Article thumbnail
Location of Repository

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

By Eva Mann, Michael Koller, Christian Mann, Tischa van der Cammen and Johann Steurer

Abstract

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

Topics: Research Article
Publisher: BioMed Central
Year: 2004
DOI identifier: 10.1186/1471-2318-4-4
OAI identifier: oai:pubmedcentral.nih.gov:434505
Provided by: PubMed Central

Suggested articles

Citations

  1. (2002). (page number not for citation purposes) Twomey C, Westendorp RG: Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial. Lancet
  2. (1997). [No authors listed]. Prevention of pneumococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep
  3. (1997). A randomized trial of office-based screening for common problems in older persons.
  4. (2002). A: The MRC trial of assessment and management of older people in the community: objectives, design and interventions [ISRCTN23494848]. BMC Health Serv Res
  5. (1995). AE: [The "Geriatric Assessment" Study Group (AGAST): recommendations for the use of assessment procedures].
  6. (1969). Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist
  7. (1994). C: Hypertension in the elderly. Implications and generalizability of randomized trials.
  8. (1988). CH: Screening for impaired hearing in the elderly. JAMA
  9. (1991). CH: Working group recommendations: targeting criteria for geriatric evaluation and management research.
  10. (1998). Development and validation of a simple questionnaire to facilitate identification of women likely to have low bone density.
  11. (2002). DM: Clinical use of bone densitometry: scientific review. JAMA
  12. (1986). Do general practitioners "miss" depression in elderly patients?
  13. (1997). Dying, not old age, to blame for costs of health care. Lancet
  14. (2001). Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA
  15. (1968). Experiences of two preventive clinics for the elderly. Br Med J
  16. (1999). Fedson DS: Influenza vaccination in 29 countries. An update to 1997. Pharmacoeconomics
  17. (2001). From the Centers for Disease Control and Prevention. Influenza and pneumococcal vaccination levels among persons aged > or = 65 years--United States,
  18. (1999). From the Centers for Disease Control and Prevention. Influenza and pneumococcal vaccination levels among persons aged >/= 65 years--United States,
  19. (1996). GC: [A prevention program for health problems in the elderly. Ambulatory Geriatric Screening (AGES) for use in general practice]. Fortschr Med
  20. (1996). GC: [Ambulatory Geriatric Screening (AGES) in general practice. 1: Patient questionnaire]. Fortschr Med
  21. (1996). GC: [Ambulatory geriatric screening (AGES) in general practice. 2: Physician assistant questionnaire--medical examination]. Fortschr Med
  22. (2001). Generalist and subspecialist physicians' knowledge, attitudes, and practices regarding influenza and pneumococcal vaccinations for elderly and other high-risk patients: a nationwide survey. Arch Intern Med
  23. (2002). Home visits to prevent nursing home admission and functional decline in elderly people: systematic review and meta-regression analysis. JAMA
  24. (2003). How are family physicians managing osteoporosis? Qualitative study of their experiences and educational needs. Can Fam Physician
  25. (1991). Impacts of geriatric evaluation and management programs on defined outcomes: overview of the evidence.
  26. (2001). Importance of patients' perceptions and general practitioners' recommendations in understanding missed opportunities for immunisations in Swiss adults. Vaccine
  27. (1982). JB: The effects of a system of geriatric screening and assessment on general practice workload. Health Bull (Edinb )
  28. (1995). JC: A trial of annual in-home comprehensive geriatric assessments for elderly people living in the community.
  29. (1999). JF: The effect of visual and hearing impairments on functional status.
  30. (2001). JP: Evaluation of decision rules for referring women for bone densitometry by dual-energy x-ray absorptiometry. JAMA
  31. (2000). JV: Development and validation of the Osteoporosis Risk Assessment Instrument to facilitate selection of women for bone densitometry. CMAJ
  32. (1992). Larrabee GJ: Assessment of memory complaint in age-associated memory impairment: the MACQ. Int Psychogeriatr
  33. (2003). Lips P: Prevention of hip fractures by external hip protectors: a randomized controlled trial. JAMA
  34. (1993). LZ: Comprehensive geriatric assessment: a meta-analysis of controlled trials. Lancet
  35. (2000). PL: The detection of dementia in the primary care setting. Arch Intern Med
  36. (2001). Pre-publication history The pre-publication history for this paper can be accessed here:
  37. (2001). Prevention and control of influenza.
  38. (1994). RB: A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission.
  39. (1970). RC: Progress in development of the index of ADL. Gerontologist
  40. (1984). RL: Effectiveness of a geriatric evaluation unit. A randomized clinical trial.
  41. (1987). Rowe JW: The emergence of geriatric assessment units. The "new technology of geriatrics".
  42. (1994). Screening an elderly population for verifiable adverse drug reactions. Methodological approach and initial data of the Berlin Aging Study (BASE).
  43. (1994). Screening, detection and management of depression in elderly primary care attenders. I: The acceptability and performance of the 15 item Geriatric Depression Scale (GDS15) and the development of short versions. Fam Pract
  44. (1972). Sociomedical study of patients over 75 in general practice.
  45. (2001). Tessier D: Diabetes in elderly adults.
  46. (1975). The development of visual standards:
  47. (1991). The timed "Up & Go": a test of basic functional mobility for frail elderly persons.
  48. (1990). Tinetti ME: A simple procedure for general screening for functional disability in elderly patients. Ann Intern Med
  49. (2000). Waid-Guide - Agenda für geriatisches Screening und Assessment. Teil 1: Tests für die multidimensionale Abklärung.
  50. (2000). Waid-Guide - Agenda für geriatisches Screening und Assessment. Teil 2: Tests für die klinische Geriatrie.

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.