Comprehensive Geriatric Assessment and the role it plays in improving care delivered to the older person

Dr Diarmuid O’Shea is a Consultant Geriatrician at St Vincent’s University Hospital Dublin, and Clinical Lead for the National Clinical Programme of Older People in Ireland.  

Ms. Carmel Hoey is a Nursing & Midwifery Planning and Development Officer at the NMPD Unit, Galway, and HSE Service Planner for the National Clinical Programme of Older People in Ireland. 

Countries around the world are seeing significant growth in the numbers of people living longer and healthier lives. We all need to reflect proactively on how we can best maximise the intergenerational benefits this will undoubtedly bring and we must also address the challenges it will generate.

Ireland is no different, with a substantial growth evident in our older population. The number of people aged over 65 years increased by 14% between 2006 and 2011. An increase of 17% is predicted between 2011 and 2016, and a further 17% is expected by 2021 (Central Statistics Office, 2013).

Demographic changes around the world will impact and drive the way many services are delivered.  We need to make the world we live in age accommodating and friendly.  We need sufficient health and social care services that help support and manage older people when they are struggling or unwell.  While we all strive to make the added years, healthy years – we need to be able to support those that are frail, vulnerable or disabled.

In 2010, the Royal College of Physicians of Ireland (RCPI) in partnership with Health Services Executive set up the National Clinical Programme for Older People in Ireland.  This clinically led group developed and published a Specialist Geriatric Services Model of Care, Part 1: Acute Service Provision’ in 2012.  We are currently modernising our model of care and promoting the need for a meaningful response to these challenges with the evolution of an Integrated Care Programme for Older People in Ireland.

There is much more happening in Ireland – this year our Citizens Assembly met to address the challenges and opportunities around ageing, and will soon issue their report.  The RCPI, in conjunction with the National Clinical Programme for Older People ran a national meeting “Transforming Care of Older People in Ireland”.  Our national gerontological society, which is 65 years old this September will run a meeting on “Changing Perspectives in Gerontology – the Next 65 years!”.

The model of care published in 2012, is a key component in the care journey for older people and recommends that older people should have access, if required, to the following services in secondary care:

  • Dedicated in-patient Specialist Geriatric Wards ;
  • Specialist Geriatric Teams ;
  • Comprehensive Geriatric Assessment (CGA) for all those identified as frail, at risk, older people to fully assess their individual needs and the range of services they require;
  • Access to in-patient rehabilitation facilities;
  • Ambulatory day hospital services; and
  • Improved links with community based services (residential care and home supports).

One additional component of this model has been developed by our multi-disciplinary group.  It is this document on CGA that is the focus of our blog today.

CGA is fundamental to the assessment, planning and intervention required to meet the health and social care needs of the older person that is frail or at risk of frailty.  Rather than the traditional way of working separately, CGA facilitates nurses, physiotherapists, occupational therapists, social workers, doctors and other members of the team to work closely together to ensure an integrated assessment and response to the older person’s individual needs.  Adequately resourced, this can be available to an older person in the community or in the hospital.  CGA has the potential to improve the care people receive in hospital, reduce unnecessary hospital admissions, lengths of stay and re-admissions.

As mentioned in our April blog, the ability to understand, recognise and identify frailty is crucial.  We are currently developing a nationwide “Fundamentals of Frailty Education programme”.  This has the potential to become a key enabler to drive the changes that will facilitate the understanding of the need for CGA. It emphasises improving the quality of life and functional status of the older adult and at the same time, improves prognosis and outcome for this frail group of older people.

The aim of our guidance document is to act as a practical resource to assist with the comprehensive assessment of older people in order to improve outcomes for frail, older patients.  It does not address the interventions but it is implicit that a coordinated multi-disciplinary plan is implemented following CGA. The information in the guide is grounded on evidence based practice and multidisciplinary expert opinion.

CGA allows broad and integrated plans for immediate and future management, rehabilitation, care and monitoring to be made and communicated across the multi-disciplinary team and across the care settings.  Optimising and maintaining function of older adults whilst promoting wellness and independence, should be the key outcomes of successful geriatric assessment and intervention.

We have a great opportunity now to build on the foundation of knowledge and research that exists to enable us to improve on how we provide and deliver care to older people in our society.  Let us hope that we use this knowledge and research wisely.

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