Marjon van Rijn is a PhD candidate at the department of Geriatric Medicine in the Academic Medical Center in Amsterdam and lecturer at the School of Nursing, Faculty of Health, Amsterdam University of Applied Sciences the Netherlands. In this blog she comments on her recent paper in Age and Ageing.
Comprehensive Geriatric Assessment (CGA) is increasingly implemented in community care settings and involves an assessment of physical, psychological, functional and social geriatric conditions, such as urinary incontinence, memory problems, fall risk and loneliness.
In this study, CGA is part of a complex intervention to prevent disability in community dwelling older people. Older people with an increased risk of functional decline, according to the Identification of Seniors at Risk questionnaire that was validated for primary care, were invited for a CGA at home. A community care registered nurse visited older persons to conduct the CGA, and if necessary, made an individual care plan with several follow up visits.
Currently, little is known about the extent to which geriatric conditions are recognized as relevant problems in community-dwelling older people. Here, we report on the prevalence of geriatric conditions in community-dwelling older people at increased risk of functional decline and the extent to which the older person recognizes CGA-identified conditions as relevant problems.
Out of the six geriatric problems that were identified per person, on average one problem was recognized. That is, for only one out of six identified problems participants felt a need for further testing or treatment. Functional dependency and (increased risk of) alcohol and drug dependency were the most commonly identified problems, while pain and incontinence were the most widely recognized ones and most interventions were started for pain and depressive symptoms.
This study demonstrates that CGA in a setting with high quality primary care detects many geriatric conditions in community-dwelling older people, yet results in low recognition rates and low intervention rates of these geriatric conditions. Possible explanations for these findings might be that older people simply accept certain conditions as a part of normal ageing, problems were perhaps already treated or were not perceived as appropriate problems to discuss with the GP.
More insight into priorities and goals of older people can contribute to a cost-effective, affordable CGA and further improve shared decision making in older people.