© 1997 Oxford University Press
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The performance of simple instruments in detecting geriatric conditions and selecting community-dwelling older people for geriatric assessment
Division of Family Medicine, UCLA School of Medicine 50-071 CHS, 10833 Le Corrte Avenue, Los Angeles, CA 90095-1683, USA
1Multicampus Program in Geriatric Medicine and Gerontology, UCLA School of Medicine Los Angeles, CA USA
Address correspondence to: R. C. Maly. Fax: (+1) 310 794 6097. e-mail: mnaly{at}fammed.medsch.ucla.edu
BACKGROUND:: comprehensive geriatric assessment (CGA) appears to be less effective when performed in outpatient clinics than in hospital settings. The effectiveness of outpatient CGA might be improved by selectively targeting frailer community-dwelling elderly people. The purpose of this study was to evaluate die clinical performance of rapidly-administered standard screening measures for geriatric syndromes in selecting community-dwelling older people for outpatient CGA.
METHODS:: urban-dwelling older people were screened for CGA at community sites using a self-administered questionnaire containing standardized measures for each of four geriatric target conditions: depression, urinary incontinence, falls and functional impairment. The study sample included all 150 consecutive subjects who were screened, failed on one or more of the four target criteria and completed community-based, academically administered CGA. Diagnostic accuracy of the screening instruments was assessed using CGA diagnoses as the ‘gold standard’. In addition, patients' potential for benefiting from CGA was determined by whether diey received major medical recommendations for further evaluation or treatment.
RESULTS:: after completing CGA, 60.2% of those failing on functional impairment, 53.5% of diose failing on depression, 30.7% of those failing on falls and 92.7% of diose failing on urinary incontinence, were confirmed as having diese or highly related conditions as clinical problems. Overall, 81.3% of the subjects completing CGA received at least one major recommendation for further medical intervention; most of diese recommendations (79.5%) were for a target-related condition and die remainder (20.5%) addressed anodier significant medical condition.
CONCLUSION:: simple screening instruments used in community settings have variable degrees of accuracy, but may be markers for frailty and dius can identify older people likely to benefit from geriatric assessment.
Keywords: geriatric assessment, screening falls, depression, functional impairment
Received October 9, 1996;
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