The Effectiveness of Inpatient Geriatric Evaluation and Management Units: A Systematic Review and Meta‐Analysis

Craen, Katleen Van; Braes, Tom; Wellens, Nathalie; Denhaerynck, Kris; Flamaing, Johan; Moons, Philip; Boonen, Steven; Gosset, Christiane; Pétermans, Jean; Milisen, Koen

doi:10.1111/j.1532-5415.2009.02621.x

Cited by 185 publications

(154 citation statements)

References 45 publications

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“…The demand to gather data of geriatric patients for research, 42 and for regulatory and monitoring purposes is growing rapidly. Widespread implementation of the interRAI portfolio would imply possibilities of large-scale benchmarking making reliability, validity, and feasibility studies become essential.…”

Section: Discussionmentioning

confidence: 99%

Convergent Validity of the Cognitive Performance Scale of the interRAI Acute Care and the Mini-Mental State Examination

Wellens

Flamaing

Tournoy

et al. 2013

The American Journal of Geriatric Psychiatry

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Objective: The Cognitive Performance Scale (CPS) is generated from five items of the interRAI/ Minimum Data Set instruments, a comprehensive geriatric assessment method. CPS was initially designed to assess cognition in residential care, where it has shown good psychometric performance. We evaluated the performance of the interRAI Acute Care in identifying cognitive impairment among patients hospitalized on acute geriatric wards. Methods: An observational study was conducted on two geriatric wards. Trained raters independently completed the interRAI Acute Care and the Mini-Mental State Examination (MMSE) in 97 inpatients (85 AE 5 years; 67% female). The level of agreement between CPS and MMSE was explored using comparisons of means, agreement coefficients, and diagnostic accuracy. Results: Cognitive impairment was present in 61% of the participants. Average MMSE scores were significantly different between groups with low CPS scores compared with those with high CPS scores (p <0.05). CPS explained only 48.8% of the variability in MMSE. Agreement in defining cognitively impaired subjects was moderate (percentage observed agreement, 68%; k ¼ 0.41). With MMSE score less than 24 as a gold standard, diagnostic accuracy of CPS was moderate (area under curve ¼ 0.73), with low sensitivity, but excellent specificity. When lowering the MMSE cutoff to less than 18 and focusing on patients with severe cognitive impairment, CPS agreement coefficients and sensitivity increased but specificity decreased. Using education-adjusted MMSE cutoffs did not substantially affect the results. Conclusion: CPS can be used for coarse triage between intact and severe cognitive impairment. Although promising results have been obtained in residential and community settings, our results suggest that CPS fails to differentiate across different levels of cognitive impairment in hospitalized geriatric patients. (Am J Geriatr Psychiatry 2013; 21:636e645)

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Section: Discussionmentioning

confidence: 99%

Convergent Validity of the Cognitive Performance Scale of the interRAI Acute Care and the Mini-Mental State Examination

Wellens

Flamaing

Tournoy

et al. 2013

The American Journal of Geriatric Psychiatry

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“…It also has unique features such as linking premorbid and actual functioning; multiple assessment periods following patient's functional evolution; CAPs, scales and evidence based clinical protocols supporting clinical decision making for those familiar or unfamiliar with geriatric care. In addition to the advantages in clinical use, thirdgeneration CGA meets the growing need in geriatric research of transparency and uniformity (29) of data collection systems. The international use of interRAI tools in non-acute settings proved the strength as representative database for clinical research (4).…”

Section: Discussionmentioning

confidence: 99%

First-generation versus third-generation comprehensive geriatric assessment instruments in the acute hospital setting: A comparison of the Minimum Geriatric Screening Tools (MGST) and the interRAI Acute Care (interRAI AC)

Wellens

Flamaing²,

Moons

et al. 2011

The Journal of nutrition, health and aging

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Objective:Comparison of the first-generation Minimum Geriatric Screening Tools (MGST) and the third-generation interRAI Acute Care (interRAI AC). Design: Based on a qualitative multiphase exchange of expert opinion, published evidence was critically analyzed and translated into a consensus. Results: Both methods are intended for a multi-domain geriatric assessment in acute hospital settings, but each with a different scope and goal. MGST contains a collection of single-domain, internationally validated instruments. Assessment is usually triggered by care givers' clinical impression based on geriatric expertise. A limited selection of domains is usually assessed only once, by disciplines with domain-specific expertise. Clinical use results in improvement to screen geriatric problems. InterRAI AC, tailored for acute settings, intends to screen a large number of geriatric domains. Based on systematic observational data, risk domains are triggered and clinical guidelines are suggested. Multiple observation periods outline the evolution of patients' functioning over stay in comparison to the premorbid situation. The method is appropriate for application on geriatric and non-geriatric wards, filling geriatric knowledge gaps. The interRAI Suite contains a common set of standardized items across settings, facilitating data transfer in transitional care. Conclusion: The third-generation interRAI AC has advantages compared to the first-generation MGST. A cascade system is proposed to integrate both, complementary methods in practice. The systematic interRAI AC assessment detects risk domains. Subsequently, clinical protocols suggest components of the MGST as additional assessment. This cascade approach unites the strength of exhaustive assessment of the interRAI AC with domain-specific tools of the MGST.

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“…11 De implementatie van de CGA resulteerde in lagere sterfte bij de ouderen na 6 maanden, maar niet na 12 maanden nazorg. 12 Multidisciplinaire interventies, inclusief lichamelijke oefening, zijn geassocieerd met een afname van functieverlies, 13,14 kortere ziekenhuisopname tegen dezelfde kosten in vergelijking met 'reguliere zorg', [13][14][15][16] minder (her)opnamen in ziekenhuizen en verpleeghuizen, [17][18][19] minder valincidenten, 15,20 en beter ervaren gezondheid en tevredenheid met het leven. 18,21,22 Deze effecten treden op tussen 6 en 12 maanden na de start van de interventies, met een piekeffect na 3 maanden.…”

Section: Achtergrondunclassified

“…23 In verschillende studies is gewezen op het belang van gespecialiseerde geriatrische afdelingen, vaak in combinatie met multidisciplinaire nazorg, zoals casemanagement na ontslag uit het ziekenhuis met revalidatiemogelijkheden. 19,[23][24][25][26] Ziekenhuisgerelateerd functieverlies bij oudere patiënten is een onderschat probleem. In Nederland zijn de medische behandeling en verpleegkundige zorg grotendeels gericht op de gediagnosticeerde ziekte, met weinig aandacht voor een reactiverende behandeling om functieverlies bij de oudere patiënt te voorkomen.…”

Section: Achtergrondunclassified

Integrale interventie ter voorkoming van functieverlies bij ouderen tijdens ziekenhuisopname: het Zorgprogramma voor Preventie en Herstel

Vos

Asmus-Szepesi²,

Bakker

et al. 2014

Tijdschr Gerontol Geriatr

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Integrated approach to prevent functional decline in hospitalized elderlyBackground: Hospital related functional decline in older patients is an underestimated problem. Thirty-five procent of 70-year old patients experience functional decline during hospital admission in comparison with pre-illness baseline. This percentage increases considerably with age. Methods/design: To address this issue, the Vlietland Ziekenhuis in The Netherlands has implemented the Prevention and Reactivation Care Programme (PReCaP), an innovative program aimed at reducing hospital related functional decline among elderly patients by offering interventions that are multidisciplinary, integrated and goal-oriented at the physical, social, and psychological domains of functional decline. Discussion: This paper presents a detailed description of the intervention, which incorporates five distinctive elements: (1) Early identification of elderly patients with a high risk of functional decline, and if necessary followed by the start of the reactivation treatment within 48 h after hospital admission; (2) Intensive follow-up treatment for a selected patient group at the prevention and Reactivation Centre; (3) Availability of multidisciplinary geriatric expertise; (4) Provision of support and consultation of relevant professionals to informal caregivers; (5) Intensive follow-up throughout the entire chain of care by a casemanager with geriatric expertise. Outcome and process evaluations are ongoing and results will be published in a series of forthcoming papers.

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The Effectiveness of Inpatient Geriatric Evaluation and Management Units: A Systematic Review and Meta‐Analysis

Cited by 185 publications

References 45 publications

Convergent Validity of the Cognitive Performance Scale of the interRAI Acute Care and the Mini-Mental State Examination

Convergent Validity of the Cognitive Performance Scale of the interRAI Acute Care and the Mini-Mental State Examination

First-generation versus third-generation comprehensive geriatric assessment instruments in the acute hospital setting: A comparison of the Minimum Geriatric Screening Tools (MGST) and the interRAI Acute Care (interRAI AC)

Integrale interventie ter voorkoming van functieverlies bij ouderen tijdens ziekenhuisopname: het Zorgprogramma voor Preventie en Herstel

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