Rapid Geriatric Assessment: A Tool for Primary Care Physicians

[Feasibility, Reliability, and Validity of the VIG-Express Questionnaire as an Instrument for Rapid Multidimensional Geriatric Assessment: A Multicenter Study]

OBJECTIVE

To evaluate the feasibility, reliability and validity of the VIG-express questionnaire.

DESIGN

Descriptive, observational, cross-sectional and multicenter study.

SETTING

Catalonia.

PARTICIPANTS

24 professionals from 18 centers: 10 from Primary Care, 5 from hospitals acute, 2 intermediate care and 3 residential.

MAIN MEASUREMENTS

For the feasibility analysis, the administration time -mean and standard deviation (SD)-. The questionnaire was administered twice to the same patient by the same professional (intraobserver agreement), or by two different professionals (interobserver agreement), evaluating the intraclass correlation coefficient (ICC). Discriminant validity was calculated by comparing the responses of subgroup with higher fragility (percentile >75) and subgroup with lower fragility (percentile <25), for each item of the questionnaire.

RESULTS

195 questionnaires were administered, 59 repeatedly, in a group of elderly (mean age of 79 years) and fragile (mean score of 0.33 in the Fragile Index-VIG). The average administration time was 6.52minutes (DE: 6.02). The concordance in the degree of fragility score obtained a ICC of 0.95 (intraobserver) and 0.72 (interobserver). In discriminant validity, the differences in response frequencies between the two subgroups ranged from 1.7 (oncological disease) to 67.1 (medication management), all of which were statistically significant (p<0.05), with the sole exceptions of the presence of oncological and neurological diseases.

CONCLUSIONS

The VIG-express questionnaire appears to be a feasible, reliable and valid tool for rapid multidimensional/geriatric assessment.

Validation of the Italian Version of the Rapid Geriatric Assessment in Community-Dwelling Older Adults

Background/Objectives: The Rapid Geriatric Assessment (RGA) is a tool designed to screen for frailty, sarcopenia, anorexia related to aging, and cognitive impairment. This study aimed to translate and validate the RGA for use among Italian community-dwelling older adults. Methods: This cross-cultural study involved 100 community-dwelling older adults randomly recruited through convenience sampling from general practitioner offices in Genoa (Italy), between January and June 2019. The RGA includes the Simple FRAIL Questionnaire Screening Tool, SARC-F Screening for Sarcopenia, Simplified Nutritional Assessment Questionnaire (SNAQ), and Rapid Cognitive Screening (RCS). These were validated against gold-standard tools: the Abbreviated Comprehensive Geriatric Assessment (aCGA) and Multidimensional Prognostic Index (MPI). Additional assessments included the Timed Up and Go (TUG) and Handgrip test. The validation process included forward-backward translation, synthesis, and consensus by independent reviewers. Psychometric properties, internal consistency (Cronbach alpha), and validity correlations were analyzed. Results: The RGA demonstrated satisfactory psychometric properties, with internal consistency (Cronbach alpha = 0.59) and significant validity correlations (RGA and aCGA, rho = 0.34, p = 0.001; RGA and MPI, rho = 0.49, p < 0.001). Discriminant validity was confirmed by significant correlations between specific subitems and reference measures: FRAIL with TUG (p < 0.05), SARC-F with Handgrip strength (p = 0.013), SNAQ with BMI, and RCS with MMSE (p < 0.001). Conclusions: The Italian version of the RGA is a reliable screening tool for geriatric syndromes in community-dwelling older adults. While it does not replace a CGA, the RGA may identify individuals who may benefit from further evaluation using a complete CGA.

Clinician's Guide to Geriatric Assessment

The population of older adults is rapidly growing worldwide. Because of the substantial shortage of geriatricians, all clinicians need basic fluency in older adult care. In our approach to evaluating an older adult in the clinic or at the bedside, we apply the "Geriatric 5Ms" framework to manage the patient's care. The Geriatric 5Ms consist of the following key steps. First, consider the mind: the cognitive and psychological domains of a patient's health. Second, evaluate mobility and fall risk. Third, review and reconcile medications, particularly high-risk medications. Fourth, ask what matters most to the patient. Fifth, assess multicomplexity: how the intersection of multiple chronic conditions and social determinants of health influence the patient's health care management. Herein, we provide clinicians with practical suggestions and resources for quickly and effectively applying the Geriatric 5Ms to the care of older adults.

Clinimetric Properties of the "FIND-NEEDS" to Screen Geriatric Conditions

INTRODUCTION

Comprehensive geriatric assessment (CGA) is used to thoroughly assess and identify complex healthcare problems among older adults. However, administration of CGA is time-consuming and labor intensive. A simple screening tool with the mnemonic "FIND-NEEDS" was developed to quickly identify common geriatric conditions. The present study was to evaluate the clinimetric properties of the FIND-NEEDS.

METHODS

The participants comprised first-visiting older adults aged 65 years and above (and who were able to communicate by themselves or with the help of a caregiver) who were assessed (October to December, 2021) using the FIND-NEEDS and CGA at geriatric outpatient clinics of a tertiary, referred medical center. The FIND-NEEDS was examined for its criterion-related validity and compared with the CGA results. Two types of scoring (summed score and binary score) of FIND-NEEDS and CGA were analyzed using Spearman correlation, sensitivity and specificity, and area under receiver operating characteristic curve (AUC).

RESULTS

The mean age of the 114 outpatients was 78.3 ± 7.6 years, and 79 (69.3%) were female. The internal consistency was excellent when using all FIND-NEEDS items, and was acceptable when using domain scores. Exploratory factor analysis showed that most of the FIND-NEEDS domain scores had factor loadings higher than 0.3. Intercorrelations of binary scores between domains of FIND-NEEDS and CGA showed most domains were moderately correlated. The overall correlation of summed scores between FIND-NEEDS and CGA was high. The FIND-NEEDS summed score was moderately correlated with CGA score (r = 0.494; p < 0.001), and the binary score showed excellent correlation (r = 0.944; p < 0.001). When using the CGA score as the gold standard, the FIND-NEEDS showed excellent AUC (0.950), sensitivity (1.00), and specificity (0.90).

DISCUSSION/CONCLUSION

The present study demonstrated that the FIND-NEEDS had acceptable clinimetric properties to screen for geriatric problems among older adults. Further in-depth assessment and care plan can then be conducted afterwards.

One Step at a Time: Improving Gait Speed Measurement in a Geriatric Medicine Clinic

(1) Background: Mobility assessment is a key component of the assessment of an older adult as a part of the Age-Friendly Health System (AFHS) "geriatric 4Ms" framework. Several validated tools for assessing mobility and estimating fall risk in older adults are available. However, they are often under-utilized in daily practice even in specialty geriatric medicine care settings. We aimed to increase formal mobility assessment with brief gait speed measurement in a geriatric medicine outpatient clinic using phased change interventions. (2) Methods: This quality improvement (QI) initiative was conducted in a single outpatient geriatric medicine clinic. All clinic attendees who could complete a gait speed measurement were eligible for inclusion. The outcome measure was the completion of a 4 m gait speed. Several change interventions were implemented on a phased basis using the Model for Improvement methodology during the period from December 2018 to March 2020. Statistical process control charts were used to record gait speed measurements and detect non-random shifts. (3) Results: During this QI initiative, 80 patients were seen, accounting for 142 clinic visits. In response to change interventions, gait speed measurement at clinic visits increased from a median of 25% of visits to 67% by March 2020. (4) Conclusions: Adopting an AFHS care model is an urgent and challenging task to improve the quality of care for older adults. This initiative details how to effectively incorporate a brief, validated assessment of mobility using gait speed measurement into every geriatric medicine outpatient visit and progresses implementation of the AFHS "geriatric 4Ms". Mobility assessment can aid in identifying older adults at increased fall risk.

[Geriatric syndromes in intermediate care resources: Screening, prevalence and inpatient mortality. Multicenter prospective study]

OBJECTIVE

To determine the prevalence of geriatric syndromes (GS) in the geriatric population of the different intermediate care resources, as well as its relationship with intrahospital mortality.

MATERIAL AND METHODS

A prospective observational descriptive study, carried out in intermediate care resources in the Vic area (Barcelona) between July 2018 and September 2019. All people aged ≥65 years and/or criteria of complex chronic patient and/or advanced chronic disease, who were assessed for the presence of GS using the trigger questions of the Frail VIG-Index (IF-VIG), administered at baseline, on admission, on discharge and 30 days after discharge.

RESULTS

Four hundred and forty-two participants were included, of which 55.4% were women, with a mean age of 83.48 years. There are significant differences (P<.05) between frailty, age and number of GS in relation to the intermediate care resource at the time of admission. There were significant differences in the prevalence of GS between the group of patients who died during the hospitalization (24.7% of the sample) in relation to the survivors: both in a situation baseline (malnutrition, dysphagia, delirium, loss of autonomy, pressure ulcers, and insomnia), as well as in the admission assessment (falls, malnutrition, dysphagia, cognitive impairment, delirium, loss of autonomy, and insomnia).

CONCLUSIONS

There is a close relationship between the prevalence of GS and in-hospital mortality in intermediate care resources. In the absence of more studies, the use of the IF-VIG as a screening checklist for GS could be useful for its detection.

Comparison of Rapid Cognitive Screen against Montreal Cognitive Assessment in screening for cognitive impairment in the old and old-old

BACKGROUND

The Montreal Cognitive Assessment (MoCA) was developed as a screening tool for mild cognitive impairment (MCI). Given the need for a rapid screening test in settings such as primary care, we compare the validity of the Rapid Cognitive Screen (RCS) against the MoCA, and determine cut-off scores in the old and old-old.

METHODS

Cross-sectional study involving community-dwelling 'old' (65 to 79 years old) and 'old-old' (≥ 80 years old) without dementia. Cognitive impairment was defined by MoCA score 17 to 22. Validation was done using the receiver operating characteristic (ROC) curve analysis: area under the curve (AUC), sensitivity (Sn), and specificity (Sp).

RESULTS

Of the 183 participants (mean age 72.1 ± 5.2 years),15.8% (n = 29) were classified as cognitively impaired. The overall ROC curve had an AUC of 0.82 (95% CI 0.75-0.90, P < 0.01) with an optimal cut-off of 7/8 on RCS (Sn 0.77, Sp 0.72). The 'old' and 'old-old' group had AUC of 0.82 (95% CI 0.74-0.91, P < 0.01) with 8/9 as optimal cut-off (Sn 0.51, Sp 0.96) and AUC of 0.85 (95% CI 0.66-1.03, P < 0.01) with 7/8 as optimal cut-off (Sn 0.71, Sp 1.00) respectively. In multivariate analysis, age was associated with 0.05 (95% CI -0.10-0.00, P < 0.04) point decrement, while >6 years of education was associated with 0.82 (95% CI 0.32-1.33, P < 0.01) point increment in RCS scores.

CONCLUSION

The three-item RCS is quick and easy to administer. Although RCS met the criterion for good validity against MoCA in predicting cognitive impairment, its utility as a first-line screening tool needs to be further validated in a large-scale population study.

Frailty and Geriatric Medicine During the Pandemic

The term frailty in the era of coronavirus disease 2019 (COVID-19) has a manifold implication. The vast majority of the countries worldwide being hit by the pandemic have shown the frailty of their health and social care systems. Although the surprise factor could somehow justify the unpreparedness experienced during the first wave, the second wave still led to significant difficulties almost everywhere. Looking at Italy's situation, it is evident how the stress test applied by COVID-19 on the system has threatened its stability, getting it closer to collapsing many times. It is true that Italy, in particular the Northern regions, has been the epicenter of COVID-19 in Europe in a time when information about the severe acute respiratory syndrome coronavirus 2 was still lacking and confusing. Nevertheless, what happened has demonstrated significant issues in the structure, priorities, and organization of the system. It has exemplified the obsolete approach adopted in clinical practice, particularly when applied to frail older persons. The COVID-19 pandemic has made emerging the need for a substantial reshaping of our healthcare system. The hospital-centered model has dramatically failed. To adequately face the new challenges brought by the increasing complexity of our aging society, it is critical to move the barycenter of action toward the community/primary care, promoting the integration of services and centralization of clinical/administrative data. It is vital to train healthcare professionals in the identification and basic principles of geriatric conditions, clarifying the role that geriatricians play. In the present article, some cornerstone concepts of geriatric medicine (i.e., definition of geriatrics, multidisciplinarity, integrated care, and development of clinical databases for filling the evidence-based medicine gaps) are presented, explaining the challenges they have faced during the COVID-19 pandemic and possible solutions for implementing improvements in the future.

A concept analysis of interprofessional collaborative practice for community-dwelling older adults

Models of interprofessional collaborative practice have demonstrated improved outcomes for community-dwelling older adults. However, the concept of interprofessional collaborative practice for community-dwelling older adults needs clarification and a clear definition. A concept analysis based on the method posited by Walker and Avant was conducted to formulate an operational definition of this concept. Defining attributes, antecedents, consequences and empirical referents were identified from a review of the literature. A model case and contrary case were selected to further clarify the concept of interprofessional collaborative practice for community-dwelling older adults. Nurses are ideal leaders of interprofessional teams caring for older adults and can utilize this concept in practice, education and research.

[VIG-Express: Consensus on an express multidimensional/geriatric assessment system in Catalonia]

OBJECTIVE

To reach a consensus on an rapid multidimensional/geriatric assessment (RMGA) tool for all health and social professionals of Catalonia as a shared and universal system to assess patients with multimorbidities, frailty, complexity or advanced conditions.

DESIGN

Three-phase consensus of professionals, combining in-person sessions with telematics.

LOCATION

Catalonia.

PARTICIPANTS

A group of 27 interdisciplinary professionals from different care settings.

METHOD

The Design Thinking methodology for an initial consensus on the characteristics of the RMGA tool (Phase 1) has been combined with the Lean Startup methodology to create a new RMGA tool (Phase 2), and then tested in a group of patients (Phase 3).

RESULTS

In Phase 1, a consensus was reached that the perfect RMGA tool should allow for an ad hoc assessment of patients, be fast and flexible (<10 min), identify altered dimensions using trigger questions and facilitate the diagnosis of the condition (ideally quantified). In Phase 2, a prototype of a new RMGA tool containing 15 + 2 questions (VIG-Express) was developed, which was then tested in 35 patients in Phase 3.

CONCLUSIONS

Based on preliminary results, the VIG-Express tool seems to facilitate a simple, rapid multidimensional assessment and the customization of interventions, as well as provide a unique look and shared narrative between professionals from different care settings. More studies will be required to corroborate these findings.

Rapid Geriatric Assessment Using Mobile App in Primary Care: Prevalence of Geriatric Syndromes and Review of Its Feasibility

With the aging population and consequent increase in associated prevalence of frailty, dementia, and multimorbidity, primary care physicians will be overwhelmed with the complexity of the psychosocial and clinical presentation. Geriatric syndromes including frailty, sarcopenia, cognitive impairment, and anorexia of aging (AA) either in isolation or in combination are associated with an increased risk of adverse outcomes and if recognized early, and appropriately managed, will lead to decreased disability. Primary care practices are often located in residential settings and are in an ideal position to incorporate preventive screening and geriatric assessment with personalized management. However, primary care physicians lack the time, multidisciplinary resources, or skills to conduct geriatric assessment, and the limited number of geriatricians worldwide further complicates the matter. There is no one effective strategy to implement geriatric assessment in primary care which is rapid, cost-effective, and do not require geriatricians. Rapid Geriatric Assessment (RGA) takes <5 min to complete. It screens for frailty, sarcopenia, AA, and cognition with assisted management pathway without the need of a geriatrician. We developed RGA iPad application for screening with assisted management in two primary care practices and explored the feasibility and overall prevalence of frailty, sarcopenia, and AA. The assessment was conducted by trained nurses and coordinators. Among 2,589 older patients ≥65 years old, the prevalence of frailty was 5.9%, pre-frail 31.2%, and robust 62.9%. Fatigue was present in 17.8%, and among them, the prevalence of undiagnosed depression as assessed by the Patient Health Questionnaire (PHQ)-9 was 76.4% and 13.5% of total. The prevalence of sarcopenia was 15.4%, and 13.9% experienced at least one fall in the past year. AA was prevalent in 10.9%. The time taken to do the assessment with defined algorithm was on average 5 min or less per patient, and 96% managed to complete the assessment prior to seeing their doctor in the same session. The RGA app is a rapid and feasible tool to be used by any healthcare professional in primary care for identification of geriatric syndrome with assisted management.

Novel Insights into the Pathogenesis of Spinal Sarcopenia and Related Therapeutic Approaches: A Narrative Review

Spinal sarcopenia is a complex and multifactorial disorder associated with a loss of strength, increased frailty, and increased risks of fractures and falls. In addition, spinal sarcopenia has been associated with lumbar spine disorders and osteoporosis, which renders making decisions on treatment modalities difficult. Patients with spinal sarcopenia typically exhibit lower cumulative survival, a higher risk of in-hospital complications, prolonged hospital stays, higher postoperative costs, and higher rates of blood transfusion after thoracolumbar spine surgery. Several studies have focused on the relationships between spinal sarcopenia, appendicular muscle mass, and bone-related problems-such as osteoporotic fractures and low bone mineral density-and malnutrition and vitamin D deficiency. Although several techniques are available for measuring sarcopenia, each of them has its advantages and shortcomings. For treating spinal sarcopenia, nutrition, physical therapy, and medication have been proven to be effective; regenerative therapeutic options seem to be promising owing to their repair and regeneration potential. Therefore, in this narrative review, we summarize the characteristics, detection methodologies, and treatment options for spinal sarcopenia, as well as its role in spinal disorders.

Cardiac Manifestations of Sarcopenia

OBJECTIVES

Screening questions for sarcopenia used in the community (SARC-F) may be regarded as indicators of exercise tolerance.

DESIGN

Observational study.

SETTING

We tested the hypothesis that community-living older people who are screened positive for sarcopenia using the SARC-F tool but without a history of heart failure (HF) have a higher prevalence of cardiac abnormalities compared with those who are SARC-F negative.

PARTICIPANTS

Participants were recruited from a territory-wide primary care needs assessment for older people based in community centres, and from non-acute hospitals in the same region as the study centre.

MEASUREMENTS

Participants with a total score of >=4 and who did not have any history of HF were invited to attend for further cardiac assessment. Grip strength, walking speed, and the 6-minute walk test and echocardiography were carried out. Patients with frailty and at least Grade II diastolic dysfunction were considered to have heart failure with preserved ejection fraction (HFpEF) if they also had concomitant elevated N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) of at least 300 pg/ml.

RESULTS

Diastolic dysfunction (DD) was significantly associated with SARC-F score >=4 and higher circulating NT-proBNP levels. ROC curves evaluating the predictive values of SARC-F, HGS and gait speed for DD showed that a combination of SARC-F and HGS or gait speed provided significant incremental value in predicting DD.

CONCLUSIONS

Community living older people with sarcopenia detected using a simple questionnaire have a higher prevalence of DD accompanied by elevated NT proBNP. Addition of hand grip strength or walking speed improve the magnitude of the association. SARC-F may be used as a tool to detect early cardiac dysfunction in the community.

Factors influencing safe glucose-lowering in older adults with type 2 diabetes: A PeRsOn-centred ApproaCh To IndiVidualisEd (PROACTIVE) Glycemic Goals for older people: A position statement of Primary Care Diabetes Europe

Diabetes in later life is associated with a range of factors increasing the complexity of glycaemic management. This position statement, developed from an extensive literature review of the subject area, represents a consensus opinion of primary care clinicians and diabetes specialists. It highlights many challenges facing older people living with type 2 diabetes and aims to support primary care clinicians in advocating a comprehensive, holistic approach. It emphasises the importance of the wishes of the individual and their carers when determining glycaemic goals, as well as the need to balance intended benefits of treatment against the risk of adverse treatment effects. Its ultimate aim is to promote consistent high-quality care for older people with diabetes.

Applicability of laboratory deficit-based frailty index in predominantly older patients with end-stage renal disease under chronic dialysis: A pilot test of its correlation with survival and self-reported instruments

AIM

Laboratory deficit-based frailty index (LFI) exhibited outcome-prediction ability in the elderly, but not in those with end-stage renal disease (ESRD). We hypothesized that LFI results might have outcome correlation and correlate closely with other instruments in ESRD patients.

METHODS

We prospectively enroled ESRD patients between 2014 and 2015 and administered self-report frailty instruments (Strawbridge questionnaire, Edmonton frail scale (EFS), Groningen frailty indicator (GFI), Tilburg frailty indicator, G8 questionnaire and FRAIL scale), and Cardiovascular Health Study (CHS) scale, with two types of LFI calculated. They were followed up until June 30, 2017. Correlations between the results of six instruments, CHS scale, and those of LFI were identified, followed by Kaplan-Meier survival analyses and logistic regression analyses to compare those with high and low LFI.

RESULTS

The frailty prevalence was 33.3% (CHS), 78.8% Strawbridge questionnaire, 45.5% (EFS), 57.6% (GFI), 27.3% (Tilburg frailty indicator), 84.8% (G8) and 18.2% (FRAIL) among ESRD participants. LFI-1 results were significantly correlated with those of LFI-2 (P < 0.01), EFS (P = 0.04) and GFI (P < 0.01), while LFI-2 results were not. Those with CHS or GFI-identified frailty had significantly lower 1,25-(OH)₂ -D levels than those without. After 32.3 ± 5.4 months, patients with high LFI-1 scores, but not LFI-2, had a significantly higher mortality than those with lower scores. GFI and EFS scores were also independently associated with LFI-1, while CHS scores exhibited borderline association only.

CONCLUSION

Among a group of predominantly older ESRD patients, LFI differentiates patients with good and poor outcomes, supporting its applicability in these patients.

Rapid Geriatric Assessment, Physical Activity, and Sleep Quality in Adults Aged more than 65 Years: A Preliminary Study

OBJECTIVE

(1) To evaluate geriatric syndromes using the Rapid Geriatric Assessment; (2) To investigate possible association of geriatric syndomes with physical activity and sleep quality in adults aged more than 65 years who applied to outpatients physical medicine and rehabilitation clinic.

DESIGN

A cross-sectional study.

SETTING

Outpatient physical medicine and rehabilitation clinic in Edirne, Turkey.

PARTICIPANTS

A total of 56 adults (mean aged 69.7 ± 4.0 (range, 65-80) years, 33 women).

MEASUREMENTS

The Rapid Geriatric Assessment, which includes the FRAIL Questionnaire Screening Tool for frailty, Simplified Nutritional Assessment Questionnaire (SNAQ), SARC-F Screen for Sarcopenia, and Rapid Cognitive Screen (RCS), was used to assess geriatric syndromes. The International Physical Activity Questionnaire (IPAQ) was used to obtain data regarding health-related physical activity. The Pittsburgh Sleep Quality Index (PSQI) was used to measure sleep quality during the past month.

RESULTS

The mean age of the patients was 69.7 ± 4.0 years. Of the 56 patients, 12.5% were frail, 50.0% were pre-frail, 35.7% had sarcopenia, 44.6% had a risk of weight loss, 33.9% had dementia, 57.1% were physically inactive, and 53.6% had poor sleep quality. The total FRAIL and SARC-F scores were positively correlated with the global PSQI score (correlation coefficient (r) = 0.300, p < 0.05; r = 0,327, p < 0.05, respectively) and negatively correlated with the total RCS score (r= -0,267, p < 0.05; r = -0,314, p < 0.05, respectively)). The total FRAIL score was positively correlated with the SARC-F score (r = 0.695, p < 0.001), and the concurrence of frailty and sarcopenia in the same patients was 10.7%. The global PSQI score was negatively correlated with the SNAQ score (r = -0.273, p < 0.05).

CONCLUSION

Frailty and sarcopenia were positively correlated with poor sleep quality and negatively correlated with cognition and physical activity. In clinical practice, the Rapid Geriatric Assessment and determination of physical activity level could assist in disability prevention.

Approach to frailty in the elderly in primary care and the community

Frailty is a distinct clinical syndrome wherein the individual has low reserves and is highly vulnerable to internal and external stressors. Although it is associated with disability and multiple comorbidities, it can also be present in individuals who seem healthy. Frailty is multidimensional and its pathophysiology is complex. Early identification and intervention can potentially decrease or reverse frailty, especially in the early stages. Primary care physicians, community nurses and community social networks have important roles in the identification of pre-frail and frail elderly through the use of simple frailty screening tools and rapid geriatric assessments. Appropriate interventions that can be initiated in a primary care setting include a targeted medical review for reversible medical causes of frailty, medication appropriateness, nutritional advice and exercise prescription. With ongoing training and education, the multidisciplinary engagement and coordination of care of the elderly in the community can help to build resilience and combat frailty in our rapidly ageing society.

Brief assessments and screening for geriatric conditions in older primary care patients: a pragmatic approach

This paper discusses the rationale behind performing a brief geriatric assessment as a first step in the management of older patients in primary care practice. While geriatric conditions are considered by older patients and health professionals as particularly relevant for health and well-being, they remain too often overlooked due to many patient- and physician-related factors. These include time constraints and lack of specific training to undertake comprehensive geriatric assessment. This article discusses the epidemiologic rationale for screening functional, cognitive, affective, hearing and visual impairments, and nutritional status as well as fall risk and social status. It proposes using brief screening tests in primary care practice to identify patients who may need further comprehensive geriatric assessment or specific interventions.

Performance of a brief geriatric evaluation compared to a comprehensive geriatric assessment for detection of geriatric syndromes in family medicine: a prospective diagnostic study

Background

Geriatric syndromes are rarely detected in family medicine. Within the AGE program (active geriatric evaluation), a brief assessment tool (BAT) designed for family physicians (FP) was developed and its diagnostic performance estimated by comparison to a comprehensive geriatric assessment.

Methods

This prospective diagnostic study was conducted in four primary care sites in Switzerland. Participants were aged at least 70 years and attending a routine appointment with their physician, without previous documented geriatric assessment. Participants were assessed by their family physicians using the BAT, and by a geriatriciant who performed a comprehensive geriatric assessment within the following two-month period (reference standard). Both the BAT and the full assessment targeted eight geriatric syndromes: cognitive impairment, mood impairment, urinary incontinence, visual impairment, hearing loss, undernutrition, osteoporosis and gait and balance impairment. Diagnostic accuracy of the BAT was estimated in terms of sensitivity, specificity, and predictive values; secondary outcomes were measures of feasibility, in terms of added consultation time and comprehensiveness in applying the BAT items.

Results

Prevalence of the geriatric syndromes in participants (N=85, 46 (54.1%) women, mean age 78 years (SD 6))ranged from 30.0% (malnutrition and cognitive impairment) to 71.0% (visual impairment), with a median number of 3 syndromes (IQR 2 to 4) per participant. Sensitivity of the BAT ranged from 25.0% for undernutrition (95%CI 9.8% - 46.7%) to 82.1% for hearing impairment (95%CI 66.5% - 92.5%), while specificity ranged from 45.8% for visual impairment (95%CI 25.6–67.2) to 87.7% for undernutrition (76.3% to 94.9%). Finally, most negative predictive values (NPV) were between 73.5% and 84.1%, excluding visual impairment with a NPV of 50.0%. Family physicians reported BAT use as per instructions for 76.7% of the syndromes assessed.

Conclusions

Although the BAT does not replace a comprehensive geriatric assessment, it is a useful and appropriate tool for the FP to screen elderly patients for most geriatric syndromes.

Trial registration

The study was registered on ClinicalTrials.gov on February 20, 2013 (NCT01816087).

Electronic supplementary material

The online version of this article (10.1186/s12877-018-0761-z) contains supplementary material, which is available to authorized users.

Frail-VIG index: a concise frailty evaluation tool for rapid geriatric assessment

BACKGROUND

Demographic changes have led to an increase in the number of elderly frail persons and, consequently, systematic geriatric assessment is more important than ever. Frailty Indexes (FI) may be particularly useful to discriminate between various degrees of frailty but are not routinely assessed due, at least in part, to the large number of deficits assessed (from 30 to 70). Therefore, we have developed a new, more concise FI for rapid geriatric assessment (RGA)-the Frail-VIG index ("VIG" is the Spanish/Catalan abbreviation for Comprehensive Geriatric Assessment), which contains 22 simple questions that assess 25 different deficits. Here we describe this FI and report its ability to predict mortality at 24 months.

METHODS

Prospective, observational, longitudinal study of geriatric patients followed for 24 months or until death. The study participants were patients (n = 590) admitted to the Acute Geriatric Unit at the at the University Hospital of Vic (Barcelona) during the year 2014. Participants were classified into one of seven groups based on their Frail-VIG score (0-0.15; 0.16-0.25; 0.26-0.35; 0.36-0.45; 0.46-0.55; 0.56-0.65; and 0.66-1). Survival curves for these groups were compared using the log-rank test. ROC curves were used to assess the index's capacity to predict mortality at 24 months.

RESULTS

Mean (standard deviation) patient age was 86.4 (5.6) years. The 24-month mortality rate was 57.3% for the whole sample. Significant between-group (deceased vs. living) differences (p < 0.05) were observed for most index variables. Survival curves for the seven Frail-VIG groups differed significantly (X² = 433.4, p < 0.001), with an area under the ROC curve (confidence interval) of 0.90 (0.88-0.92) at 12 months and 0.85 (0.82-0.88) at 24 months. Administration time for the Frail-VIG index ranged from 5 to 10 min.

CONCLUSIONS

The Frail-VIG index, which requires less time to administer than previously validated FIs, presents a good discriminative capacity for the degree of frailty and a high predictive capacity for mortality in the present cohort. Although more research is needed to confirm the validity of this instrument in other populations and settings, the Frail-VIG may provide clinicians with a RGA method and also a reliable tool to assess frailty in routine practice.

Involvement of Advanced Practice Nurse in the Management of Geriatric Conditions: Examples from Different Countries

The increasing demand for healthcare services is placing great strain on healthcare systems throughout the world. Although the older population is increasing worldwide, there is a marked deficit in the number of persons trained in geriatrics. It is now recognized that early detection and treatment of geriatric conditions (e.g., frailty, sarcopenia, falls, anorexia of aging, and cognitive decline) will delay or avert the development of disability. At the same time, recent years have seen an increased interest and use of advanced practice nurses (APN). Models of best practices of supervision and collaboration have been promulgated by many organizations. APN's roles and scope of practice have been expanded in many countries and the quality and cost-effectiveness of healthcare systems have improved. Nevertheless, in older people, evidence of advanced practice roles remains scattered, and there is little synthesis of evidence, and therefore it is not easy to visualize the different practice models and their components. The aim of this paper is to explain the need for advanced practice nurses to manage geriatric conditions.

Translation, Adaptation and Validation of Rapid Geriatric Assessment to the Brazilian context

OBJECTIVES

Translate, cross-culturally adapt and validate the Rapid Geriatric Assessment (RGA) for Brazilian community-dwelling adults.

DESIGN

Cross-sectional study, using a quantitative approach.

SETTING

Urban population from the city of São Carlos, located in the interior of São Paulo State, Brazil.

PARTICIPANTS

148 individuals aged 60 or over.

MEASUREMENTS

Participants were assessed using the RGA, Fried Frailty Phenotype, International Physical Activity Questionnaire - long version, Addenbrooke´s Cognitive Exam - Revised Version, Mini Nutritional Assessment, short Form - 36, EuroQol 5-Dimension, Geriatric Depression Scale - short version, in addition to performing Dual Energy X-ray Absorptiometry to diagnose sarcopenia, according to the criteria established by the European Working Group on Sarcopenia in Older People.

RESULTS

In the translation and adaption process of the RGA, steps recommended by the literature were followed: initial translation, synthesis of translations, backward translation, evaluation from the panel of judges, and pre-test. When evaluating the psychometric properties of the scale, satisfactory reliability (internal consistency and stability) and validity (content, concurrent criterion and convergent, divergent and discriminant construct) were verified.

CONCLUSION

The Brazilian version of the RGA is reliable and valid, and can be used in the Brazilian context to evaluate the elderly population.

Clinical Update on Nursing Home Medicine: 2017

This is the 11th annual Clinical Update from the AMDA meeting article. This year the topics covered are hypertension after the Systolic Blood Pressure Intervention Trial; chronic obstructive pulmonary disease risk factors, diagnosis and management including end-of-life planning, and the difficulties with exacerbations such as breathlessness; diagnosis and treatment of cognitive impairment and dementia; and wound care and pressure ulcer management.