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.

scholarly journals Promoting Early Assessment of Frailty in the New Normal: An Updated eFI-CGA Software Tool

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 824-824
Author(s):  
Katayoun Sepehri ◽  
Hilary Low ◽  
Grace Park ◽  
Xiaowei Song
Keyword(s):  
Assessment Tool ◽  
Frailty Index ◽  
Software Tool ◽  
Primary Care Providers ◽  
Adverse Outcomes ◽  
Care Providers ◽  
Early Assessment ◽  
New Normal ◽  
Care Plans ◽  
Frailty Assessment

Abstract Frailty is a state of diminished physiological reserves. Being able to detect and manage frailty early is crucial for effective controlling of frailty-related adverse outcomes. Frailty can be assessed using the frailty index that counts the number of health deficits accumulated over time. Our previous research has enabled an electronic Comprehensive Geriatric Assessment (eCGA) and the calculation of the frailty index based on the eCGA (eFI-CGA). While the standalone eFI-CGA has been used by primary care providers in assessing home-living patients, its initial release was prior to the covid-19 pandemic; the associated new challenges were not targeted by the early version. In facilitating effective virtual assessment and care planning during the current “lockdown” and in the upcoming “new normal”, most recently the eFI-CGA version 3.0 was released. In this paper, we 1) introduce the updated electronic frailty assessment tool and its usage, 2) describe the major updates of the software in dealing with challenges due to social isolation and remote assessment, and 3) evaluate the end-user experience with the upgraded methods in frailty assessment. These new developments and implementations allowed a search function to resume disrupted assessment sessions and quickly retrieve previously saved assessment records. The improved user interface promoted the clinicians to conveniently record detailed care plans and management details. The study provided a successful example of moving from disruption to transformation, benefiting the highly demanded healthcare of older adults in this challenging time.

scholarly journals PL02: Derivation and validation of a feasible emergency department specific frailty index to predict adverse outcomes

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S26
Author(s):  
A. Brousseau ◽  
E. Dent ◽  
R.E. Hubbard ◽  
D. Melady ◽  
M. Émond ◽  
...  
Keyword(s):  
Emergency Department ◽  
Geriatric Assessment ◽  
Long Term Care ◽  
Assessment Tool ◽  
Frailty Index ◽  
Geriatric Medicine ◽  
Adverse Outcomes ◽  
Validation Sample ◽  
Term Care

Introduction: Frailty is an overarching concept in geriatric medicine. However its utility in the emergency department (ED) was not well understood. Objectives were to derive and validate an ED specific frailty index (FI-ED), using a cumulative deficits model; and to evaluate its ability to predict adverse outcomes. Methods: This was a large multinational prospective cohort study using data from: The Management of Older Persons in Emergency Departments (MOPED) and the interRAI study. The FI-ED was derived from the Canadian sample and validated in the multinational sample. Inclusion criteria were all patients ≥75 years old presenting to an ED. The FI-ED used 24 variables identified in the interRAI ED-Contact Assessment tool, a brief focussed geriatric assessment. Its ability to predict adverse outcomes were analysed by logistic regression with odds ratio (OR). Results: There were 3903 participants: 2153 in the derivation sample and 1750 in the validation sample. In the derivation sample, increasing FI-ED was significantly associated with admission (OR 1.43 [95% CI 1.34-1.52]), death in hospital (OR 1.55 [1.38-1.73]), prolonged hospital stay (OR 1.37 [1.22-1.54]), needs for Comprehensive Geriatric Assessment (OR 1.51 [1.41-1.60]) and discharge to long-term care (OR 1.30 [1.16-1.47]). In the validation sample, results were similar except for long-term care disposition (OR 0.84 [0.75 0.85]). Conclusion: The FI-ED conformed to characteristics previously reported in other geriatric populations. It was accurately derived and validated from a brief geriatric assessment feasible in the ED and can be used to predict adverse outcomes.

10-Minute Targeted Geriatric Assessment Predicts Disability and Hospitalization in Fast-Paced Acute Care Settings

2019 ◽  
Vol 74 (10) ◽  
pp. 1637-1642 ◽  
Author(s):  
Márlon J R Aliberti ◽  
Kenneth E Covinsky ◽  
Daniel Apolinario ◽  
Alexander K Smith ◽  
Sei J Lee ◽  
...  
Keyword(s):  
Risk Factors ◽  
Activities Of Daily Living ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Daily Living ◽  
Assessment Tool ◽  
Sociodemographic Factors ◽  
Adverse Outcomes ◽  
Risk Patients ◽  
Standard Risk

Abstract Background Limited time and resources hinder the use of comprehensive geriatric assessment in acute contexts. We investigated the predictive value of a 10-minute targeted geriatric assessment (10-TaGA) for adverse outcomes over 6 months among acutely ill older outpatients. Methods Prospective study comprising 819 acutely ill outpatients (79.2 ± 8.4 years; 63% women) in need of intensive management (eg, intravenous therapy, laboratory test, radiology) to avoid hospitalization. The 10-TaGA provided a validated measure of cumulative deficits. Previously established 10-TaGA cutoffs defined low (0–0.29), medium (0.30–0.39), and high (0.40–1) risks. To estimate whether 10-TaGA predicts new dependence in activities of daily living and hospitalization over the next 6 months, we used hazard models (considering death as competing risk) adjusted for standard risk factors (sociodemographic factors, Charlson comorbidity index, and physician estimates of risk). Differences among areas under receiver operating characteristic curves (AUROC) examined whether 10-TaGA improves outcome discrimination when added to standard risk factors. Results Medium- and high-risk patients, according to 10-TaGA, presented a higher incidence of new activities of daily living dependence (21% vs 7%, adjusted subhazard ratio [aHR] = 2.4, 95% CI = 1.3–4.5; 40% vs 7%, aHR = 5.0, 95% CI = 2.8–8.7, respectively) and hospitalization (27% vs 13%, aHR = 2.0, 95% CI = 1.2–3.3; 37% vs 13%, aHR = 2.9, 95% CI = 1.8–4.6, respectively) than low-risk patients. The 10-TaGA remarkably improved the discrimination of models that incorporated standard risk factors to predict new activities of daily living dependence (AUROC = 0.76 vs 0.71, p < .001) and hospitalization (AUROC = 0.71 vs 0.68, p < .001). Conclusions The 10-TaGA is a practical and efficient comprehensive geriatric assessment tool that improves the prediction of adverse outcomes among acutely ill older outpatients.

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.

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 Impact of the comprehensive geriatric assessment on treatment decision in geriatric oncology

2019 ◽  
Author(s):  
Sandrine Sourdet ◽  
Delphine Brechemier ◽  
Zara Steinmeyer ◽  
Stephane Gerard ◽  
Laurent Balardy
Keyword(s):  
Multivariate Analysis ◽  
Cancer Treatment ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Treatment Plan ◽  
Geriatric Oncology ◽  
Treatment Decision ◽  
Adverse Outcomes ◽  
Physical Performances ◽  
The Impact

Abstract Background The comprehensive geriatric assessment (CGA) is the gold standard in geriatric oncology to identify patients at high risk of adverse outcomes and optimize cancer and overall management. Many studies have demonstrated that CGA could modify oncologic treatment decision. However, there is little knowledge on which domains of the CGA are associated with this change. Moreover, the impact of frailty and physical performances on cancer treatment changes have been rarely assessed. Methods This is a cross-sectional study of older patients with solid or hematologic cancer referred by oncologists for a geriatric evaluation before cancer treatment. A comprehensive geriatric assessment was performed by a multidisciplinary team to decide if the initial cancer treatment plan was appropriate or not. We performed a multivariate analysis to identify CGA domains associated with the risk to judge the treatment inappropriate. Results 418 patients, mean age 82.8 ± 5.5, were included between 2011 and 2015. The initial cancer treatment plan was judged inappropriate in 56 patients (14.6%). In multivariate analysis, the treatment was judged inappropriate in patients with cognitive impairment (p=0.006), malnutrition (p=0.011), and low physical performances according to the Short Physical Performance Battery (p=0.001). Conclusion Cognition, malnutrition and low physical performances significantly affects cancer treatment decision in older adults with cancer. More studies are needed to evaluate their association with survival, treatment toxicity and quality of life. The role of physical performances should be specifically explored.

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