In-home preventive comprehensive geriatric assessment (CGA) reduces mortality-A randomized controlled trial

The study should prove the effectiveness of a preventive in-home CGA regarding mortality and time able to stay in the community. We performed a randomized controlled trial with a mean follow-up of 6.2 years. The home visits were performed in Germany. 1620 community-living persons aged 70 years and older (n=630 intervention; 990 controls) from 20 general practitioner surgeries were visited. The intervention was performed by trained medical students it included a CGA using the STEP-tool (standardized assessment of elderly people in primary care in Europe; a combination of a structured questionnaire and a structured physical examination) and additional tests, followed by recommendations for the general practitioner. The controls received usual general practitioner care. Follow-up visit was made at mean 6.2 years after randomization. The main outcome parameters were mortality and time able to stay at home. Follow-up-rate was 75%. In COX-regression-analyses, a 20% reduction of mortality and a 22% lower risk of nursing-home admission were shown in the intervention group at the follow up. Despite the main limitations of the study (general practitioners volunteered to participate, follow-up-rate <80%, possible performance of geriatric assessments also in the control group, intervention group had poorer health status than the control group, adherence to recommendations from the assessment was not verified) we conclude that the implementation of a preventive geriatric assessment into primary care in Germany seems to be reasonable.     

Effects of individual dietary counseling as part of a comprehensive geriatric assessment (CGA) on frailty status: A population-based intervention study

Background/PurposeIn this study, our aim was to evaluate the effects of individual dietary counseling as part of a comprehensive geriatric assessment (CGA) on frailty status among community-dwelling people aged 75 years or older.MethodsData were obtained from a subpopulation of participants in the population-based Geriatric Multidisciplinary Strategy for the Good Care of the Elderly (GeMS) intervention study in 2004 to 2007. In the present study, the population consisted of 159 persons at risk of malnutrition in the year 2005 in an intervention and a control group. Nutritional status was assessed with the Mini Nutritional Assessment (MNA). Frailty was defined according to the five frailty criteria used in the Cardiovascular Health Study (CHS). Assessment of nutritional status and frailty status was performed at the beginning of the study and at 1-year follow-up.ResultsAt baseline the mean age of the 159 community-dwelling participants with risk of malnutrition was 83 years and 126 (79%) of them were female. The proportions of frail and pre-frail persons were 25% (n = 19) and 61% (n = 47) in the intervention group, and 26% (n = 21) and 61% (n = 50) in the control group. After the 1-year nutritional intervention, compared to the control group, the intervention group tended to have a better outcome of frailty and MNA (OR = 1.89, 95% CI: 1.08–3.54, OR = 2.61, 95% CI: 1.67–5.56, respectively) and was less likely to deteriorate as assessed with MNA (OR = 0.23, 95% CI: 0.14–0.87). In multivariate analysis, change in MNA (OR = 1.12, 95% CI: 1.03–1.31) was associated independently with improved frailty status.ConclusionIt appears that multidisciplinary geriatric assessment including individual dietary counseling has a positive effect on frailty status. More emphasis on good nutrition in the older population might have a preventive effect on the incidence of frailty.     

Utilization of comprehensive geriatric assessment in cancer patients

A growing and diverse aging population, recent advances in research on aging and cancer, and the fact that a disproportional burden of cancer still occurs in people aged 65 years and older have generated great interest in delivering better cancer care for older adults. This is particularly true as more survivors of cancer live to experience cancer as a chronic disease. Cancer and its treatment precipitate classic geriatric syndromes such as falls, malnutrition, delirium, and urinary incontinence. Comprehensive Geriatric Assessment (CGA), by taking all patient's needs into account and by incorporating patient's wishes for the level of aggressiveness of treatment, offers a model of integrating medical care with social support services. It holds the promise of controlling health care costs while improving quality of care by providing a better match of services to patient needs. Three decades after the CGA was initially developed in England, oncologists have begun taking notice on the potential benefits that CGA might bring to the field of geriatric oncology. This article describes the utilization of the CGA in cancer patients with an eye toward promoting interdisciplinary care for older cancer patients. To set an initial context, a search of computerized databases took place, using "comprehensive geriatric assessment" and "cancer" as keywords. A selection of literature from between 1980 and 2003 was reviewed. Additional articles were identified through the bibliography of relevant articles.     

A polar diagram for comprehensive geriatric assessment

Comprehensive geriatric assessment has become synonymous with geriatric practice. This includes evaluation of the older person's physical and mental health, and the functional and social status. We propose a new way of representing a person's condition, called the "polar diagram". This shows the subject's scores on the evaluation scales that are arranged in radial positions inside a circle. The outer part of the circle corresponds to the best condition. Gaps between the best condition and the actual scores are easily identified. The diagram can be employed to monitor the subject's condition and to assess any changes in outcomes.     

老年综合评估在老年高血压患者综合治疗中的应用

目的研究老年综合评估在老年高血压患者综合治疗中的应用。方法选取122例老年原发性高血压患者,随机分为试验组61例和对照组61例。试验组在口服降压药物治疗的同时进行老年综合评估,并依据评估结果实施相应干预措施。观察2组治疗前和治疗后的血压变化情况,并进行分析。结果试验组和对照组治疗后偶侧收缩压/舒张压均较治疗前降低[(132. 72±10. 53)/(69. 28±6. 49) mm Hg(1 mm Hg=0. 133 k Pa) vs (165. 54±9. 28)/(82. 46±8. 87) mm Hg,(147. 21±8. 85)/(69. 61±4. 63) mm Hg vs (164. 26±8. 99)/(81. 92±9. 74) mm Hg,P 0. 01];试验组偶测收缩压较对照组下降更明显(P 0. 01)。试验组和对照组治疗后24 h收缩压/舒张压较治疗前降低[(131. 57±10. 14)/(69. 05±6. 04) mm Hg vs (161. 33±10. 10)/(80. 84±7. 86) mm Hg,(144. 30±8. 69)/(70. 51±4. 88) mm Hg vs (161. 28±8. 92)/(80. 10±7. 73) mm Hg,P 0. 01];试验组24 h收缩压较对照组下降更明显(P 0. 01)。2组治疗后的血压变异性均较治疗前明显降低,且试验组降低更为明显(P 0. 05,P 0. 01)。结论高血压患者进行老年综合评估,能够提高或维持其生活质量,使降压治疗效果更优化。     

The abbreviated comprehensive geriatric assessment (aCGA): a retrospective analysis

BACKGROUND: A comprehensive geriatric assessment (CGA) is a multidimensional assessment that is designed to detect health problems. A barrier to conducting the CGA is the length of time required to complete the entire assessment. OBJECTIVE: To understand what items contained in the instruments that make up the CGA could be compiled to construct an abbreviated CGA (aCGA). DESIGN/SETTING: A retrospective chart review of patients at the H. Lee Moffitt Cancer Center. PARTICIPANTS: Over 500 charts between 1995 and 2001 were reviewed on patients 70 and over. MEASUREMENTS: Item-to-total correlations and Cronbach's alpha coefficient were calculated. Construct validity was assessed using a Pearson's product moment correlation coefficient. RESULTS: Fifteen items were compiled to form the aCGA. Cronbach's alpha was 0.65-0.92 on each instrument of the entire CGA compared to 0.70-0.94 on the aCGA. Correlations ranged from 0.84 to 0.96 for the entire CGA and the aCGA. CONCLUSION: An aCGA can be helpful in screening for those seniors who would benefit from the entire CGA.     

The radar chart method and its analysis as a comprehensive geriatric assessment system for elderly disabled patients]

In order to simply express the results of comprehensive geriatric assessment (CGA) for elderly disabled patients, we tried to develop a CGA system using a radar chart method in 50 patients (age 73-101, mean 85 +/- 5.4) admitted to our hospital during May 1997. Our clinical database for CGA included 7 major factors (diagnosis, mental function, physical function, nutritional state, complication, coronary risk factors, social background). Finally, the radar chart was made from the results of 6 scored factors other than diagnosis and the correlation was examined statistically between these factors. This study suggests that: (1) the radar chart method display of CGA is useful for all medical staff to understand the results of CGA for elderly disabled patients and the characteristic patterns of each disease, (2) because significant positive correlations were found between 3 factors (mental, physical, nutritional) in patients with cerebrovascular disease (CVD), a more global strategy for medical care planning, especially for treatment, nursing care and rehabilitation program is necessary in patients with CVD, (3) in patients with Alzheimer's disease (AD), significant positive correlation was found only between physical and nutritional factors; mental factors showed significant negative correlation only with the duration of morbidity and as a result, quality of life is a more important problem for planning care of patients with AD, (4) for elderly disabled patients, nutritional assessment and nutritional care planning are very important as well as mental and physical care planning.     

术前综合评估对老年冠心病患者冠状动脉介入治疗后中短期再入院率和门诊率的影响

目的 了解术前综合评估能否降低老年冠心病患者冠脉介入治疗术后3个月及6个月内非计划再入院率及门诊就诊率。方法 冠心病住院的老年患者100名,患者随机进入综合评估（CGA）组和常规治疗组。综合评估组患者根据CGA结果制定患者围手术期及出院后治疗方案,常规治疗组患者按照常规制定方案,每组又按是否接受了冠脉介入手术治疗,分为手术亚组和未手术亚组。所有患者在出院后3、6月进行电话随访,随访内容包括患者是否在出院后3、6个月因为各种原因再次入院治疗,是否因为各种不适门诊就诊。结果 无论是否接受CGA和冠脉介入手术,各组患者出院后3、6月再入院率均无明显差异。与常规治疗组患者相比,综合评估组患者出院后3个月门诊率无明显差异,出院后6个月门诊率显著降低（36% vs. 56%,P<0.05）。与常规治疗组的手术亚组患者相比,综合评估组的手术亚组老年患者出院后3个月（33% vs. 75%,P<0.05）、6个月（53% vs. 100%,P<0.01）的门诊率均显著降低。结论 术前CGA可以显著降低接受了冠脉介入手术的老年冠心病患者出院后中短期门诊率。     

Hyponatremia in geriatric inhospital patients: effects on results of a comprehensive geriatric assessment

Objectives: To study whether geriatric patients with mild-to-moderate hyponatremia (≤131 mmol/l) reveal different outcomes in structured tests for functional and cognitive impairments, depression and malnutrition compared to normonatremic patients. Design: Single-center, retrospective case control study. Setting: The study was conducted in a Geriatric Evaluation and Management Unit of a Department for Geriatrics and Internal Medicine. Methods and Participants: We included 2,880 elderly patients (75.6% female, mean age 78.6 ± 6.98 years), consecutively admitted to the GEMU primarily or from another hospital or emergency department. Results were compared between a group of 129 patients with mild-to-moderate hyponatremia (118-131 mmol/l) and an age- and sex-matched control group of 129 patients with normal serum sodium values (>135 mmol/l). To assess functional and cognitive status, depression and malnutrition we used standardized tests of a geriatric assessment. Results: 16.7% (n = 477) of the total 2,880 patients were hyponatremic (≤135 mmol/l), 4.5% (n = 129) revealed moderate hyponatremia. Compared to the control group, these patients had significantly worse results in all tests of the Geriatric Assessment, including Activities of Daily Living, Mini Mental State Examination, Clock Completion Test, Geriatric Depression Score, Tinetti Mobility Test and the Timed Up&Go Test and the Mini Nutritional Assessment. Comorbidities were assessed by the Charlson Comorbidity Index and the Cumulative Illness Rating Scale with no significant difference between the two groups. The hyponatremic patients received significantly more medications than the normonatremic control group, but we could not find a significant difference with respect to the use of a distinct single drug therapy. Conclusion: We were able to demonstrate that geriatric patients with mild-to-moderate hyponatremia revealed a significantly worse outcome in all standardized tests of the geriatric assessment compared to a normonatremic control group. Serum sodium levels should therefore be considered when interpreting common tests of geriatric assessment.     

Comprehensive geriatric assessment in Korean elderly cancer patients receiving chemotherapy

Background  

Growing evidence suggests that a comprehensive geriatric assessment (CGA) in older patients with cancer can detect unsuspected health problems, predict survival, and predict tolerance to chemotherapy. However, studies regarding CGA in cancer patients are scarce in Asia.     

The abbreviated comprehensive geriatric assessment (aCGA) for use in the older cancer patient as a prescreen: scoring and interpretation

The abbreviated CGA (aCGA) can be used as a prescreening assessment to identify patients who would most benefit from the complete CGA. OBJECTIVE: To develop cutpoints for scoring the aCGA that are consistent with existing limitations as revealed by the full CGA. DESIGN/SETTING: A retrospective chart review of patients at the H. Lee Moffitt Cancer Center. PARTICIPANTS: Over 500 charts between 1995 and 2001 were reviewed on cancer patients 70 and over. MEASUREMENTS: Each of the four domains: functional status (activities of daily living (ADL), instrumental activities of daily living (IADL), depression, using the geriatric depression scale (GDS), and cognition using the mini-mental state examination (MMSE)) are scored separately. RESULTS: For the depression domain, a score of 2 or more toward depression indicates that the entire GDS be administered. For the MMSE, a score of 6 or lower indicates necessity of the entire MMSE. For the ADL/IADL, any deficit on either scale (needs assistance or complete assistance) requires further clinical evaluation using the entire instruments. CONCLUSIONS: These guidelines provide the clinician with parameters to target patients most likely to benefit from more intensive geriatric evaluation.     

Influence of geriatric consultation with comprehensive geriatric assessment on final therapeutic decision in elderly cancer patients

Elderly patients represent a heterogeneous population in which decisions on cancer treatment are often difficult. The present study aims to report a 2-year period of the activity of geriatric assessment consultations and the impact on treatment decisions. Since January 2007, we have systematically carried out geriatric consultations, using well-known international scales, for elderly patients in whom treatment decisions appear complex to oncologists. From January 2007 to November 2008, 161 patients (57 men, 104 women; median age 82.4 years, range 73-97) were seen at geriatric consultations. Most of the patients (134/161) were undergoing first-line treatment and cancer was metastatic in 86 patients (53%). Geriatric assessment found severe comorbidities (grade 3 or 4 in CIRS-G scale) in 75 patients, dependence for at least one activity of daily living (ADL) in 52 patients, cognitive impairment in 42 patients, malnutrition in 104 patients (65%) and depression in 39 patients. According to the oncologists' prior decisions, there were no changes in treatment decisions in only 29 patients. Cancer treatment was changed in 79 patients (49%), including delayed therapy in 5 patients, less intensive therapy in 29 patients and more intensive therapy in 45 patients. Patients for whom the final decision was delayed or who underwent less intensive therapy had significantly more frequent severe comorbidities (23/34, p<0.01) and dependence for at least one ADL (19/34, p<0.01). In this study, we have found that comprehensive geriatric evaluation did significantly influence treatment decisions in 82% of our older cancer patients.     

Results of comprehensive geriatric assessment effect survival in patients with malignant lymphoma

Purpose  

The prevalence of elderly and comorbid patients (pts) with malignant lymphoma (ML) will steadily increase in future. Elderly patients comprise a heterogeneous population. Comprehensive geriatric assessment (CGA) is an established diagnostic tool in geriatric medicine. However, the prognostic value in patients with ML is unclear. We sought to establish a relationship between results of CGA and survival time in patients with ML.