Abstract
BackgroundIn clinical practice, GPs appeared to have an internalized concept of “vulnerability.” This study investigates the variability between general practitioners (GPs) in their vulnerability-assessment of older persons.MethodsSeventy-seven GPs categorized their 75-plus patients (n = 11392) into non-vulnerable, possibly vulnerable, and vulnerable patients. GPs personal and practice characteristics were collected. From a sample of 2828 patients the following domains were recorded: sociodemographic, functional [instrumental activities in daily living (IADL), basic activities in daily living (BADL)], somatic (number of diseases, polypharmacy), psychological (Mini-Mental State Examination, 15-item Geriatric Depression Scale; GDS-15) and social (De Jong-Gierveld Loneliness Scale; DJG). Variability in GPs' assessment of vulnerability was tested with mixed effects logistic regression. P-values for variability (pvar) were calculated by the log-likelihood ratio test.ResultsParticipating GPs assessed the vulnerability of 10,361 patients. The median percentage of vulnerable patients was 32.0% (IQR 19.5 to 40.1%). From the somatic and psychological domains, GPs uniformly took into account the patient characteristics ‘total number of diseases’ (OR 1.7, 90% range = 0, pvar = 1), ‘polypharmacy’ (OR 2.3, 90% range = 0, pvar = 1) and ‘GDS-15’ (OR 1.6, 90% range = 0, pvar = 1). GPs vary in the way they assessed their patients' vulnerability in the functional domain (IADL: median OR 2.8, 90% range 1.6, pvar<0.001, BADL: median OR 2.4, 90% range 2.9, pvar<0.001) and the social domain (DJG: median OR 1.2, 90% range = 1.2, pvar<0.001).ConclusionsGPs seem to share a medical concept of vulnerability, since they take somatic and psychological characteristics uniformly into account in the vulnerability-assessment of older persons. In the functional and social domains, however, variability was found. Vulnerability assessment by GPs might be a promising instrument to select older people for geriatric care if more uniformity could be achieved.Trial RegistrationNetherlands Trial Register NTR1946
Highlights
In aging societies the prevalence of vulnerability increases [1]
The present study investigates the variability between general practitioners (GPs) in their vulnerability assessment of older people, to determine whether GPs share a uniform concept of vulnerability
Of the remaining 1031 persons, 292 were assessed as ‘unknown’ and 739 assessments were missing
Summary
In aging societies the prevalence of vulnerability increases [1]. The vulnerable older population is described as the group of older people that presents the most complex and challenging problems to physicians and other healthcare professionals and often require geriatric care [2]. Frailty and vulnerability are terms widely used in discussions on older people, in policy documents and in daily care. The term vulnerability indicates a more heterogeneous group of older people with multiple chronic conditions and/or loss of function in one or more domains (e.g. functional, somatic, psychological and social domains) [4,5]. Physicians, especially general practitioners (GPs), appear to be able to work with an implicit concept of vulnerability [12,13]. Most general practitioners are aware of the existence of this subset of older patients who are vulnerable intuitively, without measuring the specific characteristics of frailty. GPs appeared to have an internalized concept of ‘‘vulnerability.’’ This study investigates the variability between general practitioners (GPs) in their vulnerability-assessment of older persons
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