Effectiveness of a geriatric intervention in primary care: a randomized clinical trial

Monteserín, Rosa; Brotons, Carlos; Moral, Irene; Altimir, Salvador; José, Antonio San; Santaeugenia, Sebastián; Sellarés, Jaume; Padrós, Jaume González

doi:10.1093/fampra/cmp101

Cited by 71 publications

(72 citation statements)

References 21 publications

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“…We also found that in addition to advanced age, a self-report of worse health, history of falls, weight loss, and depressed mood in the MAGE questionnaire were significantly associated with hospitalization or ED visits within 1 year. Previous studies have shown that geriatric screening and risk assessment can have high detection rates and help to identify high-risk elderly who may benefit from targeted interventions in different settings [9][10][11]. The results of this study are similar to other validated instruments that evaluate risk, but some important differences should be highlighted.…”

Section: Discussionsupporting

confidence: 56%

Patient-Reported Geriatric Symptoms as Risk Factors for Hospitalization and Emergency Department Visits

Chandra¹,

Crane²,

Tung³

et al. 2015

Aging and disease

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There is an urgent need to identify predictors of adverse outcomes and increased health care utilization in the elderly. The Mayo Ambulatory Geriatric Evaluation (MAGE) is a symptom questionnaire that was completed by patients aged 65 years and older during office visits to Primary Care Internal Medicine at Mayo Clinic in Rochester, MN. It was introduced to improve screening for geriatric conditions. We conducted this study to explore the relationship between self-reported geriatric symptoms and hospitalization and emergency department (ED) visits within 1 year of completing the survey. This was a retrospective cohort study of patients who completed the MAGE from April 2008 to December 2010. The primary outcome was an ED visit or hospitalization within 1 year. Predictors included responses to individual questions in the MAGE. Data were obtained from the electronic medical record and administrative records. Logistic regression analyses were performed from significant univariate factors to determine predictors in a multivariable setting. A weighted scoring system was created based upon the odds ratios derived from a bootstrap process. The sensitivity, specificity, and AUC were calculated using this scoring system. The MAGE survey was completed by 7738 patients. The average age was 76.2 ± 7.68 years and 57% were women. Advanced age, a self-report of worse health, history of 2 or more falls, weight loss, and depressed mood were significantly associated with hospitalization or ED visits within 1 year. A score equal to or greater than 2 had a sensitivity of 0.74 and specificity of 0.45. The calculated AUC was 0.60. The MAGE questionnaire, which was completed by patients at an outpatient visit to screen for common geriatric issues, could also be used to assess risk for ED visits and hospitalization within 1 year. Key words: emergency department, geriatric screening, hospitalizationAging is associated with a higher burden of disease, disability, and complex medical needs. In order to effectively address these concerns, screening strategies that identify issues that affect the quality of life and health outcomes in the elderly are needed. Health care providers are keenly interested in identifying predictors of adverse health outcomes such as emergency department (ED) visits and hospitalizations in the elderly. This interest, largely due to an increase in the aging population, is further driven by the Affordable Care Act which provides impetus to contain costs and reduce avoidable hospital readmissions [1]. Previous studies have examined predictors for increased health care utilization and adverse outcomes and introduced instruments, which incorporate factors such as medical complexity, self-rated health, previous utilization, and socioeconomic and functional status, to assess this risk in different settings [2][3][4][5][6][7]. Falls, urinary incontinence, vision and hearing difficulties, weight loss, depression, poor memory, and poor self-rate of health are common geriatric issues which deeply affect the qualit...

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Section: Discussionsupporting

confidence: 56%

Patient-Reported Geriatric Symptoms as Risk Factors for Hospitalization and Emergency Department Visits

Chandra¹,

Crane²,

Tung³

et al. 2015

Aging and disease

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“…4 However, controversy exists over whether the introduction of CGA will be beneficial and cost-effective in primary care. [5][6][7][8][9][10] Furthermore, implementation of CGA is hampered by time and financial constraints. 8,11 Therefore, more efficient CGA tools are necessary for family practice, for which we developed a stepwise approach in which a short tool is used as a first step to select the patients who will really benefit from CGA.…”

mentioning

confidence: 99%

Diagnosis of Frailty after a Comprehensive Geriatric Assessment: Differences between Family Physicians and Geriatricians

Kempen

Melis

Perry

et al. 2015

The Journal of the American Board of Family Medicine

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Background: To compare the outcomes of Comprehensive Geriatric Assessments by family physicians and geriatricians.Methods: An explorative observational study was conducted in six family practices (12 ambulatory family practitioners) and 1 geriatric department (4 hospital-based geriatricians) from a university medical center in Nijmegen (the Netherlands). As participants, we included 587 patients aged 70 years and older and registered in the six family practices. The main outcome measures were the judgment on the following: 1) absence or presence of frailty and 2) the state (good-fair-poor) on 8 underlying domains (physical, medication, cognition, sensory, instrumental activities of daily living scale, mobility, mental, and social) according to family physicians and geriatricians based on a Comprehensive Geriatric Assessment.Results: Family physicians and geriatricians agreed on frailty absence/presence in 76% of cases. Geriatricians considered elderly more often frail than family physicians did (n ‫؍‬ 294, 50% vs n ‫؍‬ 213, 36%). Disagreement on frailty status was notably found in the patients who had less distinct, either poor or good, health states. Discordant frailty judgments, in which the geriatrician rated a person as frail and the family physicians did not, were related to geriatricians more often rating physical health as impaired. Further, geriatricians' judgments of frailty were more strongly related to impaired scores on the domains cognition, sensory, mobility, and mental compared with family physicians judgments: odds ratios 79.3 versus 9.3, 7.6 versus 2.0, 25.0 versus 3.0, and 18.0 versus 2.2, respectively. Impaired physical health and problematic medication use had equally strong associations with frailty in geriatricians and family physicians: odds ratios of 11.5 versus 10.4 and 2.4 versus 2.5, respectively.Conclusions: Geriatricians more often judge patients as frail compared with family physicians and seem to evaluate the available information differently. With increasing collaboration between primary and secondary care, understanding these differences becomes increasingly relevant. (J Am Board Fam Med 2015;28:240 -248.)

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“…Verschiedene Metaanalysen geben immer wieder Hinweis darauf, dass die als präventiv zu bewertende Maß-nahme eines geriatrischen Assessments zumindest kleine positive Effekte auf Mortalität, Morbidität und Funktion haben kann [3,14,19]. Allerdings sind diese Aussagen nur mit Einschrän-kungen auf das deutsche Gesundheitssystem übertragbar.…”

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“…Mehrere Studien weisen darauf hin, dass ein Assessment allein auf Populationsbasis beispielsweise aller über 65-jährigen Hausarztpatienten keine positiven Effekte hat, selbst dann nicht, wenn es auf wesentliche und häufige Erkrankungen des Alters wie Hör-und Sehprobleme, Urininkontinenz und Immobilität beschränkt wird [6,8]. Die Begrenzung auf spezifische Subpopulationen, wie jene Patienten, die bereits erste Einschränkungen aufweisen und denen Frailty und damit der Verlust der Fähigkeit zur selbststän-digen Lebensführung droht, ist vermutlich effektiver [14].…”

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Das geriatrische Basisassessment in der Hausarztpraxis

et al. 2012

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Effectiveness of a geriatric intervention in primary care: a randomized clinical trial

Abstract: A specific intervention in patients over 74 years attended in primary care reduces morbidity and mortality in patients at risk of frailty and increases the proportion of patients that reversed their initial status at risk of frailty.

Cited by 71 publications

References 21 publications

Patient-Reported Geriatric Symptoms as Risk Factors for Hospitalization and Emergency Department Visits

Patient-Reported Geriatric Symptoms as Risk Factors for Hospitalization and Emergency Department Visits

Diagnosis of Frailty after a Comprehensive Geriatric Assessment: Differences between Family Physicians and Geriatricians

Das geriatrische Basisassessment in der Hausarztpraxis

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