Services

I start my journey with an individual by conducting a Comprehensive Geriatric Assessment (CGA).

A Comprehensive Geriatric Assessment is a multidimensional diagnostic process designed to evaluate an older adult's functional abilities, medical conditions, mental health, social circumstances, and overall well-being. This holistic approach helps to create personalized care plans that address medical, psychological, and social factors, aiming to optimize quality of life and independence for the individual. Through this thorough evaluation, risks such as falls, cognitive decline, and medication interactions can be proactively managed or mitigated.

I will explain my assessment findings and provide a summary of your assessment. A written report and recommendations will be provided to you, your General Practitioner, and family (if you wish).

Older Person Syndromes

Dr Eugene D’Souza can work with you to address syndromes and health issues that are more common as we age.

Cognition & Memory

Cognitive decline in older adults often manifests as difficulties with memory, attention, and executive functioning. While mild forgetfulness can be a normal part of ageing, persistent issues may indicate underlying conditions such as dementia or depression. Early recognition is critical, as reversible causes like medication side effects, metabolic imbalances, or sensory deficits can mimic cognitive impairment.

Frailty

Frailty is a clinical syndrome characterised by decreased physiological reserve and increased vulnerability to stressors. It is associated with adverse outcomes such as falls, hospitalisation, and mortality. Common indicators include unintentional weight loss, exhaustion, slow walking speed, and reduced grip strength. Management is multidisciplinary, focusing on nutrition, physical activity, and addressing reversible contributors. Early intervention can improve resilience and quality of life.

Falls & Bone Health

Falls are a leading cause of morbidity and mortality in older adults, often resulting in fractures, hospitalisation, and loss of independence. Risk factors include muscle weakness, impaired vision, polypharmacy, and environmental hazards. Assessment should encompass gait analysis, balance testing, and review of medications. Prevention strategies include strength and balance training, home safety modifications, and management of underlying conditions such as neuropathy or vestibular disorders.

Polypharmacy

Polypharmacy, typically defined as the use of 5+ medications, is prevalent among older adults and increases the risk of adverse drug events, interactions, and non-adherence. Contributing factors include multimorbidity and fragmented care. Regular medication reviews are essential, prioritising deprescribing of unnecessary or harmful drugs while ensuring therapeutic goals are met. Patient education and shared decision-making are key to safe and effective management.

Advanced Care Planning

Advanced care planning (ACP) is a proactive process that enables individuals to express their values, goals, and preferences for future medical care, particularly in the context of serious illness or declining health. ACP discussions should occur early and involve the patient, family, and healthcare team to ensure alignment with the person’s wishes. Key components include identifying a substitute decision-maker, documenting advance directives, and discussing scenarios such as resuscitation, hospitalisation, and palliative care. Effective ACP reduces uncertainty, supports dignity, and improves end-of-life care quality.

Delirium

Delirium is an acute disturbance in attention, awareness, and cognition that develops over a short period and tends to fluctuate throughout the day. It often arises from an underlying medical condition, medication effect, infection, or metabolic imbalance, and is particularly common among older adults and hospitalized patients. Early recognition is essential because delirium signals a potentially serious underlying issue and is associated with increased morbidity, prolonged hospital stays, and functional decline. A structured assessment and prompt treatment of the underlying cause are central to effective management.

Chronic Disease Management

Managing chronic diseases in older adults requires a holistic, patient-centered approach that prioritizes function and quality of life over disease-specific targets. Conditions such as diabetes, heart failure, and COPD often coexist, creating complex care needs and increasing the risk of polypharmacy. Comprehensive geriatric assessment (CGA) helps identify priorities, including symptom control, medication optimization, and psychosocial support. Regular monitoring, shared decision-making, and coordination across healthcare providers are essential to prevent complications and hospitalizations. Lifestyle interventions, rehabilitation, and caregiver involvement further enhance outcomes.

Continence

Urinary and fecal incontinence are common in older adults and significantly impact dignity, independence, and quality of life. Causes range from reversible factors like infection and medications to chronic conditions such as neurodegenerative disease or pelvic floor weakness. Assessment should include a detailed history, physical examination, and evaluation of mobility and cognition. Management strategies involve bladder training, pelvic floor exercises, medication review, and environmental modifications. Addressing continence early reduces complications such as skin breakdown and social isolation, while supporting caregiver well-being.

Movement Disorders

Movement disorders, including Parkinson’s disease, essential tremor, and drug-induced parkinsonism, often impair mobility and increase fall risk in older adults. Clinical features such as tremor, rigidity, bradykinesia, and postural instability require careful assessment, as symptoms may overlap with frailty or medication side effects. Management is multidisciplinary, combining pharmacological therapy with physiotherapy, occupational interventions, and fall prevention strategies. Non-motor symptoms—such as cognitive decline, mood disorders, and autonomic dysfunction—should also be addressed. Early intervention and tailored care plans can preserve independence and improve quality of life.

What to bring with you to your appointment...

A copy of your referral.
Any recent blood test, brain imaging reports and/or other specialist reports.
ALL your current medications – prescribed and non-prescribed.
Someone with you. It is a long assessment and often the support of a trusted family member, friend or carer helps with remembering old and new information.
Please let us know if an interpreter is required (memory testing is best done in a person’s primary language, and for best results need to be done with a professional interpreter).