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

David J. Stott; Amanda K. Buttery; Adam Bowman; Rona Agnew; Katriona Burrow; Sarah L. Mitchell; Scott Ramsay; Paul V. Knight

doi:10.1093/ageing/afl049

EFFECTIVENESS OF A COMPREHENSIVE GERIATRIC ASSESSMENT TO IMPROVE THE LIFE QUALITY OF THE ELDERLY AND TO EASE THE CAREGIVERS BURDEN

Acta medica Eurasica ◽

10.47026/2413-4864-2021-4-79-90 ◽

2021 ◽

pp. 79-90

Author(s):

Evgenia A. Gurianova ◽

Enje E. Rechapova ◽

Ekaterina S. Sidyakina

Keyword(s):

Elderly People ◽

Geriatric Assessment ◽

Comprehensive Geriatric Assessment ◽

Life Quality ◽

Modern Society ◽

The Elderly ◽

Diagnostic Process ◽

Modern World ◽

Rehabilitation Programs

In the modern world, the number of elderly people with various diseases is growing, they need an appropriate care. Care implementation requires special knowledge, mental and economic expenditures. Ensuring a decent old age for the elderly is one of the problems of modern society. Comprehensive geriatric assessment is a multidimensional interdisciplinary diagnostic process for assessing the physical, psychological, functional and socio-economic problems of elderly people in order to develop a comprehensive individual plan for their treatment and rehabilitation. Comprehensive geriatric assessment benefits the elderly population, but the effectiveness of comprehensive geriatric assessment to improve the life quality of the elderly remains unclear. The article provides an overview of studies devoted to studying the effectiveness of using comprehensive geriatric assessment. The article discusses the influence of a comprehensive geriatric assessment on determining the life quality of the elderly, the duration of their stay in the hospital, and relieving the caregivers' burden. In addition, the influence of a comprehensive geriatric assessment on the ability to determine life expectancy, to conduct early diagnosis of major geriatric syndromes, the risk of morbidity and mortality in elderly patients is being considered. It is important that on the basis of a comprehensive geriatric assessment, appropriate rehabilitation programs can be drawn up, and technologies for rehabilitation can be determined.

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Management of frailty at individual level – clinical management: Systematic literature review

Slovenian Journal of Public Health ◽

10.2478/sjph-2018-0014 ◽

2018 ◽

Vol 57 (2) ◽

pp. 106-115

Author(s):

Gregor Veninšek ◽

Branko Gabrovec

Keyword(s):

Vitamin D ◽

Geriatric Assessment ◽

Comprehensive Geriatric Assessment ◽

Physical Training ◽

Literature Search ◽

Vitamin D Supplementation ◽

Individual Level ◽

Frailty Status ◽

Home Based ◽

Frail Individual

AbstractIntroductionTo deliver quality management of a frail individual, a clinician should understand the concept of frailty, be aware of its epidemiology and be able to screen for frailty and assess it when it is present, and, finally, to recommend successful interventions.MethodologyA systematic literature search was conducted in the following databases: PubMed, Cochrane, Embase, Cinahl and UpToDate. The criterion in selecting the literature was that articles were published in the period from 2002 to 2017. From 67432 initial hits, 27 publications were selected.ResultsUseful interventions to address frailty are supplementation of vitamin D, proper nutrition, multicomponent training, home-based physiotherapy and comprehensive geriatric assessment, particularly when performed in geriatric wards.ConclusionComprehensive geriatric assessment is an effective way to decrease frailty status especially when performed in geriatric wards. Multicomponent physical training and multidimensional interventions (physical training, nutrition, vitamin D supplementation and cognitive training) are effective measures to reduce frailty.

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Caring for nursing home residents with COVID-19: a “hospital-at-nursing home” intermediate care intervention

Aging Clinical and Experimental Research ◽

10.1007/s40520-021-01959-z ◽

2021 ◽

Author(s):

Enrico Benvenuti ◽

Giulia Rivasi ◽

Matteo Bulgaresi ◽

Riccardo Barucci ◽

Chiara Lorini ◽

...

Keyword(s):

Nursing Home ◽

Geriatric Assessment ◽

Comprehensive Geriatric Assessment ◽

Hospital Admissions ◽

Nursing Home Residents ◽

Nursing Home Care ◽

Intermediate Care ◽

Healthcare Model ◽

Set Up ◽

The Impact

Abstract Background Nursing home (NH) residents have been dramatically affected by COVID-19, with extremely high rates of hospitalization and mortality. Aims To describe the features and impact of an assistance model involving an intermediate care mobile medical specialist team (GIROT, Gruppo Intervento Rapido Ospedale Territorio) aimed at delivering “hospital-at-nursing home” care to NH residents with COVID-19 in Florence, Italy. Methods The GIROT activity was set-up during the first wave of the pandemic (W1, March–April 2020) and became a structured healthcare model during the second (W2, October 2020–January 2021). The activity involved (1) infection transmission control among NHs residents and staff, (2) comprehensive geriatric assessment including prognostication and geriatric syndromes management, (3) on-site diagnostic assessment and protocol-based treatment of COVID-19, (4) supply of nursing personnel to understaffed NHs. To estimate the impact of the GIROT intervention, we reported hospitalization and infection lethality rates recorded in SARS-CoV-2-positive NH residents during W1 and W2. Results The GIROT activity involved 21 NHs (1159 residents) and 43 NHs (2448 residents) during W1 and W2, respectively. The percentage of infected residents was higher in W2 than in W1 (64.5% vs. 38.8%), while both hospitalization and lethality rates significantly decreased in W2 compared to W1 (10.1% vs 58.2% and 23.4% vs 31.1%, respectively). Discussion Potentiating on-site care in the NHs paralleled a decrease of hospital admissions with no increase of lethality. Conclusions An innovative “hospital-at-nursing home” patient-centred care model based on comprehensive geriatric assessment may provide a valuable contribution in fighting COVID-19 in NH residents.

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A MULTI-DISCIPLINARY COMPREHENSIVE GERIATRIC ASSESSMENT OF ELDERLY SUBJECTS IN A SUPERSPECIALITY TERTIARY CARE HOSPITAL, DELHI.

10.36106/6003310 ◽

2021 ◽

pp. 15-18

Author(s):

Namit Mathur ◽

Neha Mathur ◽

Vinod Kumar ◽

Vikrant Negi

Keyword(s):

Elderly People ◽

Geriatric Assessment ◽

Environmental Assessment ◽

Comprehensive Geriatric Assessment ◽

Tertiary Care ◽

Laboratory Diagnosis ◽

Underlying Disease ◽

Elderly Subjects ◽

Care Hospital ◽

Health And Social Care

Introduction: The comprehensive assessment of elderly people who requires health and social care is becoming of increasing importance. The study was conducted to detect various morbidities in elderly people based on their physical, psychological, and socio-environmental assessment. Material & Methods: history of any underlying disease of each subject was obtained. General physical examination and wherever required, relevant laboratory investigations were performed, followed by comprehensive geriatric assessment (CGA) which consisted of three components namely physical, psychological and socio environmental assessment. Results: Among 150 subjects, 37% had suspected respiratory, 33% musculo-skeletal and 27% gastrointestinal system diseases. Symptoms were less prevalent among those subjects who had regular health checkups. Depression was noted in 43% and impaired memory in 12%. Socio environment impairments that were present were unsafe homes (13%), absence of social support (6%) and lonely living (7%). Conclusion: The family physician should always perform careful CGA along with required laboratory diagnosis which can help in proper rehabilitation of the patient and unnecessary sufferings can be avoided.

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Prognostic value of a comprehensive geriatric assessment for predicting one-year mortality in presumably frail patient with symptomatic aortic stenosis

Archives of Medical Science ◽

10.5114/aoms/109391 ◽

2021 ◽

Author(s):

Camarzana Audrey ◽

ANNWEILER Cédric ◽

PINAUD Frédéric ◽

ABI-KHALIL Wissam ◽

ROULEAU Frédéric ◽

...

Keyword(s):

Aortic Stenosis ◽

Geriatric Assessment ◽

Comprehensive Geriatric Assessment ◽

Severe Aortic Stenosis ◽

Heart Team ◽

Frail Patient ◽

Transcatheter Aortic Valve ◽

History Of ◽

One Year ◽

Valve Implantation

IntroductionDespite of suffering a severe aortic stenosis, some patients are denied from either surgical or Transcatheter Aortic Valve Implantation (TAVI) therapy because of a frail condition. We aim to identify whether a comprehensive geriatric assessment (CGA) might be useful to predict prognosis of presumably frail patients with severe aortic stenosis.Material and methodsBetween March 2011 and July 2016, 818 patients were consecutively and prospectively enrolled. 161 had a CGA and were considered for analysis. Considering combined CGA and Heart team recommendations, 102 TAVI were performed (TAVI group) and 59 patients constituted the no TAVI group. Primary endpoint was all-cause mortality at one year.ResultsThere was no difference between the TAVI and the no TAVI groups considering morphometric data, cardiovascular risk factors or symptoms. The no TAVI group had higher surgical risk (logistic EuroSCORE1 33.4±17.8 vs. 22.7±14.9; p<0.001) and more moderate renal insufficiency (82% vs. 57%; p=0.001). One-year mortality was 16% in the TAVI group and 46% in the no TAVI group (p<0.001). Multivariate analysis revealed history of pulmonary edema, moderate renal failure, and not having a TAVI, to relate to 1-year mortality. There was an interaction of the Five-Times-Sit-to-Stand-Test (FTSST) upon the effect of TAVI on mortality (p=0.049), as FTSST was the only predictor for 1-year mortality in the no TAVI group (HR:0.18 95%CI 0.04–0.76; p=0.019).ConclusionsOne-year mortality was higher in geriatric-assessed frail patient who did not undergo TAVI. FTSST, which assesses patients’ mobility, was the only prognostic marker for 1-year mortality, on top of usual medical parameters.

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Home Monitoring System for Comprehensive Geriatric Assessment in Patient's Dwelling: System Design and UX Evaluation

Frontiers in Digital Health ◽

10.3389/fdgth.2021.659940 ◽

2021 ◽

Vol 3 ◽

Author(s):

Elena Villalba-Mora ◽

Xavier Ferre ◽

Rodrigo Pérez-Rodríguez ◽

Cristian Moral ◽

Myriam Valdés-Aragonés ◽

...

Keyword(s):

Monitoring System ◽

Geriatric Assessment ◽

Mobile Health ◽

Comprehensive Geriatric Assessment ◽

Population Aging ◽

Home Monitoring ◽

Clinical Settings ◽

Home Based ◽

Older Users ◽

Mobile Health Systems

Population aging threatens the sustainability of welfare systems since it is not accompanied by an extended healthy and independent period in the last years of life. The Comprehensive Geriatric Assessment (CGA) has been shown to be efficient in maintaining the healthy period at the end of the life. Frailty monitoring is typically carried out for an average period of 6 months in clinical settings, while more regular monitoring could prevent the transition to disability. We present the design process of a system for frailty home monitoring based on an adapted CGA and the rationale behind its User eXperience (UX) design. The resulting home monitoring system consists of two devices based on ultrasound sensors, a weight scale, and a mobile application for managing the devices, administering CGA-related questionnaires, and providing alerts. Older users may encounter barriers in their usage of technology. For this reason, usability and acceptability are critical for health monitoring systems addressed to geriatric patients. In the design of our system, we have followed a user-centered process, involving geriatricians and older frail patients by means of co-creation methods. In the iterative process of design and usability testing, we have identified the most effective way of conducting the home-based CGA, not just by replicating the dialogue between the physician and the patient, but by adapting the design to the possibilities and limitations of mobile health for this segment of users. The usability evaluation, carried out with 14 older adults, has proved the feasibility of users older than 70 effectively using our monitoring system, additionally showing an intention over 80% for using the system. It has also provided some insights and recommendations for the design of mobile health systems for older users.

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31 Understanding of Comprehensive Geriatric Assessment Among Fifth Year Medical Students

Age and Ageing ◽

10.1093/ageing/afz183.31 ◽

2020 ◽

Vol 49 (Supplement_1) ◽

pp. i1-i8

Author(s):

D Perera ◽

A Jones

Keyword(s):

Medical Students ◽

Geriatric Assessment ◽

Comprehensive Geriatric Assessment ◽

Hospital Admissions ◽

Geriatric Medicine ◽

Target Population ◽

Daily Basis ◽

North East ◽

The North ◽

Initial Questionnaire

Abstract Introduction There are 191 foundation programme jobs in geriatrics in the North East.1 Students often don’t receive teaching sessions on the comprehensive geriatric assessment (CGA). It is an assessment foundation trainees use on a daily basis on the geriatric ward and the acute take. Methods We designed a series of teaching sessions for fifth year medical students, delivered by different members of the multidisciplinary team. A pre- and post-session questionnaire assessed their understanding. Results Nine students completed the pre-session questionnaire:22% were able to define CGA11% identified the different components22% identified the target population, the benefits of CGA and the members involved44% offered solutions to obtaining a history from patients with confusion100% identified the barriers to carrying out CGA Seven students carried out the post session questionnaire; the table below represents the number that answered correctly. Conclusions The majority of foundation trainees will have at least one job in geriatric medicine and participate in the acute take. The average age of hospital admissions has been rising for years,2 highlighting the importance of being able to accurately and thoroughly assess the older population. The initial questionnaire demonstrated the limited understanding that fifth year students had on the comprehensive geriatric assessment. Following sessions by different members of the MDT there was clear improvement. The sessions covered: general overview of CGA; session by the frailty pharmacist; functional assessment by physiotherapy team; cognitive assessment by the dementia and delirium team; and life as an F1 on geriatric medicine. Positive feedback was received, emphasising the improvement in confidence in preparation for foundation training. References 1. Oriel website: https://www.oriel.nhs.uk/Web/FND. 2. NHS digital Hospital Admitted Patient Care Activity 2015–16.

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