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Abstract
Comprehensive geriatric assessment, defined as an interdisciplinary assessment and development of an overall plan of treatment and follow-up, has become a fundamental part of clinical geriatric care. Since the 1970s, the US Department of Veterans Affairs (VA) has encouraged the development of geriatric evaluation and management programs. Evolution of geriatric evaluation and management has occurred over time and many VA medical centers have transferred inpatient geriatric evaluation programs to long-term care Community Living Centers, home, and outpatient settings. Availability of geriatric resources and trained personnel across the continuum of care as well as administrative collaboration between care components are critical to the successful implementation of geriatric services. Facilities may need to prioritize their resources and utilize the most effective and relevant elements of geriatric evaluation and management according to patient population needs, available space, resources, and institutional priorities. New risk assessment tools derived from the VA’s experience in geriatric evaluation may be useful for targeting services for other high-risk populations.
Highlights
Comprehensive geriatric assessment, defined as an interdisciplinary assessment and development of an overall plan of treatment and follow-up, has become a fundamental part of clinical geriatric care
Geriatric evaluation consists of a comprehensive, multi-dimensional assessment and development of an interdisciplinary plan of care undertaken by an interdisciplinary team of healthcare professionals for a target a group of clinically defined high-risk high-need patients who are most likely to benefit from these services
San Francisco Veterans Affairs (VA) Medical Center has a 3-Star designation, and has a limited community living center (CLC) capacity. Both services are located in busy acute-care hospitals with active geriatric training programs and have a similar consultation rate of 2 to 4 patients per day, but developed with different foci
Summary
Comprehensive geriatric assessment, defined as an interdisciplinary assessment and development of an overall plan of treatment and follow-up, has become a fundamental part of clinical geriatric care This concept originally focused on inpatient populations. No longer is geriatric evaluation and management confined to inpatient units These services may currently be located in inpatient, long-term care-community living center (CLC) or outpatient settings [7]. Geriatric evaluation consists of a comprehensive, multi-dimensional assessment and development of an interdisciplinary plan of care undertaken by an interdisciplinary team of healthcare professionals for a target a group of clinically defined high-risk high-need patients who are most likely to benefit from these services. We track the evolution of GEM services at Tennessee Valley Healthcare System which transferred its Geriatric Evaluation Unit to the long-term care-community living center in November. 2017, and contrast the Tennessee Valley Healthcare System experience with GEM to the ACE Unit at the San Francisco VA Medical Center discussing the evolution of geriatric evaluation services in the VA from a 30-year clinical, operations and policy perspective
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