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PubMed1983

The Sandoz Clinical Assessment-Geriatric (SCAG) scale. A general-purpose psychogeriatric rating scale.

In response to a need for an easily used general-purpose rating scale designed specifically for the evaluation of pharmacotherapy in senile dementia and related conditions, the Sandoz Clinical Assessment-Geriatric (SCAG) scale was developed. This scale has been widely used in geriatric psychopharmacologic research and has been found to be sensitive, valid, and reliable for this purpose. In order to provide investigators with guidelines for the evaluation of the 18 items and global evaluation provided on the scale, with a view to improving interrater reliability, a manual was developed for this purpose. As the existence of this manual is not widely known, it is presented so that the SCAG scale may be used in a more uniform manner from investigator to investigator.

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PubMedDate not supplied

Follow-up of comprehensive geriatric assessment in a family medicine residency clinic.

BACKGROUND: The objective of this study was to evaluate the effect of outpatient geriatric consultation by referring academic physicians and to verify the results of a previous study. METHODS: We conducted a retrospective review of charts of 37 patients referred for geriatric consultation during a 7-month period of a university- and community-hospital-affiliated family practice residency clinic in urban northeast Washington, DC. The consultation involved team assessment, which led to formal recommendations to the attending physician. Main outcome measures included total number and category of recommendations made, as well as a total number and category of recommendations adhered to by referring physicians. RESULTS: There were 29 women and 8 men with an average age of 79.1 years; 5 were white and 32 were African-American. For the 23 patients for whom follow-up could be determined, the mean number of total diagnoses per patient was 11.4 (SD 3.5). The mean total number of recommendations made per patient was 18.1 (SD 5.9). The mean total number of recommendations acted upon per patient by referring physicians was 9.5 (SD 4.4). The recommendations fell into the following categories: rehabilitative 64 percent, radiologic 57.1 percent, laboratory 56.9 percent, total medication 55.6 percent, medical 50 percent, health maintenance 47.1 percent, social service 46.2 percent, sensory 33 percent, other 28.6 percent, educational 20 percent, and nutritional 14.3 percent. CONCLUSIONS: Multidisciplinary geriatric assessment in an academic outpatient setting provides a comprehensive assessment for faculty and resident physicians in training. Recommendations will be adhered to only 50 to 70 percent of the time, possibly because of the demographic and socioeconomic mix and overall health of the patient population, health care priorities of the referring physician, and costs and availability of various interventions. Physicians in training should be exposed through continuing medical education to various aspects of geriatric assessment.

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PubMed2001

Making geriatric assessment work: selecting useful measures.

Often the goal of physical therapy is to reduce morbidity and prevent or delay loss of independence. The purpose of this article is to describe issues to consider when selecting measures of physical function for use with community-dwelling older adults over the age of 65 years. We chose 16 measures of physical function for review because they have been used in studies of community-dwelling older adults and some psychometric properties of reliability and validity have been described in the literature. Three major issues are discussed: (1) appropriateness of the measure for community-dwelling adults, (2) practical aspects of test administration, and (3) psychometric properties. These issues are illustrated using examples from the 16 measures. Two scenarios, applying the measures to the assessment of community-dwelling well older people and to the assessment of community-dwelling frail older people, are used to illustrate how this information can be used.

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PubMed1978

The benefits to an elderly population of continuing geriatric assessment.

There is currently great interest in the care of the elderly in general practice and discussion about the role of surveillance programmes. We report a comparison between two surveys of an elderly population carried out with a view to determining the difference in findings between two surveys of the same population.Each patient had an average of 4.8 problems at the time of the second assessment. The number of active and unknown problems fell from 6.4 per patient at the initial assessment.The greatest improvements were found in such topics as clothing, bedding, heating, dentition, diet, vision, and hearing, and the least in such aspects as dependency, home hazards, and problems with a caring relative.We remain convinced that a continuing programme of geriatric assessment is valuable in general practice.

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PubMedDate not supplied

Geriatric assessment and management protocols: issues for home infusion therapy providers.

The accurate assessment of patients' health, functional abilities, and sociobehavioral status is essential for providing quality, cost-effective infusion services to home-based elders. Baseline and ongoing assessment identifies serious current, emerging, and potential problems, and facilitates interventions to prevent significant comorbidities and premature mortality. Three types of assessment (screening, intermediate or evaluation, and comprehensive) have been used successfully with geriatric populations across a variety of settings to improve patient outcomes. Further, Medicare now requires the completion of an OASIS assessment for the reimbursement of home health services to all seniors. Geriatric assessment has been found to improve care quality and cost effectiveness, but protocol development and evaluation can be challenging. Home infusion therapy providers, encouraged to implement and evaluate evidence-based assessment and management protocols, question the usefulness of these protocols, especially for short-term geriatric patients. Research, education, and policy strategies can be used to overcome the many barriers to developing quality, cost-effective assessment and management protocols for elderly home infusion therapy recipients.

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PubMed2004

[Geriatric assessment. Is it significantly helpful in selection of elderly tumour patients for a difficult therapy?].

With increasing life expectancy, a therapeutic decision raises the question of the primary goals to be aimed for. Is an absolute gain in age a goal equal to the preservation of an active life? While in younger patients the strategy followed by the patient and the doctor will usually be that of long-term survival, the decision making process for older patients with functional deficits is more challenging. Though functional deficits show a positive correlation with age, a causal relationship does not exist, which implies considerable inter-individual heterogeneity in the group of older patients. In particular, patients who have reached older ages "successfully" without any major limitations in their health should be considered for more intensive treatment strategies. At the same time, younger patients with relevant functional limitations and without any chance of improvement may not benefit from these interventions. The comprehensive geriatric assessment (CGA) offers the opportunity to describe and classify these deficits systematically. It therefore has a key role in the individual decision making process.

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PubMed1992

Co-ordinating geriatric and general medical services; experience of a geriatric assessment ward in the Royal Infirmary of Edinburgh.

The paper describes the work of an assessment unit setup to provide a service for frail elderly patients admitted to general medical units at the Royal Infirmary of Edinburgh during the period of April 1989 to March 1990. Patients were selected on the basis of diagnosis, mental and physical function, age and social background and transferred to the assessment ward within 24 hours of admission to a medical ward. Most of the 376 patients admitted to the ward had a high level of multiple pathology and physical incapacity and a third had an acute confusional state. The mean length of stay was 19.4 days. There was a 13% mortality with 71% of survivors returning to their own homes. Review of mobility and self care capacity of the group revealed a striking increase in function during their stay in the ward. Factors increasing the likelihood of discharge included having a spouse, receiving support at home, having a low initial dependence rating. Adverse factors included having cerebrovascular disease, having dementia and initial maintenance of urine and faeces.

Activities of Daily Living↗
PubMedDate not supplied

Admission criteria in short-term geriatric assessment units: a Delphi study.

BACKGROUND: In recent years, short-term geriatric care units that operate using an interdisciplinary approach have been established in Quebec and elsewhere, in order to provide frail elderly persons with better health care. The purpose of this study is to determine criteria that target the greatest number of individuals most likely to benefit from hospitalization in this type of care unit. METHODS: A Delphi survey was conducted. The panel of experts consisted of 54 physicians and nurses working in short-term geriatric care units in Quebec. Three questionnaires were mailed and 4-level Likert scales were used. Median values, and 25th and 75th percentiles to a maximum of 2, were chosen a priori as the definition of consensus. RESULTS: The survey used 14 inclusion criteria and 17 exclusion criteria. Inclusion criteria were divided into two categories and exclusion criteria were divided into four. INTERPRETATION: A typical clinical profile of a patient who should be admitted to a STGCU emerges: an elderly person presenting multiple pathologies, acute or sub-acute functional disability, and often related psychosocial problems. The instrument developed by this project is a practical guide for professionals in STGAUs as well as those responsible for allocating resources in the health care system.

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PubMed1991

Geriatric assessment in the home.

Home assessment of health, environmental, and social factors, and their interactions that may impair the patient's functional capabilities and quality of life can play a critical role in the care of frail elderly patients. Home assessments can reveal important new health and social problems not identified in a clinical visit. Recent information suggests that home assessment is identified with good patient outcomes. Although this type of assessment is traditionally carried out by a nurse in the context of an interdisciplinary team, an individual primary care physician can also establish an ad hoc, multidisciplinary team to help care for frail elderly patients using principles derived from a comprehensive home assessment.

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PubMed2004

Assessing geriatrics in undergraduate medical education: two different approaches.

Most medical schools do not have a separate course in geriatrics, but rather incorporate geriatrics into existing courses. Tracking and assessing curriculum content is more difficult in this setting. This paper describes and compares two approaches to assess curriculum content in geriatrics: a survey of course directors and a course objectives review. The results suggest that course directors report more geriatric content when asked as part of a regular survey than they identify as specific course objectives. Course objectives may be more reflective of the actual emphasis placed on aging-related material in courses. These two approaches appear to be complementary. Medical educators may find both self-report and course objective analysis to be useful and complementary in tracking geriatric material in the undergraduate medical curriculum.

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