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Garrard JW, Cox NJ, Dodds RM, Roberts HC, Sayer AA. Comprehensive geriatric assessment in primary care: a systematic review. Aging Clin Exp Res 2020; 32:197-205. [PMID: 30968287 PMCID: PMC7033083 DOI: 10.1007/s40520-019-01183-w] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 03/23/2019] [Indexed: 11/29/2022]
Abstract
Background Comprehensive geriatric assessment (CGA) involves the multidimensional assessment and management of an older person. It is well described in hospital and home-based settings. A novel approach could be to perform CGA within primary healthcare, the initial community located healthcare setting for patients, improving accessibility to a co-located multidisciplinary team. Aim To appraise the evidence on CGA implemented within the primary care practice. Methods The review followed PRISMA recommendations. Eligible studies reported CGA on persons aged ≥ 65 in a primary care practice. Studies focusing on a single condition were excluded. Searches were run in five databases; reference lists and publications were screened. Two researchers independently screened for eligibility and assessed study quality. All study outcomes were reviewed. Results The authors screened 9003 titles, 145 abstracts and 97 full texts. Four studies were included. Limited study bias was observed. Studies were heterogeneous in design and reported outcomes. CGAs were led by a geriatrician (n = 3) or nurse practitioner (n = 1), with varied length and extent of follow-up (12–48 months). Post-intervention hospital admission rates showed mixed results, with improved adherence to medication modifications. No improvement in survival or functional outcomes was observed. Interventions were widely accepted and potentially cost-effective. Discussion The four studies demonstrated that CGA was acceptable and provided variable outcome benefit. Further research is needed to identify the most effective strategy for implementing CGA in primary care. Particular questions include identification of patients suitable for CGA within primary care CGA, a consensus list of outcome measures, and the role of different healthcare professionals in delivering CGA. Electronic supplementary material The online version of this article (10.1007/s40520-019-01183-w) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- James W Garrard
- Radcliffe Department of Medicine, University of Oxford, Oxford, OX1 2JD, UK.
| | - Natalie J Cox
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Richard M Dodds
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK
- AGE Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne, UK
| | - Helen C Roberts
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Wessex, University of Southampton, Southampton, UK
| | - Avan A Sayer
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK
- AGE Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne, UK
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Hildon ZJL, Tan CS, Shiraz F, Ng WC, Deng X, Koh GCH, Tan KB, Philp I, Wiggins D, Aw S, Wu T, Vrijhoef HJM. The theoretical and empirical basis of a BioPsychoSocial (BPS) risk screener for detection of older people's health related needs, planning of community programs, and targeted care interventions. BMC Geriatr 2018; 18:49. [PMID: 29454316 PMCID: PMC5816546 DOI: 10.1186/s12877-018-0739-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 01/31/2018] [Indexed: 01/29/2023] Open
Abstract
Background This study introduces the conceptual basis and operational measure, of BioPyschoSocial (BPS) health and related risk to better understand how well older people are managing and to screen for risk status. The BPS Risk Screener is constructed to detect vulnerability at older ages, and seeks to measure dynamic processes that place equal emphasis on Psycho-emotional and Socio-interpersonal risks, as Bio-functional ones. We validate the proposed measure and describe its application to programming. Methods We undertook a quantitative cross-sectional, psychometric study with n = 1325 older Singaporeans, aged 60 and over. We adapted the EASYCare 2010 and Lubben Social Network Scale questionnaires to help determine the BPS domains using factor analysis from which we derive the BPS Risk Screener items. We then confirm its structure, and test the scoring system. The score is initially validated against self-reported general health then modelled against: number of falls; cognitive impairment; longstanding diseases; and further tested against service utilization (linked administrative data). Results Three B, P and S clusters are defined and identified and a BPS managing score (‘doing’ well, or ‘some’, ‘many’, and ‘overwhelming problems’) calculated such that the risk of problematic additive BPS effects, what we term health ‘loads’, are accounted for. Thirty-five items (factor loadings over 0.5) clustered into three distinct B, P, S domains and were found to be independently associated with self-reported health: B: 1.99 (1.64 to 2.41), P: 1.59 (1.28 to 1.98), S: 1.33 (1.10 to 1.60). The fit improved when combined into the managing score 2.33 (1.92 to 2.83, < 0.01). The score was associated with mounting risk for all outcomes. Conclusions BPS domain structures, and the novel scoring system capturing dynamic BPS additive effects, which can combine to engender vulnerability, are validated through this analysis. The resulting tool helps render clients’ risk status and related intervention needs transparent. Given its explicit and empirically supported attention to P and S risks, which have the potential to be more malleable than B ones, especially in the older old, this tool is designed to be change sensitive. Electronic supplementary material The online version of this article (10.1186/s12877-018-0739-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Zoe J-L Hildon
- Johns Hopkins University, Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA. .,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore. .,Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Faculty of Public Health & Policy, London, England. .,, Singapore, Singapore.
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,, Singapore, Singapore
| | - Farah Shiraz
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,, Singapore, Singapore
| | - Wai Chong Ng
- Tsao Foundation, 298 Tiong Bahru Road, #15-01/06 Central Plaza, Singapore, 168730, Singapore
| | - Xiaodong Deng
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,, Singapore, Singapore
| | - Gerald Choon Huat Koh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,, Singapore, Singapore
| | - Kelvin Bryan Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Ministry of Health, College of Medicine, Building 16 College Road, Singapore, 169854, Singapore.,, Singapore, Singapore
| | - Ian Philp
- University of Stirling, Stirling, UK
| | - Dick Wiggins
- UCL Institute of Education, IOE - Social Science, University College London, 20 Bedford Way, London, WC1H 0AL, England
| | - Su Aw
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,, Singapore, Singapore
| | - Treena Wu
- Tsao Foundation, 298 Tiong Bahru Road, #15-01/06 Central Plaza, Singapore, 168730, Singapore
| | - Hubertus J M Vrijhoef
- Department of Patient & Care, Maastricht University Medical Center, Maastricht, the Netherlands.,Vrije Universiteit Brussels, Laarbeeklaan 103, 1090, Brussel, Belgium.,Panaxea, Matrix II, unit 1.08/9, Science Park 400, 1098, XH Amsterdam, The Netherlands
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Craig C, Chadborn N, Sands G, Tuomainen H, Gladman J. Systematic review of EASY-care needs assessment for community-dwelling older people. Age Ageing 2015; 44:559-65. [PMID: 25911539 PMCID: PMC4476847 DOI: 10.1093/ageing/afv050] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 02/04/2015] [Indexed: 11/13/2022] Open
Abstract
Background: undertaking comprehensive geriatric assessments (CGAs) combined with long-term health and social care management can improve the quality of life of older people [
1]. The EASY-Care tool is a CGA instrument designed for assessing the physical, mental and social functioning and unmet health and social needs of older people in community settings or primary care. It has also been used as a frailty assessment tool and for gathering population-level data. Objective: to review the evidence of reliability, validity and acceptability of EASY-Care and its appropriateness for assessing the needs of community-dwelling older people. Methods: systematic search of literature databases using pre-defined search terms (January 1994—May 2014) for English language articles reporting on the reliability, validity, acceptability and implementation of EASY-Care in primary care and community settings. Eligible articles were critically reviewed. Discussion papers mapping professionals' use of the tool were also included as these could be considered an aspect of validity. Results: twenty-nine papers met the inclusion criteria and underwent data extraction. A narrative synthesis was performed, because there was a variety of quantitative and qualitative outcomes and characteristics. Reliability evidence for EASY-Care is minimal. Evidence for validity is good, and it has received numerous positive endorsements of acceptability in international settings from older people and practitioners. Conclusion: evidence supports the use of EASY-Care for individual needs assessment; further research is needed for other uses. Of the papers that made statements about who should administer EASY-Care, the majority indicated that nurses were preferable to self-completion.
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Affiliation(s)
- Christopher Craig
- National Institute for Health Research, CLAHRC East Midlands, University of Nottingham, Nottingham, UK
| | - Neil Chadborn
- National Institute for Health Research, CLAHRC East Midlands, University of Nottingham, Nottingham, UK
| | - Gina Sands
- National Institute for Health Research, CLAHRC East Midlands, University of Nottingham, Nottingham, UK
| | - Helena Tuomainen
- Warwick Medical School, Division of Mental Health and Well-being, University of Warwick, Warwick, UK
| | - John Gladman
- National Institute for Health Research, CLAHRC East Midlands, University of Nottingham, Nottingham, UK
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Talarska D, Pacholska R, Strugała M, Wieczorowska-Tobis K. Functional assessment of the elderly with the use of EASY-Care Standard 2010 and Comprehensive Geriatric Assessment. Scand J Caring Sci 2015; 30:419-26. [PMID: 26058414 DOI: 10.1111/scs.12241] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 03/26/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND The wide variation in performance among the elderly leads to the search for a suitable instrument to identify the necessary support. The aim of this study was to examine the scope of independent functioning of the elderly and to indicate the necessary support using basic instruments, Comprehensive Geriatric Assessment (CGA) and EASY-Care Standard 2010. METHODS For statistical analysis were qualified 101 questionnaires of patients from oncological surgery clinic. RESULTS The study group was dominated by women (79.2%). The average age for the entire group was 74.7 ± 7.5 years. In terms of basic life activities (Barthel Index), 75.2% of the elderly performed most of their activities independently. The Lawton IADL (Instrumental Activity of Daily Living Scale) median was 25 points. Moderate depression (Geriatric Depression Scale) reported 37.6% of the group. The influence of age, education, mode of movement and efficiency in basic and instrumental life activities and depression (Geriatric Depression Scale) was demonstrated in the results in three scales of the EASY-Care Standard 2010 questionnaire: Independence score, Risk of break down in care and Risk of falls. There was no difference in terms of gender and the nature of the residence. CONCLUSION The study group of the elderly was characterised by a good level of efficiency in basic and instrumental activities of daily living. Questionnaire EASY-Care Standard 2010 enables to identify functional limitations of the elderly that may form the basis for planning individual support.
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Affiliation(s)
- Dorota Talarska
- Department of Preventive Medicine, Karol Marcinkowski University of Medical Sciences, Poznań, Poland
| | | | - Magdalena Strugała
- Department of Preventive Medicine, Karol Marcinkowski University of Medical Sciences, Poznań, Poland
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Philip KE, Alizad V, Oates A, Donkin DB, Pitsillides C, Syddall SP, Philp I. Development of EASY-Care, for Brief Standardized Assessment of the Health and Care Needs of Older People; With Latest Information About Cross-National Acceptability. J Am Med Dir Assoc 2014; 15:42-6. [DOI: 10.1016/j.jamda.2013.09.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 09/05/2013] [Indexed: 10/26/2022]
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Haywood KL, Garratt AM, Fitzpatrick R. Quality of life in older people: a structured review of self-assessed health instruments. Expert Rev Pharmacoecon Outcomes Res 2012; 6:181-94. [PMID: 20528554 DOI: 10.1586/14737167.6.2.181] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A range of terms (including quality of life, health-related quality of life and health status) describe a broad set of aspects of self-reported health that can be captured by questionnaires and related instruments. Health in older people particularly requires attention to broader aspects of the impact of health on physical, social and psychological function. A structured review was performed to assess how well such issues are measured by available instruments. A total of 45 instruments were identified that have received some degree of evaluation to establish their use in assessing the health of older individuals. Two types of instruments were included in the review: generic and older-people-specific instruments. The SF-36 has by far the largest evidence base to support its use in older people. The OMFAQ has the best evidence base amongst older-people-specific instruments. Many instruments have only minimal evidence of measurement properties. Concepts such as quality of life are still defined and used in a variety of ways, and major questions must be addressed before uniform practice emerges in this important area of health policy.
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Affiliation(s)
- Kirstie L Haywood
- College of Nursing Institute, Radcliffe Infirmary, Royal, Woodstock Road, Oxford, OX2 6HE, UK.
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Olde-Rikkert MGM, Long JF, Philp I. Development and evidence base of a new efficient assessment instrument for international use by nurses in community settings with older people. Int J Nurs Stud 2012; 50:1180-3. [PMID: 22980483 DOI: 10.1016/j.ijnurstu.2012.08.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 07/24/2012] [Accepted: 08/08/2012] [Indexed: 10/27/2022]
Abstract
In a world where 12% of the population, and 22% of that of more developed regions, will be older than 65 years by 2030, new targeted programs and social protections will be needed for older people in many countries. As economic and human resources become more scarce, efficient instruments are needed to realize sustainable health care for these large populations of older subjects. To address this need a new assessment instrument was developed. The core of the instrument consists of focused geriatric assessment by a health or social care practitioner working in primary or community care, most often a nurse. The assessment data result in an efficiently targeted care and welfare action plan based on the patients' priorities. This instrument was initially developed, tested and spread within Europe, and then in validation studies across all WHO regions of the world. Because of the urgent societal questions on quality and sustainability of primary health care, especially for older people, we briefly review and summarize the development and evidence base of the instrument, which was called EASY-Care Standard. In a series of studies across many populations it proved to have high acceptability, reliability, validity and cost-effectiveness. Therefore, EASY-Care has great potential as a universal tool for global use in promoting independence in old age, and can make an important contribution to the quality and sustainability of health and social care in our aging societies.
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Richards CT, Gisondi MA, Chang CH, Courtney DM, Engel KG, Emanuel L, Quest T. Palliative care symptom assessment for patients with cancer in the emergency department: validation of the Screen for Palliative and End-of-life care needs in the Emergency Department instrument. J Palliat Med 2011; 14:757-64. [PMID: 21548790 DOI: 10.1089/jpm.2010.0456] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE We sought to develop and validate a novel palliative medicine needs assessment tool for patients with cancer in the emergency department. METHODS An expert panel trained in palliative medicine and emergency medicine reviewed and adapted a general palliative medicine symptom assessment tool, the Needs at the End-of-Life Screening Tool. From this adaptation a new 13-question instrument was derived, collectively referred to as the Screen for Palliative and End-of-life care needs in the Emergency Department (SPEED). A database of 86 validated symptom assessment tools available from the palliative medicine literature, totaling 3011 questions, were then reviewed to identify validated test items most similar to the 13 items of SPEED; a total of 107 related questions from the database were identified. Minor adaptations of questions were made for standardization to a uniform 10-point Likert scale. The 107 items, along with the 13 SPEED items were randomly ordered to create a single survey of 120 items. The 120-item survey was administered by trained staff to all patients with cancer who met inclusion criteria (age over 21 years, English-speaking, capacity to provide informed consent) who presented to a large urban academic emergency department between 8:00 am and 11:00 pm over a 10-week period. Data were analyzed to determine the degree of correlation between SPEED items and the related 107 selected items from previously validated tools. RESULTS A total of 53 subjects were enrolled, of which 49 (92%) completed the survey in its entirety. Fifty-three percent of subjects were male, age range was 24-88 years, and the most common cancer diagnoses were breast, colon, and lung. Cronbach coefficient α for the SPEED items ranged from 0.716 to 0.991, indicating their high scale reliability. Correlations between the SPEED scales and related assessment tools previously validated in other settings were high and statistically significant. CONCLUSION The SPEED instrument demonstrates reliability and validity for screening for palliative care needs of patients with cancer presenting to the emergency department.
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Pilotto A, Addante F, D'Onofrio G, Sancarlo D, Ferrucci L. The Comprehensive Geriatric Assessment and the multidimensional approach. A new look at the older patient with gastroenterological disorders. Best Pract Res Clin Gastroenterol 2009; 23:829-37. [PMID: 19942161 PMCID: PMC4986608 DOI: 10.1016/j.bpg.2009.10.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2009] [Revised: 09/28/2009] [Accepted: 10/01/2009] [Indexed: 01/31/2023]
Abstract
The Comprehensive Geriatric Assessment (CGA) is a multidimensional, usually interdisciplinary, diagnostic process intended to determine an elderly person's medical, psychosocial, and functional capacity and problems with the objective of developing an overall plan for treatment and short- and long-term follow-up. The potential usefulness of the CGA in evaluating treatment and follow-up of older patients with gastroenterological disorders is unknown. In the paper we reported the efficacy of a Multidimensional-Prognostic Index (MPI), calculated from information collected by a standardized CGA, in predicting mortality risk in older patients hospitalized with upper gastrointestinal bleeding and liver cirrhosis. Patients underwent a CGA that included six standardized scales, i.e. Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), Short-Portable Mental Status Questionnaire (SPMSQ), Mini-Nutritional Assessment (MNA), Exton-Smith Score (ESS) and Comorbity Index Rating Scale (CIRS), as well as information on medication history and cohabitation, for a total of 63 items. The MPI was calculated from the integrated total scores and expressed as MPI 1=low risk, MPI 2=moderate risk and MPI 3=severe risk of mortality. Higher MPI values were significantly associated with higher short- and long-term mortality in older patients with both upper gastrointestinal bleeding and liver cirrhosis. A close agreement was found between the estimated mortality by MPI and the observed mortality. Moreover, MPI seems to have a greater discriminatory power than organ-specific prognostic indices such as Rockall and Blatchford scores (in upper gastrointestinal bleeding patients) and Child-Plugh score (in liver cirrhosis patients). All these findings support the concept that a multidimensional approach may be appropriate for the evaluation of older patients with gastroenterological disorders, like it has been reported for patients with other pathological conditions.
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Affiliation(s)
- Alberto Pilotto
- Geriatric Unit & Gerontology-Geriatrics Research Laboratory, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, Viale Cappuccini 1, San Giovanni Rotondo, Italy.
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Comparison of two tools developed to assess the needs of older people with complex care needs. J Res Nurs 2009. [DOI: 10.1177/1744987108096972] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract Greater standardisation of assessments of older people with complex care needs is a requirement of UK policy. This study explores the practicability and validity of two assessment tools, Minimum Data Set Resident Assessment Instrument (MDS-RAI) and EASY-Care. Participants, aged 65 years or over, living in care homes or awaiting hospital discharge, were assessed using randomly allocated paired instruments. Client evaluation questionnaires on the practicability of the tools were completed. Short Form 12 (SF12) questionnaires were administered to assess participants’ health status. Registered nurses undertook data collection and participated in two focus groups designed to explore the practicability of the tools. Statistical tests were applied to quantitative data to assess practicability and validity. Thematic content analysis was used to analyse focus group transcripts. In all, 238 assessments were completed. Older people and assessors generally reported that both tools were practicable, with EASY-Care preferred to MDS-RAI for practicability measures including ease of use, usefulness and acceptability. Focus groups illustrated the significance of professional judgement when using structured tools. Both tools were reasonable indicators of activities of daily living, but there were shortcomings in measurements of cognitive performance and depression. Both instruments require development to fully capture the older person’s perspectives of needs and to test the validity of key measures.
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Abstract
The aims of this study were to explore the practicability of two instruments developed to assess older people with complex care needs and to assess compliance with criteria for assessment tools that require tools to be person-centred and to support rather than replace professional judgement. Nurse assessors undertook assessments of older people living in a care-home setting or awaiting discharge from hospital, using EASY-Care and Minimum Data Set Resident Assessment Instrument (MDS-RAI). The results suggest that both tools are practicable and useful in enabling older people to identify their needs. EASY-Care was preferred to identify both health and social-care needs. It was considered to be more person-centred in that open-ended questions allowed people to describe their circumstances in their own words. Its style made it easier to develop rapport with older people and encouraged them to talk and to disclose information beyond the immediate scope of the tool itself. Nevertheless some questions provoked anxiety and assessors needed to use their professional judgement in order to achieve a person-centred, appropriate assessment. MDS-RAI appeared to be more useful in identifying nursing or medical issues. But it did not always reveal a complete picture of the person's care needs and situation. Some nurses suggested that MDS-RAI was useful in circumstances where, in their professional judgement, older people were not being realistic in discussing their needs and their expectations for future care. The findings identify how nurses can use tools to support their assessment skills.
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Affiliation(s)
- Susan Lambert
- Head of Centre for Health Economics and Policy Studies School of Health Science Swansea University,
| | - Valerie Thomas
- Tutor in Health Policy School of Health Science Swansea University
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13
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Extermann M, Aapro M, Bernabei R, Cohen HJ, Droz JP, Lichtman S, Mor V, Monfardini S, Repetto L, Sørbye L, Topinkova E. Use of comprehensive geriatric assessment in older cancer patients: recommendations from the task force on CGA of the International Society of Geriatric Oncology (SIOG). Crit Rev Oncol Hematol 2005; 55:241-52. [PMID: 16084735 DOI: 10.1016/j.critrevonc.2005.06.003] [Citation(s) in RCA: 769] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2005] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND As more and more cancers occur in elderly people, oncologists are increasingly confronted with the necessity of integrating geriatric parameters in the treatment of their patients. METHODS The International Society of Geriatric Oncology (SIOG) created a task force to review the evidence on the use of a comprehensive geriatric assessment (CGA) in cancer patients. A systematic review of the evidence was conducted. RESULTS Several biological and clinical correlates of aging have been identified. Their relative weight and clinical usefulness is still poorly defined. There is strong evidence that a CGA detects many problems missed by a regular assessment in general geriatric and in cancer patients. There is also strong evidence that a CGA improves function and reduces hospitalization in the elderly. There is heterogeneous evidence that it improves survival and that it is cost-effective. There is corroborative evidence from a few studies conducted in cancer patients. Screening tools exist and were successfully used in settings such as the emergency room, but globally were poorly tested. The article contains recommendations for the use of CGA in research and clinical care for older cancer patients. CONCLUSIONS A CGA, with or without screening, and with follow-up, should be used in older cancer patients, in order to detect unaddressed problems, improve their functional status, and possibly their survival. The task force cannot recommend any specific tool or approach above others at this point and general geriatric experience should be used.
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Affiliation(s)
- Martine Extermann
- H. Lee Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, USA.
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Haywood KL, Garratt AM, Fitzpatrick R. Quality of life in older people: a structured review of generic self-assessed health instruments. Qual Life Res 2005; 14:1651-68. [PMID: 16119178 DOI: 10.1007/s11136-005-1743-0] [Citation(s) in RCA: 273] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To review evidence relating to the measurement properties of multi-item generic patient or self-assessed measures of health in older people. METHODS Systematic literature searches to identify instruments. Pre-defined criteria relating to reliability, validity and responsiveness. RESULTS 122 articles relating to 15 instruments met the inclusion criteria. The most extensive evidence was found for the SF-36, COOP Charts, EQ-5D, Nottingham Health Profile (NHP) and SIP. Four instruments have evidence of both internal consistency and test-retest reliability--NHP, SF-12, SF-20, SF-36. Four instruments lack evidence of reliability--HSQ-12, IHQL, QWB, SQL. Most instruments were assessed for validity through comparisons with other instruments, global judgements of health, or clinical and socio-demographic variables. Five instruments lack evidence of responsiveness--GQL, HSQ-12, IHQL, QLI and QWB. CONCLUSION There is good evidence for reliability, validity and responsiveness for the SF-36, EQ-5D and NHP. There is more limited evidence for the COOP, SF-12 and SIP. The SF-36 is recommended where a detailed and broad ranging assessment of health is required, particularly in community dwelling older people with limited morbidity. The EQ-5D is recommended where a more succinct assessment is required, particularly where a substantial change in health is expected. Instrument content should be assessed for relevance before application. The concurrent evaluation of generic instruments in older people is recommended.
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Affiliation(s)
- K L Haywood
- National Centre for Health Outcomes Development, Unit of Health-Care Epidemiology, Department of Public Health, University of Oxford, Oxford, UK.
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Overcash JA, Beckstead J, Extermann M, Cobb S. The abbreviated comprehensive geriatric assessment (aCGA): a retrospective analysis. Crit Rev Oncol Hematol 2005; 54:129-36. [PMID: 15843095 DOI: 10.1016/j.critrevonc.2004.12.002] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2004] [Indexed: 11/17/2022] Open
Abstract
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.
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Affiliation(s)
- Janine A Overcash
- College of Nursing, University of South Florida, 12901 Bruce B. Downs Blvd., MDC 22, Tampa, FL 33612-4766, USA.
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Haywood KL, Garratt AM, Fitzpatrick R. Older people specific health status and quality of life: a structured review of self-assessed instruments. J Eval Clin Pract 2005; 11:315-27. [PMID: 16011644 DOI: 10.1111/j.1365-2753.2005.00538.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To review evidence relating to the measurement properties of older people specific self-assessed, multi-dimensional measures of health status. DESIGN Systematic literature searches to identify instruments. Pre-defined criteria relating to reliability, validity, responsiveness, precision and acceptability. RESULTS A total of 46 articles relating to 18 instruments met the inclusion criteria. Most evidence was found for the OARS Multidimensional Functional Assessment Questionnaire (OMFAQ), CARE, Functional Assessment Inventory (FAI) and Quality of Life Profile--Seniors Version (QOLPSV). Most instruments have been evaluated in single studies. Four instruments have evidence of internal consistency and test-retest reliability--LEIPAD, Philadelphia Geriatrics Centre Multilevel Assessment Inventory, Perceived Well-being Scale, Wellness Index (WI). Two instruments lack evidence of reliability--Brief Screening Questionnaire, Geriatric Quality of Life Questionnaire (GQLQ). Older people contributed to the content of the GQLQ, QOLPSV and WI. Most instruments were assessed for validity through comparisons with other instruments, global judgements of health, or clinical and socio-demographic variables. Limited evidence of responsiveness was found for five instruments--GQLQ, OMFAQ, PGCMAI, QOLPSV, Self-Evaluation of Life Scale (SELF). CONCLUSION Although most evidence was found for the OMFAQ this was largely for the ADL domain; evidence for reliability and responsiveness is limited. Limited evidence of reliability, validity and responsiveness was found for the PGCMAI, QOLPSV and SELF. The lack of evidence for measurement properties restricts instrument recommendation. Instrument content should be assessed for relevance before application and the concurrent evaluation of specific and widely used generic instruments is recommended. Several instruments, including the BSQ and EASY-Care, were developed recently and further evidence of instrument performance is required.
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Affiliation(s)
- Kirstie L Haywood
- Research Officer, National Centre for Health Outcomes Development, Unit of Health-Care Epidemiology, Department of Public Health, University of Oxford, Oxford OX3 7LF, UK.
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Dobrzanska L, Dean J, Graham F. Introducing a health awareness day for the over-75s. Br J Community Nurs 2004; 9:429-32. [PMID: 15577719 DOI: 10.12968/bjcn.2004.9.10.16114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Working jointly, a community staff nurse from a district nursing team within North Bradford Primary Care Trust, and a health visitor (who has a remit to work with the elderly) audited their general practice's method of offering all over-75-year-olds a routine annual health check. They found that the method, level and nature of the assessment were not standardized and were organization-led rather than patient-led. This group of patients was not receiving the best service that could be offered. A more integrated approach was needed, and the idea of a 'health awareness day' was developed. Evaluation of the day showed that it was successful in raising health awareness and in increasing referrals to the GP for a variety of problems.
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