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PubMed2002

[Subjective need for help and objectified geriatric assess. Comparison of the Halberstädter Gerontologic Study and the Augsburger Senior Study].

The Halberstadt Geriatric Study and the Augsburg Senior Citizens Study contain common elements of geriatric assessment (self-assessment of functional dependence, objective evaluation of the functional status). In our cross-sectional investigation, the objective was to examine associations between functional dependence and functional tests and to investigate whether association patterns differed between the surveyed groups. The prospective Halberstadt study began in the German Democratic Republic in 1983 within the framework of a vocational examination before employees entered retirement. In 1995 the study was reactivated; 367 survivors answered a postal questionnaire of which 167 persons took part in a test battery including performance and psychometric tests. The 214 Augsburg test persons had already taken part in the MONICA survey (monitoring of trends and determinants of cardiovascular disease). In 1997 they were assessed in a follow-up study, the aim being to determine the functional status of an elderly cohort through interviews and functional tests. In both studies functional dependence was defined by the (I)ADL concept [(instrumental) activities of daily living]. The participants' functional status was determined with the help of performance tests such as foot tapping and cognitive tests such as the Mini-Mental State Examination. Additionally, medical diagnoses and the use of medical facilities were investigated. The presence of functional dependence was consistently and predominantly significantly associated with the functional status assessed by performance tests. These results were largely confirmed by a logistic regression model. Our results show that even in populations with a different socialization, performance tests are stable indicators of functional dependence and should therefore be incorporated in geriatric assessment programs. The introduction of a standardized assessment program with subsequent intervention measures could lead to a delay of functional dependence and need of care and reduce costs in the health care system.

Activities of Daily Living↗
PubMed1993

Geriatric assessment teams in nursing homes: do they work?

Several studies have examined the effectiveness of geriatric assessment teams in outpatient and acute care settings. This project compared medical records of 69 consecutive nursing home patients randomly assigned on arrival to team (n = 33) and nonteam (standard care, n = 36) conditions. Quality-of-care indices and healthcare service utilization were compared over a 12-month postadmission period. Team patients had a significantly greater number of diagnoses and ancillary services combined with nonsignificant trends toward decreased mortality, fewer emergency department visits, and fewer drugs prescribed. The team approach improves quality of care. Additional clinical studies evaluating the effectiveness of geriatric assessment teams should be made in other nursing homes.

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PubMedDate not supplied

[Comprehensive geriatric assessment and pharmacotherapy in the clinic].

An evaluation of drug therapy is part of comprehensive geriatric assessment. Medications were systematically reviewed in 35 hospitalized patients within the first 3 days after admission and the day before discharge by external rating. The results and the assessment findings were provided to the patients' physicians. The assessment was accomplished by investigations on patient compliance and the handling of different medication containers. One-third of the total pharmacotherapeutic findings in 23 patients was related to new indications for drug treatment, the remaining 27 findings considered unclear indications and adaptations of dosing/application. In total, the number of prescriptions decreased. Fifty-six % of the findings were followed by therapeutic consequences. There was evidence of intentional and unintentional non-compliance in nearly three-quarters of the patients. Problems with handling/opening of medication containers differed with the type of the container's closure. Additional medication counseling was recommended in 14 patients. It is concluded that systematic medication review together with comprehensive geriatric assessment enhance more critical drug prescribing, and reveal patient non-compliance and problems with medication handling.

Activities of Daily Living↗
PubMed1981

Specialized geriatric assessment units and their clinical implications.

Geriatric assessment units are among the several innovative responses by members of the US health care system to the many unmet needs facing elderly people who are frail and ill. Based on British models, these units are designed to improve the assessment of medical and psychosocial problems, to provide therapy and rehabilitation, and to determine optimal posttherapy placement at as high a level of independent functioning as possible. While generally similar, the structures and functions of various North American units vary considerably in such areas as type of patients accepted, amount of rehabilitation carried out and type of institutional setting (such as chronic-care hospital, acute-care hospital or outpatient facility). These differences have a bearing on outcomes. Though few experimental studies exist, impacts from the units appear to be substantial, and include more thorough diagnosis, higher levels of patient functioning and improved placement. Physicians can apply several of the lessons from these units to improve their care of elderly patients.

Geriatric Nursing↗
PubMed1994

Making geriatric assessment an asset to your primary care practice.

Geriatric assessment provides the physician with an individualized care plan for at-risk older patients with complex health problems. Its four basic components are physical, mental, functional, and social/economic health. Although the ideal assessment is performed by a team from a variety of disciplines, primary care physicians may perform a limited version in the office and then make appropriate referrals for further evaluation. Various screening instruments are helpful, but they have their limitations. Results provide you with a blueprint that aims to restore function, lower costs, and improve the patient's quality of life.

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PubMed1994

Comprehensive geriatric assessment: applications for community-residing, elderly people with mental retardation/developmental disabilities.

The effects of using comprehensive geriatric assessment, a recently developed approach found to be effective in evaluating elderly patients, was explored with 41 community-based elderly individuals with mental retardation/developmental disabilities to determine whether it would reveal a greater number of medical, dental, and psychiatric diagnoses when compared to their previous medical care. Functional status and medication usage of these subjects was assessed and described. Statistically significant increases in the number of medical and dental diagnoses were found. An increased number of psychiatric diagnoses, though not significant, was also found. Results suggest that comprehensive geriatric assessment is useful in the evaluation of the health care needs of individuals with mental retardation/developmental disabilities.

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PubMed2005

The abbreviated comprehensive geriatric assessment (aCGA): a retrospective analysis.

BACKGROUND: A comprehensive geriatric assessment (CGA) is a multidimensional assessment that is designed to detect health problems. A barrier to conducting the CGA is the length of time required to complete the entire assessment. OBJECTIVE: To understand what items contained in the instruments that make up the CGA could be compiled to construct an abbreviated CGA (aCGA). DESIGN/SETTING: A retrospective chart review of patients at the H. Lee Moffitt Cancer Center. PARTICIPANTS: Over 500 charts between 1995 and 2001 were reviewed on patients 70 and over. MEASUREMENTS: Item-to-total correlations and Cronbach's alpha coefficient were calculated. Construct validity was assessed using a Pearson's product moment correlation coefficient. RESULTS: Fifteen items were compiled to form the aCGA. Cronbach's alpha was 0.65-0.92 on each instrument of the entire CGA compared to 0.70-0.94 on the aCGA. Correlations ranged from 0.84 to 0.96 for the entire CGA and the aCGA. CONCLUSION: An aCGA can be helpful in screening for those seniors who would benefit from the entire CGA.

Activities of Daily Living↗
PubMed1997

Determinants of patient adherence to consultative comprehensive geriatric assessment recommendations.

BACKGROUND: In consultative models of Comprehensive Geriatric Assessment (CGA), lack of implementation of CGA recommendations is well documented and appears to be a potential explanation for negative findings. The purpose of this study is to identify patient determinants of adherence to recommendations received from a community-based CGA consultative model program. METHODS: Subjects (N = 139) received self-care and/or physician-initiated CGA recommendations and were interviewed three months later to determine adherence with the most important recommendation, and health belief, communication, and social support factors associated with adherence. Independent variables were organized into the Andersen Behavioral Model for analysis. RESULTS: At the bivariate level, one predisposing factor (intention) and six enabling factors (low difficulty level, high support, high utility, high self-efficacy, agreement on the importance of the recommendation and good specific communication about the recommendation) were significant determinants of adherence. Two functional health measures and seriousness of the target condition of the recommendation were significant need factors. In the final logistic regression model, one predisposing variable (intention), one enabling variable (utility), and one need factor (high functional status), and two interaction terms significantly predicted adherence. CONCLUSION: CGA recommendations that are seen as worthwhile, not too much trouble, and able to be accomplished are the most likely to be initiated. Older adults with relatively higher functional levels are also more likely to follow through with CGA recommendations even though their needs may be lower. We found the Andersen Behavioral Model useful in the analysis of factors associated with adherence behavior to consultative CGA recommendations.

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PubMed2000

Adherence to recommendations of community-based comprehensive geriatric assessment programmes.

BACKGROUND: non-adherence to the recommendations of short-term community-based consultative comprehensive geriatric assessment programmes is a threat to the effectiveness of these programmes. OBJECTIVE: to synthesize the literature on patient and physician adherence to recommendations of community-based comprehensive geriatric assessment programmes. METHOD: I identified papers cited by an English language literature search of MEDLINE, Health Star and CINAHL databases from January 1980 to November 1999. This search was supplemented with literature identified from the reference sections of these publications. RESULTS: patient adherence rates ranged from 46 to 76%, which approximates to the rates for the consulting physician adherence (49-79%). I identified many characteristics of patient, treatment, care provider and clinical setting which influenced adherence. Understanding these factors has led to the development of adherence-enhancing strategies. However, without systematic evaluations it is difficult to evaluate the relative effectiveness of these interventions. CONCLUSION: further research which targets more representative samples and uses validated assessment tools and multiple data collection methods is needed to expand our knowledge of patterns and predictors of adherence and to evaluate the relative effectiveness of adherence-enhancing intervention strategies.

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PubMed2006

Comprehensive geriatric assessment and home-based rehabilitation for elderly people with a history of recurrent non-elective hospital admissions.

OBJECTIVE: To determine whether a co-ordinated programme of geriatric assessment and multidisciplinary home-based rehabilitation reduces disability and prevents non-elective hospital readmission in high-risk elderly patients. DESIGN: Nested case-control study comparing usual post-discharge care versus usual care plus a comprehensive geriatric assessment and home-based rehabilitation service, comprising nursing, occupational therapy and physiotherapy with geriatric medical review. Patients were >or=65 years with >or=2 non-elective hospital admissions within the previous 12 months. Disability was assessed using the 100-point Barthel index and Nottingham extended activities of daily living (EADL) score. Non-elective hospital admissions were recorded over 1-year follow-up. RESULTS: We studied 84 patients; 56 receiving the new service were matched to 28 controls. Intervention subjects received a median of 19 h [interquartile range (IQR) (7,35)] rehabilitation over 19 [IQR (6,42)] domiciliary visits. At 3 months, there was improvement in median Barthel and Nottingham EADL scores in the intervention group of 3 and 2 points, respectively, compared with reductions in controls of 3 and 6 points (both P<0.001, changes in intervention group versus controls); similar differences persisted in survivors at 12 months. There was a non-significant trend for reduction in the proportion of patients with further non-elective hospital admission in the intervention group (36/56, 64%) compared with controls (21/28, 75%; OR 0.70, 95% CI 0.34, 1.46). CONCLUSIONS: A co-ordinated programme of geriatric assessment and multidisciplinary home-based rehabilitation reduced disability in elderly patients at high risk for non-elective hospital admission. Further research is required to determine whether this approach can reduce the need for hospital admission.

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PubMed1990

Cognitive function testing in comprehensive geriatric assessment. A comparison of cognitive test performance in residential and clinic settings.

Tests of cognitive function are frequently used in geriatric assessment, but the effect of test setting has rarely been explored. To determine the effect of testing site on the performance of elderly patients undergoing a comprehensive geriatric assessment, we administered the Mini-Mental State Exam to 116 geriatric patients in the clinic and at their residence. Their cognitive abilities varied from normal to severely impaired. The patients' scores were 1.5 +/- 3.6 (mean +/- SD) higher at their residence. The clinical importance of a difference in score of 1.5 is not clear. For this reason a second analysis was performed in which a difference in scores of five points or greater between settings was considered clinically meaningful. Twenty-five percent (29 of 116) differed by five points or more. Of these 29 patients, 22 (76%) tested better in the residential setting. These differences were statistically significant (P = .001). We conclude that the testing site may affect test performance and that in-home assessment may reveal the optimal cognitive function of geriatric patients.

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PubMed1998

The association between chronic illness and functional change among participants in a comprehensive geriatric assessment program.

OBJECTIVE: To examine the association between chronic illness and functional status change during a 3-year period in older people enrolled in an in-home comprehensive geriatric assessment (CGA) and preventive care program. DESIGN: Secondary analysis of data from a longitudinal cohort study. SETTING: Santa Monica, California. PARTICIPANTS: Two hundred two community-dwelling older persons (mean age at baseline was 81 years, 70% were women, and 72% reported good health) randomized to the intervention group in a trial of in-home comprehensive geriatric assessment and preventive care. MEASUREMENTS: We studied 13 common chronic illnesses/conditions determined clinically from an annual comprehensive evaluation by gerontologic nurse practitioners (GNPs) in consultation with study geriatricians. These target conditions included hypertension, osteoarthritis, coronary artery disease, obesity, undernutrition, urinary incontinence, sleep disorders, falls, gait/balance disorders, hearing and vision deficits, depression, and unsafe home environment. The dependent variable was functional change as measured by instrumental activities of daily living (IADL) and basic activities of daily living (BADL) assessed at baseline and annually for 3 years by independent research personnel. Potential confounding variables, including comorbid conditions and other subject characteristics, were controlled for in the analyses. RESULTS: Although functional status was similar at baseline, the presence of certain target conditions in this sample was associated significantly with functional decline in IADL and BADL during the 3-year period. Four conditions (gait/balance disorders, depression, unsafe home environment, and coronary artery disease) were associated with significant declines in IADL, and four conditions (gait/balance disorders, depression, hypertension, and urinary incontinence) were associated with significant declines in BADL. Conversely, subjects with obesity had no significant change in IADL or BADL throughout the study period and had less decline in IADL compared with nonobese subjects. CONCLUSIONS: Certain chronic conditions, particularly gait/balance disorders and depression, are associated with significant decline in functional status in older persons who receive CGA. These findings may help identify older persons at risk for greatest functional decline despite participation in CGA and may also suggest the need for more effective intervention strategies in these individuals.

Activities of Daily Living↗
PubMed1990

Caregiver burden should be evaluated during geriatric assessment.

This study examines the relationship between caregiver burden and use of long-term care services following geriatric assessment. One hundred nine older subjects underwent comprehensive assessment, which included a questionnaire completed by the primary caregiver to assess the sense of burden in providing care. Logistic regression was used to identify independent predictors of service use at 12 months. Among measures of the older person's cognitive and physical abilities, only activities of daily living predicted increased use of services. When the measure of caregiver burden was added, it also entered as an independent predictor, which significantly improved the prediction of service use (chi 2 = 5.9, P less than .02). In a separate analysis, caregiver burden predicted both the use of home services and nursing-home placement. During longitudinal follow-up, the measure of burden decreased over 12 months for the sample, with the greatest reduction in burden occurring for caregivers whose relative was placed in a nursing home. The fact that caregiver burden was the most important factor in determining who would use formal services suggests that burden should be evaluated as part of geriatric assessment.

Activities of Daily Living↗
PubMed1989

Monitoring regional geriatric assessment teams: analysis of client flows and outcomes.

The Commonwealth Government funding of the Geriatric Assessment Program began in 1984. The Program included an evaluation component, and this paper reports findings for three Regional Geriatric Assessment Teams (RGATs) in Victoria focusing on (1) the identification of different starting points in the flow of clients to the RGATs, (2) the relationships between different starting points and (3) recommended care plans, and the relationships between (2) and final outcome, particularly whether or not this involved admission to nursing home care. The role performed by RGATs is reviewed in the context of introducing mandatory assessment, the success of which will depend on the effectiveness of RGATs not only in differentiating need for and securing admission to nursing home care but also in assessing for, accessing and initiating alternative services.

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PubMed1998

Streamlining outpatient geriatric assessment: essential social, environmental and economic variables.

There are no known standardized instruments that encompass all of the essential elements of a streamlined outpatient geriatric assessment. A process of arriving at a consensus on essential elements of streamlined geriatric assessment in 3 domains was initiated and described. Two rounds of the Delphi technique were conducted to identify social, environmental and economic variables essential for such an assessment. Consensus among an expert panel was achieved and a list of 27 variables was reduced to 16. This result is discussed in terms of assessment context and standardizing assessment, using case examples.

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PubMed2004

Comprehensive Geriatric Assessment (CGA) in general practice: results from a pilot study in Vorarlberg, Austria.

BACKGROUND: Most comprehensive geriatric assessment (CGA) programs refer to hospital-based settings. However the body of geriatric healthcare is provided by general practitioners in their office. Structured geriatric problem detection by means of assessment instruments is crucial for efficient geriatric care giving in the community. METHODS: We developed and pilot tested a German language geriatric assessment instrument adapted for general practice. Nine general practices in a rural region of Austria participated in this cross-sectional study and consecutively enrolled 115 persons aged over 75 years. The prevalence of specific geriatric problems was assessed, as well as the frequency of initiated procedures following positive and negative tests. Whether findings were new to the physician was studied exemplarily for the items visual and hearing impairment and depression. The acceptability was recorded by means of self-administered questionnaires. RESULTS: On average, each patient reported 6.4 of 14 possible geriatric problems and further consequences resulted in 43.7% (27.5% to 59.8%) of each problem. The items with either the highest prevalence and/or the highest number of initiated actions by the GPs were osteoporosis risk, urinary incontinence, decreased hearing acuity, missing pneumococcal vaccination and fall risk. Visual impairment was newly detected in only 18% whereas hearing impairment and depression was new to the physician in 74.1% and 76.5%, respectively.A substantial number of interventions were initiated not only following positive tests (43.7% per item; 95% CI 27.5% to 59.8%), but also as a consequence of negative test results (11.3% per item; 95% CI 1.7% to 20.9%). The mean time expenditure to accomplish the assessment was 31 minutes (SD 10 min). Patients (89%) and all physicians confirmed the CGA to provide new information in general on the patient's health status. All physicians judged the CGA to be feasible in everyday practice. CONCLUSION: This adapted CGA was feasible and well accepted in the general practice sample. High frequencies of geriatric problems were detected prompting high numbers of problem-solving initiatives. But a substantial number of actions of the physicians following negative tests point to the risks of too aggressive treatment of elderly patients with possibly subsequent negative effects.

Journal Article↗
PubMed1991

Impact of a geriatric assessment unit on subsequent health care charges.

BACKGROUND: In a recent randomized controlled trial assessing the efficacy of an inpatient geriatric assessment unit (GAU), we demonstrated that patients assigned to the unit were less likely than those in the usual care group to be admitted to a nursing home and more likely to remain living in the community. Despite evidence of benefits of GAU care, questions remain about its cost. We examine the impact of GAU treatment on subsequent health care charges. METHODS: Sequential referrals of elderly disabled patients considered at risk for institutionalization or likely to improve with rehabilitation were randomized to the GAU or to usual care. Charge data were collected on utilization of a wide variety of health care services starting at the point of randomization. RESULTS: The group randomized to the GAU experienced significantly higher rehabilitation charges per participant ($10,583 vs $2066, P = .0001), but lower mean nursing home charges ($1798 vs $3426, P = .004). Total health care charges per participant over the 1 year follow-up were greater for the GAU group ($28,406 vs $16,444, P = .004). When charges were adjusted per year of life survived, the GAU group still showed a substantial (but nonsignificant, P = .10) increase in total charges. However, when charges were adjusted per day subsequently spent residing in the community, adjusted total charges were similar between the two groups. CONCLUSIONS: Our results indicated that improved outcomes from GAU care require an investment in rehabilitation that is not totally offset by decreased institutional charges in the following year.

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