Community‐Based Geriatric Assessment

Abstract

A comprehensive review of the multidisciplinary functional assessment and treatment of 800 patients seen at a community-based geriatric assessment center was performed to profile clinical characteristics of patients attending such a program and to evaluate possible predictors of institutionalization. The most common problems addressed were senile dementia (46%), hypertension (31%), clinically significant depression (30%), and burdened caregiver (24%). More than 90% of patients were able to remain in the community after multidisciplinary treatment of their problems and marshalling of support services. The most potent predictors of institutionalization in rank order of predictive value were: falls or unstable gait, senile dementia, caregiver strain, lack of support services, and moderate to severe impairment of ability to perform activities of daily living (multiple R = 0.45; P = .001). Advantages and impediments to community-based assessment are discussed.

Dementia, disability and contact with formal services: a comparison of dementia sufferers and non-sufferers in rural and urban settings

“…The importance of supporting carers is stressed continually, yet there is little evidence of skill sharing and support in the management of dementia patients at home. It has been reported elsewhere (Martin et a/. 1985, Scott & Wenger 1994) that the admission rate to residential services is high for those suffering from dementia.…”

“…1985, Scott & Wenger 1994) that the admission rate to residential services is high for those suffering from dementia. It has been suggested that adequate formal help and psychological support for primary caregivers delays institutionalization (Brane 1986, Martin et al 1985. It has also been shown that initial effective interventions in the community are beneficid to carers over time despite declining functioning of the dementia sufferer (Pynoos & Ohta 1991).…”

“…Those in the community are on average less cognitively impaired than those in residential care, but some admissions to institutional care occur at comparable levels of impairment. It has been suggested (Wenger et al 1996) that if more adequate services were available in the community, it might be possible for more of those in the early stages of dementia to remain at home and to do so for longer periods (Martin et al 1985).…”

Polypharmacy in the Elderly: A Fait Accompli?

“…Numerous investigators have questioned the wisdom of multiple drug use in the elderly because it results in iatrogenic illness, drug-drug interactions, and decreased medication compliance. [6][7][8] Although warnings concerning the use of multiple medications in the elderly are sounded frequently, pressures to prescribe even more drugs will continue in the future. This is expected because research will enhance the physician's ability to identify diseases in the elderly and expand the physician's armamentarium of therapeutic modalities.…”

Geriatric Care Approaches in Health Maintenance Organizations

“…Treating Multi‐Problem Patients Requiring Several Disciplines Although the concept of the multidisciplinary team has gained wide acceptance, the effects of team care have been difficult to separate from the effects of the assessment process 11,19–24 . Such teams can operate in inpatient, ambulatory, home health, or long‐term care settings.…”