scholarly journals Proactive care of older people undergoing surgery ('POPS'): Designing, embedding, evaluating and funding a comprehensive geriatric assessment service for older elective surgical patients

2007 ◽  
Vol 36 (2) ◽  
pp. 190-196 ◽  
Author(s):  
D. Harari ◽  
A. Hopper ◽  
J. Dhesi ◽  
G. Babic-Illman ◽  
L. Lockwood ◽  
...  
Keyword(s):  
Older People ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Surgical Patients ◽  
Proactive Care

scholarly journals 21 The Jean Bishop Team, Hull: A New Model of Care for Comprehensive Geriatric Assessment of the Frail Population

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i1-i8
Author(s):  
K Athorn ◽  
A Folwell ◽  
D Harman ◽  
S Kar ◽  
L Windass
Keyword(s):  
Older People ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Community Services ◽  
Care Homes ◽  
Staff Satisfaction ◽  
Model Of Care ◽  
Future Planning ◽  
New Model ◽  
Proactive Care

Abstract Introduction Hull CCG recognised system’s over-reliance on reactive, hospital care and workforce deficits, requiring a modernised service model for frail older people that moved from individual provider focus to system-wide perspective, with emphasis on proactive care. Methods Electronic Frailty Index (eFI) in primary care system identified 3,200 out of 300,000 Hull residents Hull with severe frailty. Recruited 9 GPs with extended role in older people’s care and Advanced Nurse Practitioners to support 4 Community Geriatricians. Redesigned roles for pharmacy, social services and non-clinical care coordinator teams. New therapy roles created, multiple third sector organisations involved, including carer support, and purpose-built location with older people in mind. Interventions Structured and anticipatory comprehensive geriatric assessment of all 3200 residents (either at home or in care homes) by the multidisciplinary multiagency team. Pre-assessment home visit by support worker to complete patient concern’s questionnaire. Dedicated patient transport and one-stop multi-disciplinary team assessment in one building. Proactive discussion of RESPECT and advance care planning, electronic personalised care plan delivered with system-wide record sharing across providers, Same day basic diagnostics available. Complex care coordinators ongoing support in community. Multi-disciplinary outreach to care homes and truly housebound. Results 99.7% patients and carers extremely likely/likely to recommend the service 21,000 interventions for 2,500 patients seen since June 2018 Majority of patients moderately frail by Clinical Frailty Score Average saving on drug costs - £110.17 /patient/year 15% reduction in ED attendances, 29% reduction in emergency admissions Patients’ survey: adequate time and opportunity to discuss health problems/concerns, felt informed and empowered during consultation and in future planning Very high levels of staff satisfaction Conclusions and future Innovative high quality, cost-effective new model of care delivering improved patient care and experience with emphasis on proactive care and future planning High levels of patient and staff satisfaction Future expansion with disease specific teams including COPD, parkinsonism and diabetes and targeting moderately frail by eFI. Redesign of community services with improved integration across teams and providers can be a blue-print for other services.

scholarly journals Effect of in-hospital comprehensive geriatric assessment (CGA) in older people with hip fracture. The protocol of the Trondheim Hip Fracture Trial

2011 ◽  
Vol 11 (1) ◽  
Author(s):  
Olav Sletvold ◽  
Jorunn L Helbostad ◽  
Pernille Thingstad ◽  
Kristin Taraldsen ◽  
Anders Prestmo ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Older People ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment

scholarly journals Multidimensional prognostic index and the risk of fractures: an 8-year longitudinal cohort study in the Osteoarthritis Initiative

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Nicola Veronese ◽  
Lee Smith ◽  
Ekaterini Zigoura ◽  
Mario Barbagallo ◽  
Ligia J. Dominguez ◽  
...  
Keyword(s):  
Older People ◽  
Fracture Risk ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Prognostic Index ◽  
Knee Oa ◽  
Increased Risk ◽  
Cox's Regression ◽  
Clinical Fractures ◽  
Osteoarthritis Initiative

Abstract Summary In this longitudinal study, with a follow-up of 8 years, multidimensional prognostic index (MPI), a product of the comprehensive geriatric assessment, significantly predicted the onset of fractures in older people affected by knee osteoarthritis. Purpose Frailty may be associated with higher fracture risk, but limited research has been carried out using a multidimensional approach to frailty assessment and diagnosis. The present research aimed to investigate whether the MPI, based on comprehensive geriatric assessment (CGA), is associated with the risk of fractures in the Osteoarthritis Initiative (OAI) study. Methods Community-dwellers affected by knee OA or at high risk for this condition were followed-up for 8 years. A standardized CGA including information on functional, nutritional, mood, comorbidity, medication, quality of life, and co-habitation status was used to calculate the MPI. Fractures were diagnosed using self-reported information. Cox’s regression analysis was carried out and results are reported as hazard ratios (HRs), with their 95% confidence intervals (CIs), adjusted for potential confounders. Results The sample consisted of 4024 individuals (mean age 61.0 years, females = 59.0%). People with incident fractures had a significant higher MPI baseline value than those without (0.42 ± 0.18 vs. 0.40 ± 0.17). After adjusting for several potential confounders, people with an MPI over 0.66 (HR = 1.49; 95%CI: 1.11–2.00) experienced a higher risk of fractures. An increase in 0.10 point in MPI score corresponded to an increase in fracture risk of 4% (HR = 1.04; 95%CI: 1.008–1.07). Higher MPI values were also associated with a higher risk of non-vertebral clinical fractures. Conclusion Higher MPI values at baseline were associated with an increased risk of fractures, reinforcing the importance of CGA in predicting fractures in older people affected by knee OA.

scholarly journals 17 Improving Frailty Identification and Comprehensive Geriatric Assessment (CGA) Completion on the Wards

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i1-i8
Author(s):  
D Verma ◽  
F Bonora ◽  
R Walker ◽  
M Kaneshamoorthy ◽  
L Bafadhel
Keyword(s):  
Older People ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Elderly Care ◽  
Frail Older People ◽  
Clinical Frailty Scale ◽  
Improvement Project ◽  
Qualitative Feedback ◽  
Complicated Course ◽  
User Friendly

Abstract Introduction The Comprehensive Geriatric Assessment (CGA) is known to deliver substantial and measurable health improvements to frail older people, including increased independence and a reduction in mortality.1 The Clinical Frailty Scale (CFS) can detect older adults at higher risk of complicated course and longer hospital stay.2 Despite the known benefits, previous audits has shown poor documentation on geriatric wards at Southend Hospital. Therefore, we devised a Quality Improvement Project to improve the uptake of both these. Methods A total of two Plan Do Study Act (PDSA) cycles were completed where CGA completion and CFS documentation was audited. Each cycle lasted two weeks (25 patients). Qualitative feedback was obtained from the members of multidisciplinary team to aid improvements. The baseline audit was based on the introduction of a 2-page ward proforma for all new patients. The first intervention was an improved 2-page ward-proforma. The second intervention was a single page ward-proforma. Results Originally, 40% of new patients admitted onto the ward had a CGA assessment and CFS score. After the first intervention, 79% (19) patients had a CFS score and a CGA assessment. 21% had a full CGA completed and 58% had partial CGA. Feedback included wanting a single page proforma to increase uptake. Questions needed to be more unambiguous and more tick boxes. After the second intervention 100% (25) patients had a CFS score and a CGA assessment. 40% (10) had a full CGA completed and 60% (15) had a partial CGA. Feedback include incorporating the ward round documentation to avoid repetition. Conclusions The results show that by using a focused, concise and user-friendly proforma, uptake of the Comprehensive Geriatric Assessment and Clinical Frailty Scale can be significantly increased, bringing substantial and measurable health improvements to frail older people admitted to elderly care wards. References 1. Welsh TJ, Gordon AL, Gladman JR. Int J Clin Pract. 2014;68(3):290–293. 2. Juma S, Taabazuing MM, Montero-Odasso M. Can Geriatr J. 2016;19(2):34–39.

scholarly journals Comprehensive Geriatric Assessment in the perioperative setting; where next?

2019 ◽  
Vol 48 (5) ◽  
pp. 624-627 ◽  
Author(s):  
Jugdeep Dhesi ◽  
S Ramani Moonesinghe ◽  
Judith Partridge
Keyword(s):  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Geriatric Medicine ◽  
Cultural Barriers ◽  
Face Validity ◽  
Surgical Patients ◽  
National Audit ◽  
Services Research ◽  
Services Implementation ◽  
The Uk

Abstract Comprehensive Geriatric Assessment (CGA) is being employed in the perioperative setting to improve outcomes for older surgical patients. Traditionally CGA is delivered by a geriatrician led multidisciplinary team but with the acknowledged workforce challenges in geriatric medicine, it has been suggested that non-geriatricians may be able to deliver CGA. HOW-CGA developed a toolkit to facilitate the delivery of CGA by non-geriatricians in the perioperative setting. Across two hospital sites uptake and implementation of this toolkit was limited by a potential lack of face validity, behavioural and cultural barriers and an acknowledgement that geriatric medicine expertise is key to CGA and optimisation. In-keeping with this finding there has been an observed expansion in geriatrician led CGA services for older surgical patients in the UK. In order to demonstrate the effectiveness of perioperative CGA services, implementation science should be combined with health services research methodology and the use of big data through linked national audit.

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