scholarly journals Comprehensive Geriatric Assessment in the perioperative setting; where next?

2019 ◽  
Vol 48 (5) ◽  
pp. 624-627 ◽  
Author(s):  
Jugdeep Dhesi ◽  
S Ramani Moonesinghe ◽  
Judith Partridge
Keyword(s):  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Geriatric Medicine ◽  
Cultural Barriers ◽  
Face Validity ◽  
Surgical Patients ◽  
National Audit ◽  
Services Research ◽  
Services Implementation ◽  
The Uk

Abstract Comprehensive Geriatric Assessment (CGA) is being employed in the perioperative setting to improve outcomes for older surgical patients. Traditionally CGA is delivered by a geriatrician led multidisciplinary team but with the acknowledged workforce challenges in geriatric medicine, it has been suggested that non-geriatricians may be able to deliver CGA. HOW-CGA developed a toolkit to facilitate the delivery of CGA by non-geriatricians in the perioperative setting. Across two hospital sites uptake and implementation of this toolkit was limited by a potential lack of face validity, behavioural and cultural barriers and an acknowledgement that geriatric medicine expertise is key to CGA and optimisation. In-keeping with this finding there has been an observed expansion in geriatrician led CGA services for older surgical patients in the UK. In order to demonstrate the effectiveness of perioperative CGA services, implementation science should be combined with health services research methodology and the use of big data through linked national audit.

scholarly journals Feminist approach to geriatric care: comprehensive geriatric assessment, diversity and intersectionality

2021 ◽  
Author(s):  
Merle Weßel
Keyword(s):  
Standardized Testing ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Older Patients ◽  
Geriatric Medicine ◽  
Assessment Tools ◽  
Assessment Process ◽  
Social Category ◽  
Social Categories ◽  
The Social

AbstractDespite being a collection of holistic assessment tools, the comprehensive geriatric assessment primarily focuses on the social category of age during the assessment and disregards for example gender. This article critically reviews the standardized testing process of the comprehensive geriatric assessment in regard to diversity-sensitivity. I show that the focus on age as social category during the assessment process might potentially hinder positive outcomes for people with diverse backgrounds of older patients in relation to other social categories, such as race, gender or socio-economic background and their influence on the health of the patient as well as the assessment and its outcomes. I suggest that the feminist perspective of intersectionality with its multicategorical approach can enhance the diversity-sensitivity of the comprehensive geriatric assessment, and thus improve the treatment of older patients and their quality of life. By suggesting an intersectional-based approach, this article contributes to debates about justice and diversity in medical philosophy and advocates for the normative value of diversity in geriatric medicine.

Economic evaluations of comprehensive geriatric assessment in surgical patients: a systematic review

2017 ◽  
Vol 218 ◽  
pp. 9-17 ◽  
Author(s):  
Gilgamesh Eamer ◽  
Bianka Saravana-Bawan ◽  
Brenden van der Westhuizen ◽  
Thane Chambers ◽  
Arto Ohinmaa ◽  
...  
Keyword(s):  
Systematic Review ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Surgical Patients ◽  
Economic Evaluations

scholarly journals 28 Can Comprehensive Geriatric Assessment be Achieved in the Emergency Department?

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i1-i8
Author(s):  
J Cheng ◽  
C Ho ◽  
K Honney ◽  
M Wells ◽  
W Wise ◽  
...  
Keyword(s):  
Emergency Department ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Average Length ◽  
University Hospital ◽  
Emergency Setting ◽  
Care Plans ◽  
Average Length Of Stay ◽  
Standard Tool ◽  
The Uk

Abstract Background Our National Health Service is facing unprecedented challenges to accommodate our frailer healthcare users. The gold standard tool for the identification and management of frailty is the Comprehensive Geriatric Assessment (CGA) and has been shown to lead to better outcomes in terms of morbidity and mortality. Introduction With a largely elderly demographic profile in the East of England, the Norfolk and Norwich University Hospital opened the first Older People’s Emergency Department (OPED) in the UK in 2017. This work reviews the effectiveness of a geriatrician-led CGA in a dedicated OPED, which operates during daylight hours, compared to usual care in Accident & Emergency (A&E). Methods 99 patients assessed in OPED and 99 patients assessed overnight in A&E during February 2019 were included in this retrospective study. Electronic case notes for each patient were reviewed by the authors and results were expressed as percentages. Results OPED outperformed A&E in all components of the CGA; strongest areas included assessing for pain, falls risk and activities of daily living. Both departments performed well in reviewing medications and assessing for safeguarding concerns. Areas for improvement include assessing for mood disorders, sensory impairment, discussing Do Not Attempt Cardiopulmonary Resuscitation status, and end of life care plans. The average length of stay of OPED patients was only 7.3 days compared to 8.7 days in A&E, and 89% of OPED patients were discharged back to their usual residences compared to 87% in A&E. Conclusions The improved CGA process in OPED has led to better outcomes, notably through a reduction in the average length of inpatient stay. Nevertheless, certain components of the CGA still require improvement. Further examination is needed to assess long-term mortality to support the use of CGA in the emergency setting.

scholarly journals Comprehensive Geriatric Assessment for Elderly Orthopedic Inpatients Consulted by Geriatric Medicine in a Hospital

2014 ◽  
Vol 18 (4) ◽  
pp. 213-220 ◽  
Author(s):  
Go-Eun Kim ◽  
Sunyoung Kim ◽  
Chang Won Won ◽  
Hyun-Rim Choi ◽  
Byung-Sung Kim ◽  
...  
Keyword(s):  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Geriatric Medicine

scholarly journals THE ELECTRONIC FRAILTY INDEX BASED ON THE COMPREHENSIVE GERIATRIC ASSESSMENT: DEVELOPMENT AND TESTING

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S685-S686
Author(s):  
Betty Chinda ◽  
Katayoun Sepehri ◽  
Macy Zou ◽  
Mckenzie Braley ◽  
Antonina Garm ◽  
...  
Keyword(s):  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Assessment Tool ◽  
Frailty Index ◽  
Geriatric Medicine ◽  
Software Tool ◽  
Electronic Version ◽  
Adverse Outcomes ◽  
Care Providers ◽  
Data Quality Control

Abstract Frailty is characterized by loss of biological reserves across multiple systems and associated with increased risks of adverse outcomes. A Frailty Index (FI) constructed using items from the Comprehensive Geriatric Assessment (CGA) has been validated in geriatric medicine settings to estimate the level of frailty. Traditionally, the CGA used a paper form and the CGA-based FI calculation was a manual process. Here, we reported building of an electronic version of the assessment on personal computers (PC), i.e., standalone eFI-CGA, to benefit frailty assessment at points of care. The eFI-CGA was implemented as a software tool on the WinForms platform. It automated the FI calculation by counting deficits accumulation across multiple domains assessing medical conditions, cognition, balance, and dependency of activities of daily living. Debugging, testing, and optimization were performed to enhance the software performance with respect to automation accuracy (processing algorithm), friendly user interface (user manual and feedback), and data quality control (missing data and value constraints). Systematically-designed simulation dataset and anonymous real-world cases were both applied. The optimized assessment tool resulted in fast and convenient conductance of the CGA, and a 100% accuracy rate of the eFI-CGA automation for up to four decimals. The stand-alone eFI-CGA implementation has provided a PC-based software tool for use by geriatricians and primary and acute care providers, benefiting early detection and management of frailty at points of care for older adults.

Eluned Woodford-Williams

2018 ◽  
pp. 202-204
Author(s):  
Itunuayo V. Ayeni
Keyword(s):  
Mental Health ◽  
Elderly Patients ◽  
Older People ◽  
Social Workers ◽  
Old Age ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Geriatric Medicine ◽  
Holistic Approach ◽  
Old Age Psychiatry

This chapter presents a profile of Eluned Woodford-Williams. Dr Woodford-Williams pioneered a holistic approach to caring for older people, and worked at the interface of geriatric medicine and old age psychiatry. She implemented age-based admittance of all patients over 65 years, irrespective of needs, for comprehensive geriatric assessment, and taught that the reintegration of mental health social workers into healthcare was crucial for elderly patients.

31 Understanding of Comprehensive Geriatric Assessment Among Fifth Year Medical Students

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i1-i8
Author(s):  
D Perera ◽  
A Jones
Keyword(s):  
Medical Students ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Hospital Admissions ◽  
Geriatric Medicine ◽  
Target Population ◽  
Daily Basis ◽  
North East ◽  
The North ◽  
Initial Questionnaire

Abstract Introduction There are 191 foundation programme jobs in geriatrics in the North East.1 Students often don’t receive teaching sessions on the comprehensive geriatric assessment (CGA). It is an assessment foundation trainees use on a daily basis on the geriatric ward and the acute take. Methods We designed a series of teaching sessions for fifth year medical students, delivered by different members of the multidisciplinary team. A pre- and post-session questionnaire assessed their understanding. Results Nine students completed the pre-session questionnaire:22% were able to define CGA11% identified the different components22% identified the target population, the benefits of CGA and the members involved44% offered solutions to obtaining a history from patients with confusion100% identified the barriers to carrying out CGA Seven students carried out the post session questionnaire; the table below represents the number that answered correctly. Conclusions The majority of foundation trainees will have at least one job in geriatric medicine and participate in the acute take. The average age of hospital admissions has been rising for years,2 highlighting the importance of being able to accurately and thoroughly assess the older population. The initial questionnaire demonstrated the limited understanding that fifth year students had on the comprehensive geriatric assessment. Following sessions by different members of the MDT there was clear improvement. The sessions covered: general overview of CGA; session by the frailty pharmacist; functional assessment by physiotherapy team; cognitive assessment by the dementia and delirium team; and life as an F1 on geriatric medicine. Positive feedback was received, emphasising the improvement in confidence in preparation for foundation training. References 1. Oriel website: https://www.oriel.nhs.uk/Web/FND. 2. NHS digital Hospital Admitted Patient Care Activity 2015–16.

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