Primary care guidelines for geriatric assessment: A structured, comparative analysis

Geriatric assessment in undergraduate geriatric education - a structured interpretation guide improves the quantity and accuracy of the results: a cohort comparison

BACKGROUND

With regard to the growing proportion of elderly multimorbid patients, a sound undergraduate geriatric education becomes more important. Therefore we included the execution and interpretation of a comprehensive geriatric assessment (CGA) into a mandatory two-week clerkship at a general practitioner's office. The present study examined the effect of a guide structuring the students' considerations when interpreting a CGA on the quantity and accuracy of the documented findings and conclusions.

METHODS

We compared random samples out of two cohorts of fourth-year medical students (interpreting the CGA with and without using the structured interpretation guide) completing their clerkship between April 2006 and March 2008 with regard to the content of the CGA interpretation and the grades the students achieved for their clerkship documentation, which were substantially determined by the quantity and accuracy of the documentation and interpretation of the CGA.

RESULTS

The structured interpretation guide led to significantly more mentions of aspects that have to be considered in geriatric patient care and to a higher documentation rate of respective positive results. Furthermore, students who analysed the CGA by using the interpretation guide achieved significantly better grades.

CONCLUSIONS

An additional tool structuring medical students' considerations when interpreting a CGA increases the quantity and the accuracy of the documented findings and conclusions. This may enhance the students' learning gain.

Feasibility, understandability, and usefulness of the STEP self-rating questionnaire: results of a cross-sectional study

The study was designed to evaluate the acceptance of the self-rated version of the Standardized Assessment of Elderly People in primary care in Europe (STEP) by patients and general practitioners, as well as the feasibility, comprehensibility, and usefulness in gaining new information. In all, 1007 of 1540 patients aged 65 and above, from 28 different Saxon general practices took part. We recognized that 96% of the patients were able to fill in the questionnaire by themselves. It took them an average of approximately 20 minutes to do so. Further analysis of 257 randomly selected patients identified 281 previously unknown problems (1.1 per patient). In the practitioners' opinion, 16% of these problems, particularly physiological and mental ones, could lead to immediate consequences. Remarkably, newly identified psychosocial problems were not followed by any consequences. Fourteen of the 75 questionnaire items were not answered by more than 9% of the participants. Eight of the 14 frequently unanswered items were marked as difficult to understand by the patients. Altogether the self-rating version of the STEP was found to be feasible and useful. It was well accepted among patients; however, some questions need further review to improve their comprehensibility. Furthermore, it should be investigated why some identified problems do not have consequences and whether there is a need to record these issues at all.

In-home preventive comprehensive geriatric assessment (CGA) reduces mortality--a randomized controlled trial

The study should prove the effectiveness of a preventive in-home CGA regarding mortality and time able to stay in the community. We performed a randomized controlled trial with a mean follow-up of 6.2 years. The home visits were performed in Germany. 1620 community-living persons aged 70 years and older (n=630 intervention; 990 controls) from 20 general practitioner surgeries were visited. The intervention was performed by trained medical students it included a CGA using the STEP-tool (standardized assessment of elderly people in primary care in Europe; a combination of a structured questionnaire and a structured physical examination) and additional tests, followed by recommendations for the general practitioner. The controls received usual general practitioner care. Follow-up visit was made at mean 6.2 years after randomization. The main outcome parameters were mortality and time able to stay at home. Follow-up-rate was 75%. In COX-regression-analyses, a 20% reduction of mortality and a 22% lower risk of nursing-home admission were shown in the intervention group at the follow up. Despite the main limitations of the study (general practitioners volunteered to participate, follow-up-rate <80%, possible performance of geriatric assessments also in the control group, intervention group had poorer health status than the control group, adherence to recommendations from the assessment was not verified) we conclude that the implementation of a preventive geriatric assessment into primary care in Germany seems to be reasonable.