Activities of Daily Living/Activities of Daily Living scales, Geriatric Depression Scale-15	Mini-Cog, FRAIL*, Timed Up and Go tests, Patient Health Questionnaire-2, Geriatric Depression Scale-5
Output	Personalized care plan, referral, ongoing management	Positive result on screening → referral for the Comprehensive Geriatric Assessment or care pathways
Limitations	Resource-heavy, requires time and training	May miss complex cases, needs local validation

^*Fatigue, Resistance (muscle weakness), Ambulation (slow walking speed), Illnesses (co-morbidities), and Loss of weight

Validated tools used in the BGA

The BGA integrates a set of domain-specific screening tools that are time-efficient, validated, and practical for nonspecialist providers across various clinical settings. These tools focus on core geriatric syndromes including cognitive impairment, frailty, mobility, fall risk, functional dependency, depression, and malnutrition. Each tool is designed to take <5 min, allowing the BGA to be completed within a typical outpatient visit or triage evaluation.

Table 2 summarizes the widely accepted tools frequently used in the BGA, including their domains, administration times, and strengths in clinical decision-making.

Table 2.

Validated tools used in brief geriatric assessment.

Domain	Tool	Purpose	Time to administration	Validation and use
Cognition	Mini-Cog	Screening for dementia	∼3 min	Validated in primary care and emergency settings; high specificity; recommended by the American Geriatrics Society and the National Institute for Health and Care Excellence [24,25]
	General Practitioner Assessment of Cognition	Cognitive screening with informant	∼5 min	Effective in multicultural and low-literacy populations; endorsed in the Australian and UK* guidelines [26]
Mobility/ Falls	Timed Up and Go test	Gait, balance, fall risk	∼2 min	Predictive of falls and functional decline; part of the WHO† and Brief Geriatric Assessment frailty pathways [27]
Frailty	FRAIL‡ Scale	Identifies frailty risk	∼2 min	Simple 5-item tool; validated in community and primary care settings [28]
	Clinical Frailty Scale	Frailty staging	∼1 min	Visual 9-point scale; used in the emergency department and inpatient settings [29]
Mood	Geriatric Depression Scale-5	Screens for depression	∼2 min	Short form with high sensitivity and specificity for older adults [30]
	Patient Health Questionnaire-2	Depressive symptoms	<1 min	Ultra-brief screen; widely used across clinical populations [31]
Function	Katz Activities of Daily Living	Basic activities of daily living	∼3 min	Identifies functional dependence; used in home care and hospital discharge planning [32]
	Lawton Instrumental Activities of Daily Living	Instrumental daily activities	∼5 min	Assesses ability to live independently; useful in early functional decline [33]
Nutrition	Mini Nutritional Assessment-Short Form	Nutritional risk and malnutrition	∼4–5 min	Endorsed by ESPEN§ and the WHO for early detection in older adults [34]

^*United Kingdom;

^†World Health Organization;

^‡Fatigue, Resistance (muscle weakness), Ambulation (slow walking speed), Illnesses (co-morbidities), and Loss of weight;

^§The European Society for Clinical Nutrition and Metabolism.

These tools can be flexibly used based on clinical settings and patient characteristics. For instance, a primary care physician may use the Mini-Cog, FRAIL, and Geriatric Depression Scale (GDS)-5 for routine screening, whereas a home care nurse may use the Katz Activities of Daily Living (Katz ADL) and Mini Nutritional Assessment-Short Form for comprehensive in-home assessments. The modular nature of the BGA enables integration into workflows with minimal disruption while promoting the early identification of modifiable risk factors in older adults.

Clinical utility and implementation of the BGA

The BGA offers practical advantages across a range of healthcare settings by enabling the early detection of geriatric syndromes and functional decline without the resource burden of complete CGA. Its integration into routine workflows supports proactive care, risk stratification, and targeted referrals, which are essential for systems facing growing older adult populations and resources constraints.

Primary care settings

In primary care, the BGA can be included in routine follow-up evaluations for chronic diseases, annual wellness examinations, or opportunistic encounters. Tools such as the FRAIL scale, Mini-Cog, and Patient Health Questionnaire-2 can be administered in less than 10 min by a nurse or physician, flagging patients who require further evaluation or multidisciplinary care planning. Evidence shows that implementing frailty and cognitive screening in primary care improves early intervention rates and reduces the risk of hospitalization [12,13].

Emergency departments

Older adults often present to the emergency department (ED) with nonspecific complaints, and cognitive or functional decline may go unrecognized. Studies have demonstrated that brief screening tools such as the Clinical Frailty Scale or Timed Up and Go (TUG) test are feasible for ED triage and can predict poor outcomes, including admission, functional decline, and mortality [14,15]. EDs with integrated BGA protocols have reported improved identification of vulnerable patients and more appropriate care transitions.

Inpatient and transitional care

In acute wards or at hospital discharge, the BGA can help identify patients at high risk for readmission, functional decline, or post-discharge complications. A study across European hospitals found that BGA elements, such as nutritional and mobility assessments, were strong predictors of 30-day outcomes and helped tailor discharge plans [16].

Application in the Saudi context

Saudi Arabia's healthcare transformation under Vision 2030 emphasizes population health, integrated care, and proactive aging strategies. However, geriatric services remain concentrated in urban centers, and many older adults are managed in primary care without structured assessment protocols. Local research highlights the feasibility and need to integrate BGA into family medicine and primary care clinics to close the gaps in frailty screening and promote healthy aging [17,18]. Training frontline providers and embedding BGA tools in electronic health records (EHRs) would significantly enhance their scalability and system readiness.

Implementation considerations

To optimize BGA implementation, healthcare systems should provide training for general practitioners, nurses, and allied health professionals; standardize tools with clinical decision support integration into EHRs; define care pathways for positive screens (such as referral to the geriatrics department, CGA, or care coordination); and monitor outcomes such as reduced admissions, improved functional status, and patient satisfaction.

Discussion

The growing global and regional demands for age-responsive care models underscore the need for scalable geriatric assessment strategies. Although the CGA remains the gold standard for the multidimensional evaluation of older adults, its complexity and resource demands limit its routine application in many settings, especially in primary care, emergency services, and under-resourced regions [4,5]. In contrast, the BGA has consistently demonstrated value as a frontline screening approach for identifying high-risk older adults and facilitating timely interventions. This narrative review highlights that the BGA is not intended to replace the CGA but to act as a triaging and targeting tool that could help direct limited geriatric resources more efficiently. Evidence supports the utility of the BGA in improving the early detection of frailty, cognitive impairment, malnutrition, and functional decline, which are predictive of hospitalization, institutionalization, and mortality [19,20,21].

The BGA tools, such as the Mini-Cog, FRAIL, and TUG test, have been validated across diverse populations and care settings. These instruments demonstrate high sensitivity, require minimal time to administer, and can be applied by a wide range of healthcare professionals [22,23]. The successful implementation of the BGA in real-world settings requires clinical training, workflow integration, and digital enablers such as EHR prompts and risk stratification dashboards.

In Saudi Arabia, where population aging is accelerating and the healthcare system is undergoing transformation under Vision 2030, adopting the BGA across primary and community care can improve geriatric care coverage and continuity. Local pilot studies have demonstrated its feasibility and acceptance among family physicians and nurses [11,13]. National rollout efforts could be aligned with ongoing initiatives in digital health, chronic disease management, and accountable care pathways. However, the BGA is not without limitations. It may miss subtle or complex geriatric issues, especially in the absence of multidisciplinary interpretations. Screening for affected patients requires appropriate referral systems and the capacity to deliver the full CGA or care planning. Thus, the success of the BGA depends not only on tool selection but also on organizational readiness, follow-up structures, and leadership support. Future research in the context of Saudi should focus on validating culturally adapted tools, measuring BGA's impact on health outcomes and system performance, and scaling up workforce training in geriatric competencies. A hybrid model combining opportunistic BGA and selective CGA may offer the most sustainable path forward.

In conclusion, the BGA offers a timely, evidence-based solution to improve the early detection of geriatric syndromes and optimize care delivery for older adults, especially in settings where the full CGA is impractical. By using brief and validated tools across key domains, the BGA enables non-experts to rapidly screen for functional decline, cognitive impairment, frailty, and malnutrition. The successful integration of the BGA into primary care and emergency settings has shown promise globally and holds significant potential in Saudi Arabia's evolving healthcare landscape. To maximize its impact, the BGA should be embedded within digital workflows, supported by training and referral pathways, and aligned with broader strategies for healthy aging and healthcare transformation. As the demand for age-friendly health systems grows, the BGA can serve as a foundational tool for targeted, person-centered geriatric care.

Disclosure

The author declares no conflicts of interest. The work was not supported or funded by any pharmaceutical or device company.

AI disclosure

AI assistance (ChatGPT, OpenAI GPT-5) was used for language refinement, formatting alignment with SMJ requirements, and organization of the title page. The intellectual content, data interpretation, and conclusions were entirely authored by Dr. Assim AlAbdulKader.