Abstract
BackgroundGeriatric syndromes are rarely detected in family medicine. Within the AGE program (active geriatric evaluation), a brief assessment tool (BAT) designed for family physicians (FP) was developed and its diagnostic performance estimated by comparison to a comprehensive geriatric assessment.MethodsThis prospective diagnostic study was conducted in four primary care sites in Switzerland. Participants were aged at least 70 years and attending a routine appointment with their physician, without previous documented geriatric assessment. Participants were assessed by their family physicians using the BAT, and by a geriatriciant who performed a comprehensive geriatric assessment within the following two-month period (reference standard). Both the BAT and the full assessment targeted eight geriatric syndromes: cognitive impairment, mood impairment, urinary incontinence, visual impairment, hearing loss, undernutrition, osteoporosis and gait and balance impairment. Diagnostic accuracy of the BAT was estimated in terms of sensitivity, specificity, and predictive values; secondary outcomes were measures of feasibility, in terms of added consultation time and comprehensiveness in applying the BAT items.ResultsPrevalence of the geriatric syndromes in participants (N=85, 46 (54.1%) women, mean age 78 years (SD 6))ranged from 30.0% (malnutrition and cognitive impairment) to 71.0% (visual impairment), with a median number of 3 syndromes (IQR 2 to 4) per participant. Sensitivity of the BAT ranged from 25.0% for undernutrition (95%CI 9.8% - 46.7%) to 82.1% for hearing impairment (95%CI 66.5% - 92.5%), while specificity ranged from 45.8% for visual impairment (95%CI 25.6–67.2) to 87.7% for undernutrition (76.3% to 94.9%). Finally, most negative predictive values (NPV) were between 73.5% and 84.1%, excluding visual impairment with a NPV of 50.0%. Family physicians reported BAT use as per instructions for 76.7% of the syndromes assessed.ConclusionsAlthough the BAT does not replace a comprehensive geriatric assessment, it is a useful and appropriate tool for the FP to screen elderly patients for most geriatric syndromes.Trial registrationThe study was registered on ClinicalTrials.gov on February 20, 2013 (NCT01816087).
Highlights
Geriatric syndromes are rarely detected in family medicine
Sensitivity ranged from 25.0% for undernutrition to 82.1% for hearing impairment, while specificity ranged from 45.8% for visual impairment to 87.7% for undernutrition (76.3% to 94.9%)
The time added to the consultation can be a barrier if not anticipated, but it was manageable for most family physicians (FP)
Summary
Within the AGE program (active geriatric evaluation), a brief assessment tool (BAT) designed for family physicians (FP) was developed and its diagnostic performance estimated by comparison to a comprehensive geriatric assessment. Population ageing and increasing numbers of patients with multimorbidity are major challenges faced by health services in Western societies. In this context, the traditional disease-centered model of care is increasingly recognized for its limits when managing elderly multimorbid patients [1, 2]. A key concept in the management of elderly patients is “geriatric syndromes”, which are defined as “multifactorial health conditions that occur when the accumulated effects of impairments in multiple systems render [an older] person vulnerable to situational challenges” [3]. Caring for elderly patients by assessing and managing geriatric syndromes, rather than only looking for a specific disease corresponds much better to a patient-centered approach, as it targets the patients’ independence [6], a central determinant of their quality of life [7]
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