scholarly journals 52 Should Physiotherapists and Occupational Therapists be Part of the Comprehensive Geriatric Assessment Clinics within the Outpatient Setting?

2019 ◽  
Vol 48 (Supplement_4) ◽  
pp. iv13-iv17
Author(s):  
Alexandra Denning-Kemp ◽  
Hannah Melville ◽  
Teresa Meldrum ◽  
Carrie-Ann Wood
Keyword(s):  
Older Adults ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Outpatient Setting ◽  
Initial Assessment ◽  
Timed Up And Go ◽  
Complex Needs ◽  
Therapy Assessment ◽  
Number Of Patients ◽  
Therapy Intervention

Abstract Introduction The British Geriatric Society (2015) recommends a multidisciplinary team (MDT) Comprehensive Geriatric Assessment (CGA) framework as the Gold standard of care for frail older adults with complex needs. There are currently five Consultant and Nurse-led outpatient CGA clinics in the Older Persons’ Assessment Unit (OPAU), which refer into Physiotherapy (PT) and Occupational Therapy (OT) following their assessments. The aim was to improve the care of patients across the CGA pathway by auditing to establish whether therapists should be involved in the initial assessment of patients in these clinics. Of all new CGA patients in a six month period, only 8% and 2% were referred to PT and OT respectively, warranting further investigation due to the known complexity of this population. Methods Set criteria were established, incorporating the core domains of CGA, designed to highlight patients needing therapy assessment, and were screened using patient questionnaires and medical notes review over a three week period. Results 53 patients were screened against the CGA domains. Rate of completion amongst CGA domains was highly variable: polypharmacy (89%); social (66%); falls (43%); nutrition (43%); continence (25%); mood (23%); cognition (21%); vision (13%); and timed up and go (9%). During the audit, consultants referred four patients to PT and none to OT, compared with screening against the established criteria, which highlighted 28 patients to PT and 22 to OT. Overall, 86% of those screened required therapy intervention. Discussion This project identified a substantial number of patients are failing to receive full, effective CGA including onward therapy intervention, which is key in identifying and managing frailty and improved patient outcomes. Conclusions This audit highlights the value and need for a multi-disciplinary approach, including PT and OT assessment, within CGA outpatient clinics, to ensure a holistic review of and intervention in the complex needs of older adults.

scholarly journals RELATIONSHIP OF PREOPERATIVE COMPREHENSIVE GERIATRIC ASSESSMENT TO HEALTH STATUS IN OLDER ADULTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S684-S684
Author(s):  
Ji Yeon Lee ◽  
Kwang Joon Kim ◽  
Chang Oh Kim ◽  
Kyung Hee Lee
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Health Status ◽  
Cognitive Function ◽  
Length Of Stay ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Daily Living ◽  
Timed Up And Go ◽  
Self Rated Health

Abstract Although comprehensive geriatric assessment has been widely used in surgical older adults, its relationship to health status has not been fully identified. This study aimed to examine the relationships of preoperative comprehensive geriatric assessment to frailty and length of stay. This was a descriptive study based on multi-professional health assessments found in electronic medical records. Study participants were 150 older adults in a neurosurgical department. The comprehensive geriatric assessment was comprised of nutrition, functional status, physical activity, depression, cognition, and basic items such as the Timed Up and Go test, grip strength, and self-rated health. Frailty level and length of stay were dependent variables which represented health status. The result showed that instrumental activities of daily living, physical activity, nutrition, self-rated health, and cognition were significantly associated with frailty. Specifically, comparing robustness with pre-frail and frail level, worseness in the instrumental activities of daily living, self-rated health, physical activity, and nutrition were associated with frailty. With progression of frailty level from pre-frail to frail, the worse score in the cognitive function and self-rated health were associated with frailty. In addition, more depressive symptoms, postoperative complications, and prolonged in the Timed Up and Go test were associated with lengthened hospital stay. Older adults with worsened status in physical, emotional, or cognitive function tended to be frail and stay longer in the hospital. Clinicians need to pay attention to the subcomponents of the comprehensive geriatric assessment and are encouraged to implement it to improve health status of surgical older adults.

scholarly journals Prognosis of outcomes of surgical treatment of colorectal cancer among older patients

2019 ◽  
Vol 3 (28) ◽  
pp. 26-32
Author(s):  
D. A. Kochanov ◽  
M. D. Ter-Ovanesov ◽  
A. S. Gaboyan ◽  
M. Yu. Kukosh
Keyword(s):  
Colorectal Cancer ◽  
Older Adults ◽  
Surgical Treatment ◽  
Cancer Therapy ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Older Patients ◽  
Improved Outcomes ◽  
Number Of Patients

The percentage of older adults with colorectal cancer has been increased. It is a worldwide trend. We proved a necessity of using special predictive scales Charlson, CR-POSSUM, ACPGBI and use of Comprehensive geriatric assessment (CGA) as a part of preoperation eximination among older adults. This approach is improved outcomes of surgical treatment and increased the number of patients undergoing radical cancer therapy.

Screening tools for targeted comprehensive geriatric assessment in HIV-infected patients 50 years and older

2019 ◽  
Vol 30 (10) ◽  
pp. 1009-1017
Author(s):  
Aroonsiri Sangarlangkarn ◽  
Tanakorn Apornpong ◽  
Amy C Justice ◽  
Anchalee Avihingsanon
Keyword(s):  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Nutritional Assessment ◽  
Depression Scale ◽  
Mini Nutritional Assessment ◽  
Screening Tools ◽  
People Living With Hiv ◽  
Timed Up And Go ◽  
Symptom Index ◽  
Cross Sectional

Many people living with HIV (PLWH) are aging with geriatric syndromes, but few undergo comprehensive geriatric assessment (CGA) due to limited resources. Our study evaluates tools to identify aging PLWH who may forego CGA. We conducted a cross-sectional study on 357 PLWH ≥50 years old at the Red Cross, Thailand. Tools evaluated were the Veterans Aging Cohort Study Index (VACSI) and G-8, which is predictive among older cancer patients. CGA consists of eight tests: history of fall within 12 months, timed-up-and-go test (TUG), activities of daily living (ADL), instrumental ADL (IADL), Montreal cognitive assessment (MoCA), Thai depression scale (TDS), mini nutritional assessment (MNA), and HIV symptom index (HSI). We considered ≥2 impaired domains on CGA to be abnormal results. Forty-nine percent (n = 175) had ≥2 impaired domains on CGA. Few participants had experienced a fall (11%) or abnormal TUG/ADL/IADL (<2%), and only MoCA/TDS/MNA/HSI were analyzed. A VACSI < 17 produces 85% sensitivity (Se) and 30% specificity (Sp) (area under the ROC curve [AUC] = 63, 95%CI 58–69) and G-8 > 15.5 produces 90%Se and 33%Sp (AUC = 74, 95%CI 69–79) in identifying patients with <2 impaired domains. A G-8 > 13.5 produces 91%Se and 77%Sp (AUC = 89, 95%CI 86–92) in ruling out abnormal nutrition. Patients with VACSI < 17 and G-8 > 15.5 may forego CGA due to low likelihood of abnormal cognition, mood, nutrition, or symptom burden.

scholarly journals SYSTEMATIC REVIEW OF THE EFFECTS OF NON-VR EXERGAMING ON MOBILITY OUTCOMES OF OLDER ADULTS LIVING IN LONG-TERM CARE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S473-S474
Author(s):  
Charlene H Chu ◽  
Renee Biss ◽  
Afroza Sultana ◽  
Amelie Gauthier-Beaupré ◽  
Arezoo Talebzadeh
Keyword(s):  
Older Adults ◽  
Long Term Care ◽  
Meta Analysis ◽  
Berg Balance Scale ◽  
Poor Quality ◽  
Ageing Population ◽  
Timed Up And Go ◽  
Term Care ◽  
Complex Needs

Abstract Introduction: Institutionalized older adults have high-rates of mobility decline resulting in reduced quality of life and increased dependency. Given the ageing population, there has been a proliferation of exergaming technology targeting older adults to maintain their physical activity (PA) levels and prevent decline. However, it is unclear if exergaming is effective to maintain or improve the PA of institutionalized older adults. Method: Four databases (MEDLINE/CINAHL/PsycINFO/Compendex) were systematically searched (key terms like “nursing homes”, exergaming”). Quantitative manuscripts examining the effects of exergaming on PA measures of institutionalized older adults published in English between 2006-present were eligible. Virtual reality was excluded from the search. No meta-analysis was conducted due to hetereogeneity of the results. Results: 11 studies were included from a search that yielded 208 results. The exergaming platforms that were used the most were the Kinect and Wii. The most commonly used PA measures were the Berg Balance Scale and the Timed-up-and-Go (n=4 studies) with no other measures being used in more than one study. Interventions ranged in exercise (e.g. cognitive-motor training, strength training, balance, etc), frequency, duration, and modality. Study designs were also heterogeneous. Articles were of very poor to poor quality. There was minimal reporting on adverse events. Older adults with cognitive impairment were commonly excluded. Challenges in current technology and studying this group are highlighted. Conclusion: Exergaming may be promising to maintain PA but more robust research is needed. More exergaming technology designed for long-term care to meet the specific complex needs of this population is warranted.

Which parameters affect long-term mortality in older adults: is comprehensive geriatric assessment a predictor of mortality?

2016 ◽  
Vol 29 (3) ◽  
pp. 509-515 ◽  
Author(s):  
Ozgur Kara ◽  
Busra Canbaz ◽  
Muhammet Cemal Kizilarslanoglu ◽  
Gunes Arik ◽  
Fatih Sumer ◽  
...  
Keyword(s):  
Older Adults ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Long Term Mortality

Comprehensive Geriatric Assessment for Older Patients With Cancer

2007 ◽  
Vol 25 (14) ◽  
pp. 1824-1831 ◽  
Author(s):  
Martine Extermann ◽  
Arti Hurria
Keyword(s):  
Older Adults ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Cancer Care ◽  
Older Patients ◽  
Morbidity And Mortality ◽  
Psychological State ◽  
Future Research ◽  
Oncology Patient ◽  
Patients With Cancer

Purpose During the last decade, oncologists and geriatricians have begun to work together to integrate the principles of geriatrics into oncology care. The increasing use of a comprehensive geriatric assessment (CGA) is one example of this effort. A CGA includes an evaluation of an older individual's functional status, comorbid medical conditions, cognition, nutritional status, psychological state, and social support; and a review of the patient's medications. This article discusses recent advances on the use of a CGA in older patients with cancer. Methods In this article, we provide an update on the studies that address the domains of a geriatric assessment applied to the oncology patient, review the results of the first studies evaluating the use of a CGA in developing interventions to improve the care of older adults with cancer, and discuss future research directions. Results The evidence from recent studies demonstrates that a CGA can predict morbidity and mortality in older patients with cancer. Accumulating data show the benefits of incorporating a CGA in the evaluation of older patients with cancer. Prospective trials evaluating the utility of a CGA to guide interventions to improve the quality of cancer care in older adults are justified. Conclusion Growing evidence demonstrates that the variables examined in a CGA can predict morbidity and mortality in older patients with cancer, and uncover problems relevant to cancer care that would otherwise go unrecognized.

Relationship between psychological pain and death anxiety with comprehensive geriatric assessment in older adults

2020 ◽  
Vol 20 (11) ◽  
pp. 1056-1060
Author(s):  
Cagatay Cavusoglu ◽  
Ibrahim Ileri ◽  
Rana Tuna Dogrul ◽  
Cemile Ozsurekci ◽  
Hatice Caliskan ◽  
...  
Keyword(s):  
Older Adults ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Death Anxiety ◽  
Psychological Pain

Comprehensive geriatric assessment in lung cancer and hematologic malignancy.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 122-122
Author(s):  
Zachary Luke Farmer ◽  
Anthony James Caprio ◽  
Raghava Reddy Induru ◽  
Armida Parala-Metz ◽  
Markecia Kanese Cooper ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cognitive Functioning ◽  
Cancer Patients ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Web Application ◽  
Rating Scale ◽  
Hematologic Malignancy ◽  
Timed Up And Go ◽  
Lung Cancer Patients

122 Background: The incidence of cancer in patients older than 65 is nearly tenfold higher than in their younger counterparts. Comprehensive geriatric assessment (CGA) is recommended for cancer patients > 65 years, as it can more reliably assess underlying function and predict tolerance to anticancer therapy. We reviewed data for patients with lung cancer and hematologic malignancies who completed comprehensive geriatric assessment by the Senior Oncology Section within the Levine Cancer Institute. Methods: From 2015 to 2019 Levine Cancer Institute (LCI) providers performed 96 CGAs in lung cancer patients and 58 in patients with hematologic malignancy, many of the latter being evaluated for bone marrow transplantation. Data was incorporated into an LCI Senior Oncology Clinic Database using the REDCap secure web application, allowing both quantitative and qualitative data analysis. Results: Median ages were 80 in lung cancer and 67 in hematologic malignancy. The lung cancer patients had a slower gait than patients with hematologic malignancy (0.8 m/s versus 1.3 m/s). Lung cancer patients also had a longer median timed up and go (TUG) test of 13 seconds, versus 8 seconds in hematologic malignancy. Considerably more lung cancer patients had experienced a fall within the preceding six months (32 (33%) versus 9 (16%)). The median Cumulative Illness Rating Scale-Geriatric (CIRS-G) total score was significantly higher in lung than in hematologic malignancy (14 versus 8), indicating a higher degree of comorbid illness. Cognitive functioning was comparable between the two groups, with median Montreal Cognitive Assessment (MoCA) scores of 25 in lung and 26 in hematologic malignancy. Conclusions: Lung cancer patients undergoing CGA had more comorbid illnesses, slower gait speed and timed up and go, and more falls in the preceding 6 months than hematologic malignancy patients. Overall cognitive functioning was not significantly different between the two groups. These findings highlight the importance of comprehensive geriatric assessment in elderly lung cancer patients. [Table: see text]

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