The use of geriatric assessment in the community

Home ELDERLY PEOPLE Hospital

General Practitioner
Community Geriatric Evaluation Unit (Case Manager)

Eligible

CARE PLAN
General Practitioner +Case Manager + Community Geriatric Evaluation Unit

Home care

Day hospital

Hospital

Nursing home

Bernabei et al, Br Med J 1998; 316:1348-51

CGA Objectives
The primary objective is to improve function, reduce the occurrence of clinical symptoms, and enhance quality of life (Barnabei, 1988) To improve diagnosis accuracy, To guide the selection of interventions for restoring or preserving health, To recommend an optimal environment for care, To predict outcomes, To monitor clinical changes over time (D. Solomon, 1988) began with the person to be served, based on a comprehensive assessment - basic approach works across ages, programs, and problem conditions The focus varies by program: Functional maintenance, symptom management, and social integration Cure and re-integration Palliation

Setting CGA
Nursing Home (LTCF) Home Care (HC) Post-Acute Care (PAC) Assisted Living (AL) Palliative Care (PC) Independent settings in the Community (Community Health Assessment - CHA). In-patient Mental Health Care (MH) Community Mental Health Care (CMH) Setting for persons with Intellectual Disabilities (ID) in Acute Care Hospitals (AC).

Comprehensive Geriatric Assessment

Make the physical exam complete Patient level Better care plan Prognostic factors Population level Database Outcome measurements

Quality control indicators

Comparisons

Comprehensive Geriatric Assessment

Demonstrated outcomes Reduced annual costs of medical care Reduced use of acute hospitalizations Reduced recourse to nursing home Prolonged survival

CGA Meta-analysis
Mortality Hospital GEMU IGCS Community HAS HHAS OAS Total New admissions Home discharge Functional Cognitive status performance

-35% n.s. -14% n.s. n.s. -14%

n.s. n.s. -16% n.s. n.s. -12%

+80% n.s. n.s. +49% n.s. +26%

+72% n.s. n.s. n.s. n.s. n.s.

+100% +71% n.s. n.s. n.s. +41%

Stuck et al. Lancet, 1993

Mental Health
Cognitive, Cognitive, behavioral, and emotional , and emotional Detection of dementia, delirium, and Detection of dementia, delirium, and depression Neuropsychological MMSE , GDS

Functional abilities
ADL IADL

Social and Financial

present and potential caregivers and assessing their competence, willingness to provide care and acceptability to the older person. caregiver stress and the caregiver's support network cultural, ethnic, and spiritual values cultural, own assessment of the quality of life is recorded. economic resources of the elderly person, which often determine access to medical and personal care and influence options for living arrangement

Environmental
Evaluating the patient's physical environment is essential Home visits and questionnaires safety, physical barriers, and layout of the home access to services, such as shopping, pharmacy, transportation, and recreation.

Questionaire
Visual acuity Hearing acuity Urinary incontinence Depression Cognitive impairment ADL / IADL Falls Medication Hospital stay CVS Psychosocial Sleep Immunization Nutrition Osteoporosis risk factors Dental Tremor Joints Sexual function

Geriatric Giants-Common Clinical sequelae in elderly

Functional disability / quality of life Urinary incontinence Falls/gait and balance problems Dementia/Delirium Other common geriatric disorders : immobilization, inanition, isolation, iatrogenesis, instability etc

Summary
Aging is a big issue! Focus on function Consider caregivers and abuse Review medications Screen for geriatric syndromes:
falls, incontinence, dementia, depression, hearing, vision, pain

Abbreviate and target PE and assessment tools when possible Get help, use a team when possible!

Thank you