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comprehensive geriatric assessment

Indications: - functional decline with changes in physical, mental,& social status - cases of multiple 'red flags' such as potential for elder abuse, multiple recent hospitalizations, & possible cognitive impairment [1] - used to prepare individualized care plans that emcompass medical, psychologic, & functional capabilities of frail elderly - comprehensive geriatric assessment with multiple home visits can reduce functional decline & nursing home placement [1] - useful in older patients undergoing pacemaker implantation to identify disability associated with mortality & nursing home admission [6] - useful in counseling elderly with cancer & their oncologists regarding the time horizon for the benefits of treatments [1,9] - limited vidence suggests comprehensive geriatric assessment benefits independence & mortality in hospitalized frail elderly [10] * can be performed in any healthcare setting * maximum benefit is attained when the team performing the assessment also provides the care Contraindications: - not the most effective option for improving function in frail older adults - mixed results in terms of benefit for frailty status or function [1] Clinical significance: - improves healthcare outcomes in some frail elderly - no reliable guidelines identify which patients might benefit - insufficient data to determine whether comprehensive geriatric assessment results in fewer emergency department visits, fewer hospitalizations, fewer adverse drug reactions, or reduced costs of care - comprehensive geriatric assessment during emergency hospitalization results in improved survival, a higher likelihood of being home in 6 months, & reduced institutionalization - comprehensive geriatric assessment may reduce polypharmacy in the elderly [5] Procedure: - see office-based geriatric assessment - home safety evaluation Notes: - no explicit Medicare reimbursement [1]

Specific

office-based geriatric assessment

General

geriatric assessment

References

  1. Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010 - Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013 - Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  2. Li CM, Chen CY, Li CY, Wang WD, Wu SC. The effectiveness of a comprehensive geriatric assessment intervention program for frailty in community-dwelling older people: a randomized, controlled trial. Arch Gerontol Geriatr. 2010 Feb;50 Suppl 1:S39-42. PMID: 20171455
  3. Ellis G et al. Comprehensive geriatric assessment for older adults admitted to hospital: Meta-analysis of randomised controlled trials. BMJ 2011 Oct 27; 343:d6553 PMID: 22034146 - Stuck AE and Iliffe S. Comprehensive geriatric assessment for older adults. BMJ 2011 Oct 27; 343:d6799. PMID: 22034147 - Ellis G, Whitehead MA, O'Neill D, Langhorne P, Robinson D. Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane Database Syst Rev. 2011 Jul 6;(7):CD006211 PMID: 21735403
  4. Elsawy B, Higgins KE. The geriatric assessment. Am Fam Physician. 2011 Jan 1;83(1):48-56. Review. PMID: 21888128 Free Article
  5. Unutmaz GD, Soysal P, Tuven B, Isik AT Costs of medication in older patients: before and after comprehensive geriatric assessment. Clinical Interventions in Aging Volume 13 https://www.dovepress.com/costs-of-medication-in-older-patients-before-and-after-comprehensive-g-peer-reviewed-article-CIA
  6. Schoenenberger AW, Russi I, Berte B et al. Evaluation of comprehensive geriatric assessment in older patients undergoing pacemaker implantation. BMC Geriatr. 2020;20(1):287. Published 2020 Aug 12 PMID: 32787787 PMCID: PMC7424674 Free PMC article
  7. Pilotto A, Cella A, Pilotto A, et al. Three decades of comprehensive geriatric assessment: evidence coming from different healthcare settings and specific clinical conditions. J Am Med Dir Assoc. 2017;18(2):192.e1-192.e11 PMID: 28049616 https://www.jamda.com/article/S1525-8610(16)30521-7/fulltext
  8. Soto-Perez-de-Celis E, Li D, Yuan Y, et al. Functional versus chronological age: geriatric assessments to guide decision making in older patients with cancer. Lancet Oncol. 2018;19(6):e305-e316 PMID: 29893262 https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(18)30348-6/fulltext
  9. Mohile SG, Epstein RM, Hurria A et al. Communication with older patients with cancer using geriatric assessment: a cluster-randomized clinical trial from the National Cancer Institute Community Oncology Research Program. JAMA Oncol. 2020 Feb 1;6(2):196-204 PMID: 31697365 PMCID: PMC6865234 Free PMC article https://jamanetwork.com/journals/jamaoncology/fullarticle/2754746
  10. Xu Y, Ji T, Li X, et al. The effectiveness of the comprehensive geriatric assessment for older adults with frailty in hospital settings: A systematic review and meta-analysis. Int J Nurs Stud. 2024 Jul 2;159:104849. PMID: 39146609