Academic journal article Care Management Journals

The Value of Comprehensive Geriatric Assessment

Academic journal article Care Management Journals

The Value of Comprehensive Geriatric Assessment

Article excerpt

Comprehensive geriatric assessment (CGA) provides guidance in planning care for elderly patients. The goals of CGA include reduction of health care cost, early recognition and treatment of geriatric syndromes and improved survival and quality of life for patients. Evidence from randomized controlled studies has identified the value of CGA and some of its limitations. Studies of CGA in institutional settings and in home care provide the basis far specific interventions to targeted groups of high-risk patients. Strategies far fall prevention, appropriate use of pharmacotherapy, and prevention of in-hospital delirium have grown out of the application of this multidisciplinary tool. Future research focused on a more precise definition of the potential financial benefits of CGA may facilitate the task of communicating its value to decision makers.

Keywords: geriatric assessment; geriatric syndromes; fall prevention; delirium; polypharmacy

A cardinal feature of specialized care for geriatric persons is the comprehensive geriatric assessment (CGA), a multidisciplinary evaluation of global function and problems of older persons meant to provide a rational basis for subsequent care planning (Rubenstein & Rubenstein, 1991). The format of CGA may vary, but there are common domains targeted for assessment in the prevalent models (Medicare Education Partnership, Harvard Pilgrim Health Care, 1997). Comprehensive assessment requires both simple screening measures to facilitate identification of problem areas and more detailed evaluation tools to guide the development of targeted interventions within each of the following categories:

* Medication

* Cognitive function

* Mobility

* Activities of daily living (ADL) and instrumental activities of daily living (IADL)

* Social capital-resources available through social connections and relations (Cannuscio, Block, & Kawachi, 2003)

* Advance care planning

* Special sense function (e.g., vision and hearing)

* Bladder and bowel function

* Diet and nutrition

* Behavioral health (e.g., depression)

The aims of CGA may also vary. Reduction in hospital and total institutional costs, early recognition and treatment of delirium, decreased medication use at hospital discharge, and improved shortterm survival, perception of health and social functioning are among the more important.

How effective is geriatric assessment at attaining its objectives? This article presents and reviews some of the current best evidence regarding this potentially costly intervention for vulnerable elderly persons. Randomized controlled clinical trials are the chief source for the results discussed. In any study, the setting and population examined introduce sources of variation and can affect the ability to generalize results. Accurate interpretation of seemingly contradictory findings may hinge on careful attention to the characteristics of the study population and how finely the investigators have focused their intervention.

For example, one early trial of CGA demonstrated improved preventive and primary care delivery to those in the intervention group in an outpatient population associated with a Veterans Affairs (VA) hospital (Fabacher et al., 1994). The intervention involved nurse visits every 4 months for assessment of medical, functional, and psychosocial problems. At one year, examiners identified an average of four new problems per patient and recorded improved adherence to prescribed treatment and immunization schedules. Intervention subjects were significantly more likely than control subjects to have consistent primary care and to maintain functional status. Controls were more likely to experience increased use of medication. The point to recognize is that the outcome of the same strategy might be considerably different in a non-VA setting, without a predominantly male population, with fewer resources, or with less consistent adherence to prescribed treatment and intervention. …

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