RAPID GERIATRIC ASSESSMENT

Abstract

Since the article by Rubenstein and colleagues, in 19841 at the Sepulveda Veterans Affairs Medical Center, demonstrated the ability of a Comprehensive Geriatric Evaluation and Management Unit (GEMU) to improve outcomes for frail older persons, numerous studies have duplicated these findings.2,3 Meta-analyses have confirmed the value of GEMUs.4 Unfortunately, despite their success, they are not widely available in the private sector andwith themarked decline in geriatricians, there are a limited number of geriatricians available in the United States to manage these units.5 For these reasons, it has become essential to increase the knowledge of primary care providers concerning the care of older persons and to develop a brief geriatric assessment that can guide primary care providers to provide quality care for the growing aging population. At Saint Louis University, we have developed a simple Rapid Geriatric Assessment (RGA) that can be completed by the patients and/or their caregiver. The basic screen takes less than 4 minutes to complete (Figure 1). Frailty and sarcopenia have become the new giants of geriatrics.6e19 Although there is much overlap between these 2 syndromes, approximately 30% of persons have one or other of the syndromes, without any overlap.20 To screen for these 2 conditions we have used the well-validated, FRAIL21e26 and SARC-F scales.27e32 We have also included the Simplified Nutritional Assessment Scale (SNAQ),33e35 as anorexia and weight loss have important negative outcomes in older persons.36e42 The International Association of Gerontology and Geriatrics (IAGG) consensus conference has stressed the need for early detection of cognitive impairment.43e45 Many physicians find it difficult to detect cognitive impairment in their patients.46e49 The IAGG has suggested that both objective as well as subjective cognitive impairment should be tested for. The rapid Cognitive Screen (RCS),46,50 which is derived from the St Louis University Mental Status (SLUMS) examination51 has been included in the battery as an objective measure of cognition. It adds 2.5 minutes to the assessment, which can be done by any trained individual in the physician’s office. In addition to the RCS, we believe that the AD-8, developed at Washington University in St Louis, is an