Throughout the life cycle, the definition of health and well-being is changing. Deaths and sequelae due to the communicable diseases decrease; cancer, noncommunicable diseases and the negative effects of their sequelae are especially affecting elderly individuals. As the age increases, it is reported that at least two of fifth have one and at least half have two and more chronic diseases. As the number of chronic diseases increases, the likelihood of individuals having geriatric syndromes increases ( 1 ). Therefore, the elderly individuals have different levels of health status ( 2 , 3 ).

The concept of the geriatric syndrome has been tried to be defined by different authors in different ways ( 4 ). According to Ferrucci and Studenski, the geriatric syndrome is a common clinical condition with the common clinical manifestations in elderly individuals, involving organs not related to the main complaints, which are responsible for multifaceted physio-pathologic mechanisms, which have disruptive effects on their function and quality of life. The geriatric syndromes include incontinence, delirium, falls, pressure ulcers, sleep disorders, nutritional problems, malnutrition, sensory losses, pain, fatigue, depressive mood, dementia, dizziness, gait disturbances, and physical disability. It is also possible to say that geriatric syndromes contribute to the development of vulnerability and that some risk factors are common ( 5 , 6 ).

Comprehensive geriatric assessment (CGA) can be defined as a diagnosis and treatment processes, which is a result of a teamwork of many disciplines. During this process, the functional, medical, spiritual, and social needs of frail individuals are determined and a coordinated care plan is established.

The care plan created is a more comprehensive approach that transcends traditional medical disease treatment. It is aimed to identify the treatable conditions with CGA and to provide a better management to the patient ( 6 ).

Preventive elderly assessment can be considered as "Short" CGA, which can be applied in family health center setting It is easy to detect the clinical condition and diseases related to aging with CGA. Detection of geriatric syndromes can prevent or delay the development of complications. It is more likely to use it for diagnostic purposes, but it also includes management of identified problems. Sometimes it is perceived as a process of identification and referral and sometimes as a multidisciplinary process ( 6 ). The form and scope of the CGA in this framework vary according to its implementation ( 7 ).

Adequacy of the CGA indication will determine the success of the assessment to be performed. Taking a very healthy or very sick individual in the framework of the CGA will negatively affect the usefulness of CGA. The Ministry of Health Public Health Agency of Turkey issued the "Periodic Examination in the Family Medicine Practice Guide", which recommends all family physicians to screen (CGA) patients aged 65 and over every five years ( 8 ).

The expected life duration and diseases of elderly individuals should be taken into account, especially in the case of screening. Thus, for example, patients should be divided into prognostic groups such as "fit", "frail", "moderately demented" or "end of life" and the tests to be applied should be included accordingly. As the prognosis worsens and the life expectancy becomes shorter, examination intervals should be monitored and invasive interventions and other examinations should be discontinued ( 9 – 11 ).

In the preventive approach, the level of health and prognostic status of the elderly or the patient is also determined by the level of prevention and the problem (syndrome) or disease to be avoided (Table-2)( 2 , 3 ).

Therefore, the advanced aged patients, those with medical comorbidities, psychological problems, socially self-isolation, geriatric syndrome and burdened health expenditures are most likely to benefit from CGA. CGA is not recommended for those who are in the terminal period, those with advanced dementia, or those who are completely dependent ( 6 ). Among the objectives of the CGA are to maintain the functioning and the quality of life of the elderly individual. Screening and management decisions to be made due to the fact that elderly individuals are very heterogeneous in the context of physiological and functionalities should be specific to the individual ( 1 ). There is no prescription for each patient. Tests in a screening program intended for elderly people should have a screening test in particular. Elderly people should consider their life expectancy. There are formulas to support your decision concerning this.

Short, medium and long-term care goals are could be considered as CGA targets by time: ( 1 ) a. Short-term goals: goals to meet acute and short-term health needs. The goal is to correct the acute illness of the patient. It deals specifically with end-of-life and palliative care issues. It is possible to manage the problems that arise during episodic care in this context. It covers up to one year of care.

b. Medium-term goals: Covers the process from one to five years.

c. Long-term goals: Decisions and goals taken to maintain health in highly healthy and fit individuals. The life expectancy and the expectations regarding the future care plan of the patient can be assessed. After receiving consent, this issues could be discussed with relatives and caregivers.

Screenings and Preventive Medicine Approach CGA is a very intensive, comprehensive and time-consuming process, involving traditional medical examination and history. Especially in family practice, the time burden of the work and the nature of the transactions are always mentioned as an important problem.

In this framework, various tests for family practice have been developed and used to shorten the duration of CGA. ( 4 ) We want to propose the "Age-Friendly Primary Health Care Instrument Toolkit" ( 4 , 7 , 12 – 14 ) developed by a group of experts of the World Health Organization.

The "Age-Friendly Primary Health Care Instrument Toolkit" has been developed for developing andresource-constrained countries, but it is possible to apply it in every country where the family medicine is offered as a general health service model. Considering the literature, it is suggested to have the following components ( 6 ) in the "first" CGA:

a. Cognitive status b. Depressive Mood c. Urinary / Fecal Incontinence d. Functional status: ADL, IADL and Advanced ADL (AADL) e. Fall history and performance tests (Rise Walk Test, Walking Speed Test, Balance Test, etc.) f. Nutrition / Change in Body Weight g. Vision / Hearing Problems h. Oral Health I. Pain j.Drug use: Polypharmacy and drug interactions k. Alcohol / Cigarette / Substance Abuse l. vaccinations m. chemoprophylaxis n. Auxiliary Device Usage o. Sexual Function Status p. Life quality q. Access to Health Care r. Social Support / Network s. Legal Support t. Advanced Life Direction u. Financial Status vi. Housing Status w. Care Service Requirement x. Socio-medical Administrative Service Requirement (Issuing a Report, Prescription) y. The caregiver's requirements (Health, Financial, Social Security, Holiday, etc.)

z. Family APGAR and Family Dynamics The boundaries of CGA are very broad. It is possible and sometimes difficult to evaluate every point of the elderly individual's life and the environment he lives in. In family practice, psychosocial points of the elderly person should be considered. Even it is not always possible to solve all requirements by the family physician and his team alone, the coordination of the care of elderly people might be helpful as well.

Preventive Elderly Assessment ("Short" CGA) The "Age-friendly Primary Heath Care Instrument Toolkit" can be improved by taking into account the priorities of the elderly individuals in the environment, where the family physicians are working. ( 4 ) The time factor should be considered during the development process. The test should be capable to screen fairly and should not occupy the family physician and his team by means of time. Our suggested "Short" CGA for this reason, can be completed in 20 minutes in experienced hands with the addition of tests to the "Age-friendly Primary Health Care Instrument Toolkit" (MNA scan scale, DENTAL Oral Dental Scan Scale, Timing Test, Drug Questions, Lubben Scale). This test is a first-step screening test and second step tests should be performed with any pathology appearing in the first test. However, since the second step tests will only be implemented in suspicious cases, family physicians will especially save considerable time and will be able to refer their patients more accurately to specialists with pre-diagnosis obtained from this "Short" CGA, establish health records of their patients, and identify clues for health problems they can manage. The "Short" CGA form, which has been developed by the author and which serves as a first step screening tool is shown in Figure-1.

In order to save time, in addition to using the short and necessary tests, it is advisable to transfer some tests to the family health worker or outpatient nurse in your team. Further evaluations of positive screening points can be made by the physician. However, in order to be able to do this, the staff need to be well trained in this regard. As a result of "Short" CGA results, we will be able to take our management decisions about the patient or to decide to consult the patient or to form the basis of a detailed CGA to be carried out in the institution, where the physician considers to refer the patient. The findings of this assessment will be discussed in the care team meeting by including the caregiver and the patient. The care plan will be created by considering the opinions of the patient and of his / her relatives. The care plan will be established afterward. After a certain period, the care plan will be followed up and revised according to need. ( 6 ) The table summarizing the screening and intervention of older people aged 65 years and older is shown below (Table 3)( 1 ). This table is based on Ministry of Health, Public Health Agency of Turkey recommendations. ( 8 )