10,064 research outputs found
Effect of in-hospital comprehensive geriatric assessment (CGA) in older people with hip fracture : the protocol of the Trondheim Hip Fracture Trial
Background: Hip fractures in older people are associated with high morbidity, mortality, disability and reduction in
quality of life. Traditionally people with hip fracture are cared for in orthopaedic departments without additional
geriatric assessment. However, studies of postoperative rehabilitation indicate improved efficiency of
multidisciplinary geriatric rehabilitation as compared to traditional care. This randomized controlled trial (RCT) aims
to investigate whether an additional comprehensive geriatric assessment of hip fracture patients in a special
orthogeriatric unit during the acute in-hospital phase may improve outcomes as compared to treatment as usual
in an orthopaedic unit.
Methods/design: The intervention of interest, a comprehensive geriatric assessment is compared with traditional
care in an orthopaedic ward. The study includes 401 home-dwelling older persons >70 years of age, previously
able to walk 10 meters and now treated for hip fracture at St. Olav Hospital, Trondheim, Norway. The participants
are enrolled and randomised during the stay in the Emergency Department. Primary outcome measure is mobility
measured by the Short Physical Performance Battery (SPPB) at 4 months after surgery. Secondary outcomes
measured at 1, 4 and 12 months postoperatively are place of residence, activities of daily living, balance and gait,
falls and fear of falling, quality of life and depressive symptoms, as well as use of health care resources and survival.
Discussion: We believe that the design of the study, the randomisation procedure and outcome measurements
will be of sufficient strength and quality to evaluate the impact of comprehensive geriatric assessment on mobility
and other relevant outcomes in hip fracture patients
Geriatric Assessment in Advanced Kidney Disease
Peer reviewe
Surgical assessment of the geriatric oncology patient
BACKGROUND: The aging population in the United States will correlate with an increased number of cancer diagnoses as cancer is primarily a disease of the elderly. Providing this ever-growing group of individuals with quality surgical management, while taking into account the unique needs and desires of this cohort, is a great challenge facing both geriatricians and surgeons going forward. The best approach to ensure that oncogeriatric patients receive the best tailored treatment is through the completion of a pre-surgical geriatric assessment. However, only a minority of oncogeriatric patients is undergoing a comprehensive pre-surgical geriatric assessment despite the majority of geriatricians and surgeons acknowledging its importance in order to properly risk stratify their patients.
LITERATURE REVIEW FINDINGS: Multiple theories exist as to why geriatric assessments are not being utilized more frequently, but the most probable answer is that these assessments are very time-consuming, making it virtually impossible for incorporation into a healthcare provider’s busy schedule. Comprehensive literature review regarding geriatric assessments amongst the oncogeriatric population found that the most sensitive and specific domains of the geriatric assessments predicting morbidity and mortality include Frailty Index, Social Support Survey, Mini-Nutritional Assessment, and Geriatric Depression Screening.
PROPOSED METHODS: A novel educational intervention will be proposed to teach Physician Assistant and Medical Students about the domains of the geriatric assessment most predictive of post-surgical risk during their surgical clerkship. The curriculum will utilize both simulation- and competency-based education training under the guidance of geriatricians and surgeons. Students will first learn the necessary skills in a controlled classroom environment and then proceed to incorporate these skills during their clerkship with patients on their service.
CONCLUSIONS: The goal of the proposed method is to instill the confidence and skills necessary to provide an accurate geriatric assessment for oncogeriatric patients in future clinicians. The field of geriatric oncology is going to grow exponentially in the up-coming years and familiarizing future clinicians with the most predictive domains regarding surgical outcome will improve treatment outcomes for oncogeriatric patients in the immediate and foreseeable future
Spirituality within the Comprehensive Geriatric Assessment Process
In this chapter, Ellingson argues that the comprehensive geriatric assessment ( CGA) , which is used in the development of treatment plans for elderly individuals in poor health, has failed to acknowledge the import of some aspects of the elderly patient\u27s life experiences. Ellingson uses case study analysis to demonstrate the significance of spiritual and religious beliefs and practices and suggests that the CGA model should be expanded to include explicit coverage of spirituality and religious issues
Design of a consensus-based geriatric assessment tailored for older chronic kidney disease patients:results of a pragmatic approach
PURPOSE: Unidentified cognitive decline and other geriatric impairments are prevalent in older patients with advanced chronic kidney disease (CKD). Despite guideline recommendation of geriatric evaluation, routine geriatric assessment is not common in these patients. While high burden of vascular disease and existing pre-dialysis care pathways mandate a tailored geriatric assessment, no consensus exists on which instruments are most suitable in this population to identify geriatric impairments. Therefore, the aim of this study was to propose a geriatric assessment, based on multidisciplinary consensus, to routinely identify major geriatric impairments in older people with advanced CKD. METHODS: A pragmatic approach was chosen, which included focus groups, literature review, inventory of current practices, an expert consensus meeting, and pilot testing. In preparation of the consensus meeting, we composed a project team and an expert panel (n = 33), drafted selection criteria for the selection of instruments, and assessed potential instruments for the geriatric assessment. RESULTS: Selection criteria related to general geriatric domains, clinical relevance, feasibility, and duration of the assessment. The consensus-assessment contains instruments in functional, cognitive, psychological, somatic, patient preferences, nutritional status, and social domains. Administration of (seven) patient questionnaires and (ten) professional-administered instruments, by nurse (practitioners), takes estimated 20 and 40 min, respectively. Results are discussed in a multidisciplinary meeting including at least nephrology and geriatric expertise, informing nephrology treatment decisions, and follow-up interventions among which comprehensive geriatric assessment. CONCLUSION: This first multidisciplinary consensus on nephrology-tailored geriatric assessment intent to benefit clinical care and enhance research comparability for older patients with advanced CKD
Comprehensive geriatric assessment
Geriatric conditions such as functional impairment and dementia are common and frequently unrecognized or inadequately addressed in older adults. Identifying geriatric conditions by performing a geriatric assessment can help clinicians manage these conditions and prevent or delay their complications.
"Geriatric syndrome" is a term that is often used to refer to common health conditions in older adults that do not fit into distinct organ-based disease categories and often have multifactorial causes. The list includes conditions such as cognitive impairment, delirium, incontinence, malnutrition, falls, gait disorders, pressure ulcers, sleep disorders, sensory deficits, fatigue, and dizziness. These conditions are common in older adults, and they may have a major impact on quality of life and disability. Geriatric syndromes can best be identified by a geriatric assessment.
Although the geriatric assessment is a diagnostic process, the term is often used to include both evaluation and management. Geriatric assessment is sometimes used to refer to evaluation by the individual clinician (usually a primary care clinician or a geriatrician) and at other times is used to refer to a more intensive multidisciplinary program, also known as a comprehensive geriatric assessment (CGA).
This topic will review the indications for CGA, as well as its major components and evidence of its efficacy. General issues of geriatric health maintenance and the assessment of specific geriatric populations are discussed elsewhere.måsjekke
Brief assessments and screening for geriatric conditions in older primary care patients: a pragmatic approach.
This paper discusses the rationale behind performing a brief geriatric assessment as a first step in the management of older patients in primary care practice. While geriatric conditions are considered by older patients and health professionals as particularly relevant for health and well-being, they remain too often overlooked due to many patient- and physician-related factors. These include time constraints and lack of specific training to undertake comprehensive geriatric assessment. This article discusses the epidemiologic rationale for screening functional, cognitive, affective, hearing and visual impairments, and nutritional status as well as fall risk and social status. It proposes using brief screening tests in primary care practice to identify patients who may need further comprehensive geriatric assessment or specific interventions
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