Comprehensive geriatric assessment and multidisciplinary team interventions for hospitalized older adults: A scoping review

Choi, Jung-Yeon; Rajaguru, Vasuki; Shin, Jaeyong; Kim, Kwang Il

doi:10.1016/j.archger.2022.104831

Cited by 19 publications

(14 citation statements)

References 34 publications

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“…Six domains of the CGA will be assessed, including functional capacity, cognition, delirium, comorbidity, frailty, and nutrition [10]. The selection criteria of the tools to be used during the assessment of the patients were based on the available literature review [11]- [13] and on a recent scoping review about interdisciplinary team interventions in non-ICU acute care services based on the CGA [10]. Moreover, domains for assessing older people in the ICU in LMICs have been previously proposed [12].…”

Section: Resultsmentioning

confidence: 99%

“…Most of the tools in the CGA included in the assessment of older people in the ICU are selected based on theoretical approaches taken from other clinical media or other pathologies [10]. However, the CGA emphasizes clinical problem-solving incorporating standard medical assessment, providing tools to develop treatment plans and follow-up plans, coordinating the management of care, and evaluating long-term care needs.…”

Section: Preliminary Findingsmentioning

confidence: 99%

“…The difficulties inherent to the ICU in recruiting and assessing patients pose limitations in external validity, leading to criticism of the design of randomized clinical trials in these contexts [10]. Consequently, this pilot will allow us to evaluate how the main study works through the research of reliability, the study process, the necessary resources, the methods, and the potential obstacles to completion [32].…”

Section: Limitationsmentioning

confidence: 99%

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Critical Care in Older People in Low and Middle-Countries (LMICs): Comprehensive Geriatric Assessment (CGA) Protocol in Andes Mountains

Villada-Gómez,

Florian-Perez,

Murillo-Molina

et al. 2023

EJMED

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Background: The number of older adults in ICU care is increasing. Nowadays, at least fifty percent of ICU patients are aged 65 years and older. The most frequent pathologies to be admitted to the ICU in older people include acute diseases, long-term conditions, and acute or chronic disease exacerbations. Furthermore, new clinical phenotypes, and geriatric syndromes (falls, frailty, immobility) result from the interaction of age-associated conditions and comorbidity. Severity of index disease, multimorbidity, premorbid functional status, frailty, nutritional status, and cognitive level are more important determinants of long-term outcome than chronological age. Comprehensive geriatric assessment (CGA) is a recognized and useful instrument in the management of elderly patients. Methods: We present a protocol for a clinical trial on the application ofCGA in ICU in the Andes Mountains in Colombia, a Low and Middle-Income Country (LMIC). This protocol could provide valuable information for the integration of geriatrics into critical care and provide practical information on how to implement CGA in this context. Results: The selection criteria of the tools to be used during the assessment of the patients were based on the available literature review and on reviews about interdisciplinary team interventions in acute care services based on the CGA. Conclusion: The care of critically ill elderly patients in the ICU is challenging due to factors such as frailty, psychosocial vulnerability, cognitive impairment, dependence on activities of daily living, and the presence of geriatric syndromes which are important conditions for adverse health outcomes in the future. CGA technology could be considered an excellent tool for managing older people in ICU.

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Section: Resultsmentioning

confidence: 99%

Section: Preliminary Findingsmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

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Critical Care in Older People in Low and Middle-Countries (LMICs): Comprehensive Geriatric Assessment (CGA) Protocol in Andes Mountains

Villada-Gómez,

Florian-Perez,

Murillo-Molina

et al. 2023

EJMED

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“…Based on the comprehensive geriatric assessment (CGA)—a routine interdisciplinary procedure applied in the department—we collected information on the sociodemographic, medical, nutritional, and functional characteristics of patients with (HF+) and without (HF−) heart failure. The CGA is carried out by the ward’s doctors, nurses, the physiotherapist, and the psychologist using various assessment instruments and tests designed to assess these domains, as described below, to allow for a multidomain intervention and improve outcomes [ 11 ]. We classified patients as HF+ based on a prior diagnosis or, in newly diagnosed cases, on clinical symptoms present on admission (according to the New York Heart Association Classification) and the results of transthoracic echocardiography (TTE).…”

Section: Methodsmentioning

confidence: 99%

Association of Chronic Heart Failure with Frailty, Malnutrition, and Sarcopenia Parameters in Older Patients—A Cross-Sectional Study in a Geriatric Ward

Charkiewicz¹,

Wojszel

Kasiukiewicz

et al. 2023

JCM

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The need to assess sarcopenia and frailty in patients with chronic heart failure (HF) has recently been raised. This cross-sectional study of 416 geriatric ward patients (median age (Me)—82 (IQR, 77–86) years, 77.4% female, 96.9% community dwelling) aimed to assess the prevalence of dynapenia, frailty syndrome, functional and nutritional health, and co-morbidity regarding their HF status. We collected data from comprehensive geriatric assessment. We observed HF in 162 (38.9%) patients, with 80 (49.4%) classified as New York Heart Association (NYHA) class III or IV. HF patients were significantly older, more frequently male, obese, hospitalized in the previous year, burdened with multimorbidity and polypharmacy, classified as frail, dependent on daily living activities, and physically non-active. Ischemic heart disease, atrial fibrillation, diabetes, peripheral arterial disease, anemia, chronic kidney disease, history of myocardial infarction, and stroke were found significantly more often in the HF group. A considerably higher percentage of HF patients had dynapenia (54.9% versus 41.9%, p = 0.02), but the difference was significant only in women. We found no significant difference between HF and no-HF groups regarding muscle performance, except for lower median gait speed in the HF group—0.53 m/s (0.35–0.89 m/s) versus 0.68 m/s (0.44–0.99 m/s), p = 0.02). HF patients significantly more often had low grip strength accompanied by slow gait, suggesting probable severe sarcopenia (40.4% vs. 29% in patients without HF, p = 0.046). In the regression analysis, significantly higher odds for HF were observed for lower mid-arm circumference (MAC) and dynapenia when controlling for age, sex, body mass index (BMI), calf circumference (CC), peripheral arterial disease, history of stroke, ischemic heart disease, atrial fibrillation, and diabetes mellitus. Conclusions: HF geriatric patients are often burdened with frailty, obesity, multimorbidity, and polypharmacy. As a result, they are more likely to present low muscle strength (potential sarcopenia), which is frequently accompanied by functional limitations (suggestive of more advanced stages of sarcopenia). This tendency is evident mainly in older women. Nevertheless, sarcopenia can be independently associated with HF in older patients with multimorbidity and disability who are hospitalized in a geriatric department, as a multivariable logistic regression analysis demonstrated.

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“…8 Furthermore, a mutually beneficial partnership can form between the family and healthcare providers, aiding the recovery and outcomes for the patient. [9][10][11][12] Social connections involving family members help hospitalized older people feel supported. Those without family support seem to have an increased risk of a negative hospital experience, such as a fear of not receiving…”

Section: Introductionmentioning

confidence: 99%

COVID-19 and Elective Spine Surgery: The Older Persons' Experience of Going It Alone

Strayer

King

2023

Journal of Neuroscience Nursing

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BACKGROUND: Older people with debilitating degenerative spine disease may benefit from surgery. However, recovery is described as a circuitous process. In general, they describe feeling powerless and receiving depersonalized care during hospitalization. Institution of hospital no-visitor policies to reduce COVID-19 spread may have caused additional negative consequences. The purpose of this secondary analysis was to understand experiences of older people who underwent spine surgery during early COVID-19. METHODS: Grounded theory guided this study of people 65 years or older undergoing elective spine surgery. Fourteen individuals were recruited for 2 in-depth interviews at 2 time points: T1 during hospitalization and T2, 1 to 3 months post discharge. All participants were affected by pandemic-imposed restrictions with 4 interviews at T1 with no visitors, 10 with a 1-visitor policy, and 6 interviews at T2 rehabilitation setting with no visitors. Discriminate sampling of data in which participants described their experiences with COVID-19 visitor restrictions was used. Open and axial coding (consistent with grounded theory) was used for data analysis. RESULTS: Three categories, worry and waiting, being alone, and being isolated, emerged from the data. Participants had delays (waiting) in getting their surgery scheduled, which produced worry that they would lose more function, become permanently disabled, have increased pain, and experience more complications such as falls. Participants described being alone during their hospital and rehabilitation recovery, without physical or emotional support from family and limited nursing staff contact. Being isolated often occurred from institution policy, restricting participants to their rooms leading to boredom and, for some, panic. CONCLUSIONS: Restricted access to family after spine surgery and during recovery resulted in emotional and physical burden for participants. Our findings support neuroscience nurses advocating for family/care partner integration into patient care delivery and investigation into the effect of system-level policies on patient care and outcomes.

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Comprehensive geriatric assessment and multidisciplinary team interventions for hospitalized older adults: A scoping review

Cited by 19 publications

References 34 publications

Critical Care in Older People in Low and Middle-Countries (LMICs): Comprehensive Geriatric Assessment (CGA) Protocol in Andes Mountains

Critical Care in Older People in Low and Middle-Countries (LMICs): Comprehensive Geriatric Assessment (CGA) Protocol in Andes Mountains

Association of Chronic Heart Failure with Frailty, Malnutrition, and Sarcopenia Parameters in Older Patients—A Cross-Sectional Study in a Geriatric Ward

COVID-19 and Elective Spine Surgery: The Older Persons' Experience of Going It Alone

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