Components Of Comprehensive Geriatric Assessment Research Articles

How can we improve Comprehensive Geriatric Assessment for older people living with frailty in primary care and community settings? A qualitative study

ObjectiveWith advancing age comes the increasing prevalence of frailty and increased risk of adverse outcomes (eg, hospitalisation). Evidence for comprehensive geriatric assessment (CGA), a multidimensional holistic model of care, is...

Associated factors with domains of comprehensive geriatric assessment among older post-stroke patients

This is a cross-sectional study conducted on 137 post-stroke patients aged ≥ 60 years old treated at the National Geriatric Hospital to explore some factors related to domains of comprehensive geriatric assessment (CGA). The components of CGA assessed were medical status (nutrition; urinary incontinence, frailty, visual and hearing ability), functional status (Barthel index, instrumental activity daily living, risk of fall) and neuropsychological status (cognition and depression). Patients ≥ 70 years old had a prevalence of malnutrition/risk of malnutrition, cognitive impairment, urinary incontinence, and frailty syndrome significantly higher than patients under 70 years old (p<0.05). Post-stroke patients with hemiplegia had significantly higher dependency, cognitive impairment, depression, urinary incontinence, frailty syndrome, and hearing loss than patients without hemiplegia (p<0.05). There was no statistically significant difference between gender, stroke classification, post-stroke duration, and the number of strokes and domains of CGA in older post-stroke patients. In summary, this study showed that advanced age and hemiplegia were significantly associated with some CGA domains.

Stratification Using ECOG, ADL and HCT-CI Scales, but Not CGA Enables Identifying Elderly AML Patients Fit for Intensive Chemotherapy - a Multicenter Study from Polish Adult Leukemia Group

Introduction: A key part of decision-making in older AML patients is an insightful clinical assessment before qualification for treatment with intensive chemotherapy (IC). It was demonstrated that among the patients initially deemed “fit” for IC, there are vulnerable patients who experience greater treatment toxicity and have poorer outcomes. Comprehensive geriatric assessment (CGA) is a well-recognized tool for identifying such patients. However, due to its time-consuming nature, it is not commonly used. A number of other prognostic models exist, but none of them enable fast and optimal identification of patients eligible for IC. Aim: In this prospective observational study our group aimed to I) assess clinical outcomes of elderly AML patients who were stratified by Eastern Cooperative Oncology Group Performance Status (ECOG PS), Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI), Activity of Daily Living (ADL) scales and received IC and II) evaluate the predictive and prognostic value of CGA components. Material and methods: AML patients aged between 60 and 75 were considered fit for IC if they met all 3 stratification criteria: ECOG PS<2 and HCT-CI<3 and ADL=6. IC regimens included daunorubicin and cytarabine (DA) or daunorubicin, cytarabine and cladribine (DAC) followed by 2 consolidation cycles according to local references. CGA was performed by a qualified medical professional before treatment initiation. CGA included Instrumental Activities of Daily Living Score (iADL), timed up and go test (TUG), geriatric depression scale (GDS), Mini-mental scale Examination (MMSE) and Mini Nutritional Assessment (MNA). The correlations between CGA and complete response (CR) rate were determined by Chi-square test or Fisher's exact test. The Kaplan-Meier analysis and log-rank test were used to compare relapse-free survival (RFS) and overall survival (OS) Results: In total, 85 patients with a median age of 65 years [IQR:63.5-69.0] and slight male predominance (53%) were included in the study. Most patients had HCT-CI score <2 (71.8%). Secondary AML was diagnosed in 23.5% of patients, and most patients had intermediate (32.9%) or adverse (37.6%) ELN cytogenetic risk. Fifty-five (58.8%) patients achieved CR after induction. Median OS reached 16.0 months [95% CI: 11.0-21.00] with median RFS 15.3 months [95% CI: 12.1-18.4]. No significant difference in CR rate (p=0.451), OS (p=0.484) or RFS (p=0.529) was demonstrated between DA or DAC groups. Regardless of induction regimen, patients with CR presented significantly improved OS (p=0.015 for DA, p=0.029 for DAC) compared with non-CR patients. None of the CGA components was shown to influence the CR rate, OS or RFS. Conclusions: In patients aged 60-70 years with AML, stratification by ECOG, ADL, and HCT-CI is an effective tool for qualifying patients for intensive chemotherapy. Comprehensive geriatric assessment does not improve identification of vulnerable patients in this group.

246 Feasibility of a delirium intervention pathway by a frailty at the front door team

Abstract Background Consistent success in reducing delirium incidence and related falls, cognitive and functional decline, length of stay, use of one-to-one supervision, institutionalisation, readmissions, and health-care costs (hospital and 1-year) has been demonstrated in delirium, with and without dementia. Intervention strategies reduce delirium and its adverse outcomes by 30–40%. Frailty at the Front Door (FFD) emergency department teams perform 4AT as a routine component of comprehensive geriatric assessment. The aim of this study was to benchmark delirium with and without dementia in patients assessed by a FFD team in an urban tertiary referral centre and assess feasibility of an FFD delivered inter-disciplinary delirium intervention pathway. Methods Age, gender, Clinical Frailty Score (CFS), 4AT, AD8 and dementia diagnosis recorded in 500 consecutive patients in a clinical excel database were analysed using descriptive statistics. An inter-disciplinary delirium pathway, consisting of blood tests, anti-cholinergic cessation, neuro-imaging, individualised patient, carer, staff education was embedded into practice and use of the pathway recorded over a subsequent 2 month period. Results Mean (SD) age was 83 (6.9) years. Female to male ratio was 1.5:1. Mean(SD) CFS was 5 (1.2), with CFS unrecorded in 10%. 91% (n = 456) had 4AT recorded. 50% (n = 230) had a 4AT of zero. 38% (n = 177) had a 4AT of 1–3. 25% (n = 114) had a 4AT of >/=4. Of those where dementia diagnosis was recorded, n = 74, 40% (n = 29) had a 4AT of >/= 4. Where AD8 was measured, 50%(n = 12) had a 4AT of >/=4. The delirium intervention pathway was applied to 16% (n = 70) of the total population over a 2 month study period. Conclusion 4AT>/4 was retrospectively benchmarked at 25% in this population. Recording of dementia diagnosis and AD8 was low. Targeting existing resources to prevent delirium resulted in two-thirds of the expected population benefitting from standardised delirium prevention. Dedicated delirium resources in acute hospitals will further improve outcomes.

263 Improving nutritional Care for Older Adults with hip fractures: insights from a multidisciplinary quality improvement workshop

Abstract Background Enhancing nutrition is a crucial element of hip fracture care, as malnutrition poses increased mortality risk within the initial 120 days post-hip fracture. Aiming to address key considerations and potential challenges, the National Office of Clinical Audit Orthogeriatric Network conducted a quality improvement workshop focusing on nutrition. Methods A workshop exploring various elements of Orthogeriatric care was conducted in September 2022. Over 30 multidisciplinary stakeholders from various hospitals and clinical programs engaged in a survey and workshops exploring key components of Comprehensive Geriatric Assessment (CGA), including nutrition. Results Survey results indicated strong consensus on the inclusion of nutritional assessment and monitoring within the CGA for hip fracture patients. Focused small-group discussions highlighted the adverse effects of inadequate nutrition on wound healing, bone health, energy levels, the catabolic process, and frailty. The under-recognition of nutrition was highlighted. Identified barriers to optimal nutritional care included limited dietetic support, portion sizes, modified diets, repeated fasting, unclear guidance, literacy levels, and the availability of dementia-friendly equipment. Facilitators included access to dietetics support, involving family members and catering staff, enhanced oral hydration plans, protected meal times, proactive protein-based supplements, using ‘red trays’ for assistance, and ‘sip til send’ initiatives. This topic was further explored at the subsequent online network last March with a view to developing guidance on nutritional management of older hip fractures patients. Conclusion To optimise clinical outcomes, individualised nutritional interventions should be tailored to patients’ specific needs, considering local resources. The development of national consensus guidance aims to provide valuable information to enhance patient outcomes.

315 Financial planning as part of an integrated care comprehensive geriatric assessment

Abstract Background Evaluation of a social support network, including the need for support in managing finances independently is an essential component of Comprehensive Geriatric Assessment (CGA). Safeguarding of finances (e.g. third party authorities, enduring power of attorney, will) should be encouraged in all order adults, particularly those with cognitive decline to provide security and protection of their wishes should they lose capacity to manage financial decisions. We sought to evaluate financial competency and preparedness in a population attending our Integrated Care for Older Persons (ICPOP) service. Methods Participants included were new patients referred to ICPOP between January and May 2023 with completed CGAs. A retrospective analysis was conducted of patient demographics, ability to independently manage finances, dependency on personal and instrumental activities of daily living. Results Of our analytic cohort (n = 85), 56% (n = 48) were female, median age was 81. The most common reason for referral was new change in cognition which accounted for 48% (n = 41/85) of patients. Median Rockwood Clinical Frailty Scale was 5. Median Barthel score was 17. Median Lawton-Brody score was 4/8 with 80% (n = 68) patients scoring 1 in the financial section which indicates their ability to manage their finances partially or completely. 60% (n = 51) of patients collected their own pensions and on specific questioning reported managing their finances independently. No patient had an advanced care directive, 90% (n = 77/85) did not have EPoA and 41% (n = 35/85) did not have a will. Conclusion We identified that in those attending our service, very few had EPoA in place with no person having a documented advanced care directive. Over half required some if not total assistance with financial matters. Supported decision making is essential to uphold the right of the older person to make choices on their welfare, property and affairs and CGA provides opportunity for intervention in this remit.

223 Comprehensive Geriatric Assessment (CGA) in Perioperative Care: A Systematic Review of a Complex Intervention

Abstract Aim Comprehensive geriatric assessment (CGA) is a complex intervention applied to older people with evidence of benefit in medical populations. The aim of this systematic review was to describe how CGA is applied to surgical populations in randomised controlled trials. This will provide a basis for design of studies focused on optimising CGA as a complex intervention. Method A systematic review of randomised controlled trials. A systematic search was performed for studies of CGA in the perioperative period across Ovid MEDLINE, Ovid EMBASE, CINAHL and Cochrane CENTRAL, from inception to March 2021. Any randomised controlled trials of perioperative CGA versus 'standard care' were included. Results 12 121 titles and abstracts were screened, 68 full-text articles were assessed for eligibility and 22 articles included, reporting on 13 trials. 10 trials focused on inpatients with hip fracture, with 7 of these delivering CGA on a geriatric medicine ward, 3 on a surgical ward. The remaining three trials were in elective general surgery all delivering CGA on a surgical ward. CGA components, duration of intervention and personnel delivering the intervention were highly variable across the different studies. Trials favoured postoperative delivery of CGA (11/13). Only four trials reported data on adherence to the CGA intervention. Conclusions CGA as an intervention is variably described and delivered in randomised controlled trials in the perioperative setting. The reporting of both the CGA and standard care is often poor with little focus on adherence. Future research should focus on clearly defining and standardising the intervention and measuring adherence within trials.

Detecting Comparative Features of Comprehensive Geriatric Assessment through the International Classification of Functioning, Disability, and Health Linkage: A Web-Based Survey.

Multidimensional assessments are important in evaluating the overall health of older adults. The comprehensive geriatric assessment (CGA) is a representative framework; however, the burden associated with the CGA has led to the development of simplified multidimensional tools. Comparing these tools to the CGA can help utilize them effectively. However, a direct comparison is challenging owing to the conceptual nature of the CGA. In this study, we conducted a web-based survey to identify essential CGA components by linking International Classification of Functioning, Disability, and Health (ICF) category level 2 items and "not defined/not covered" (nd/nc) items. Healthcare professionals and individuals aged >65 years participated in a two-stage Delphi study. In total, 182 respondents (7 geriatricians, 22 nurses, 20 therapists, and 4 case managers) completed the survey. Sixty-one essential components for CGA were identified, including 55 ICF categories. Additionally, personal factors (i.e., proactiveness) and nd/nc items (i.e., subjective perceptions) were aggregated. The results suggest that the CGA includes objective conditions of intrinsic capacity, functional ability, and environment as well as subjective perceptions and proactiveness toward those conditions. Thus, CGA is not merely expected to assess geriatric syndrome but also to estimate broader concepts, such as interoception, resilience, and quality of life.

Comprehensive geriatric assessment for the evaluation of the health statuses of elderly patients

Background: For elderly patients with many chronic and degenerative diseases (multiple comorbidities) and geriatric syndromes, chronic and complex problems should be comprehensively evaluated. The comprehensive geriatric assessment (CGA) is an evaluation of elderly patients in which clinical, medical, and functional evaluations are performed together.Current Concepts: Components of CGA include physical, psychological, and socioenvironmental content. In the physical aspect, the presence of various diseases, determination of the severity of each disease, multi-drug intake (polypharmacy), and vaccination records are evaluated. Geriatric syndromes should also be included in the evaluation. The functional evaluation comprises visual acuity, hearing, upper and lower extremity function, gait ability, balance, fall, urinary incontinence, weight change, oral health, nutritional status, and pain. In the psychological aspect, depression and cognitive function status are evaluated. The residential environment, degree of familial and social support, economic status, and advanced medical directives are evaluated in the socioenvironmental aspect.Discussion and Conclusion: Elderly patients with functional disabilities should be screened via the CGA for various problems and geriatric syndromes that the elderly are prone to developing. Problems found require further evaluation, treatment, and management. In this way, the health and quality of life of the elderly can be maintained and improved.

Comprehensive geriatric assessment in older post-stroke patients: A cross-sectional study

This study aims to identify the components of comprehensive geriatric assessment (CGA) in older post-stroke patients. A cross-sectional study was conducted on 137 post-stroke patients aged ≥ 60 years old being treated at the National Geriatric Hospital. The components of CGA were assessed as medical status (nutrition; urinary incontinence, frailty, visual and hearing ability); functional status (Barthel index, instrumental activity daily living, risk of fall); neuropsychological status (cognition and depression). 66.4% of patients had an ischemic stroke, and 33.6% of patients had a hemorrhage stroke. In both ischemic and hemorrhagic post-stroke groups, domains such as functional impairment, malnutrition, vision loss, high risk of falls, cognitive impairment, and depression account for a high rate (≥ 50%). There was no statistically significant difference in rates of CGA domains between the two groups of patients with ischemic and hemorrhage stroke. This study showed a high prevalence of most components of CGA in older post-stroke patients both in ischemic stroke and hemorrhage stroke patients.

How Effective is Frailty and Comprehensive Geriatric Assessment to Predict the Long-Term Mortality After General Surgery?

Introduction: This study investigated the effect of preoperative comprehensive geriatric assessment(CGA) and frailty assessment on long-term mortality.Methods: This study which evaluated a total of 81 older patients underwent the CGA prior to general surgery. Katz ADL, the Lawton Brody IADL, the Mini-Nutrition Assessment test (MNAsf), the Mini-Mental State Examination (MMSE), and Yesavage Geriatric Depression Scale (GDS) were performed. Fried criteria were utilized for the assessment of frailty. The Physiological and Operative Severity Scores for the Enumeration of Mortality and Morbidity (POSSUM) score, and the Charlson Comorbidity Index (CCI) were used for operative risk assessment. The patients were screened for 3-year mortality. Results: The median age of the patients was 71 years (range, 65-84 years). 58.02% of the patients were female and 24.69% were in the frail group. The mortality rate of the frail group was significantly higher than those of the pre-frail and robust groups (p: 0.030). The Cox regression analyses revealed that MMSE (p: 0.020), Physiological Severity Score (PSS) (p: 0.034), BUPA score (p: 0.030) and educational background (p: 0.031) were independently correlated with mortality in Model 1, while MNA (p: 0.003), PSS score (p: 0.080) and educational background (p: 0.002) were correlated with mortality in Model 2. ADL, MMSE, CDT, MNA-SF, Fried score, length of hospital stay, PSS score, and BUPA score were the best predictors of mortality (AUC values: 0.61, 0.74, 0.72, 0.73, 0.69, 0.74, 0.64, and 0.66respectively). Conclusion: The results of the study demonstrated that CGA components and frailty predicted long-term mortality in general surgery patients.

Prediction of 30-Day Readmission in Hospitalized Older Adults Using Comprehensive Geriatric Assessment and LACE Index and HOSPITAL Score.

(1) Background: Elders have higher rates of rehospitalization, especially those with functional decline. We aimed to investigate potential predictors of 30-day readmission risk by comprehensive geriatric assessment (CGA) in hospitalized patients aged 65 years or older and to examine the predictive ability of the LACE index and HOSPITAL score in older patients with a combination of malnutrition and physical dysfunction. (2) Methods: We included patients admitted to a geriatric ward in a tertiary hospital from July 2012 to August 2018. CGA components including cognitive, functional, nutritional, and social parameters were assessed at admission and recorded, as well as clinical information. The association factors with 30-day hospital readmission were analyzed by multivariate logistic regression analysis. The predictive ability of the LACE and HOSPITAL score was assessed using receiver operator characteristic curve analysis. (3) Results: During the study period, 1509 patients admitted to a ward were recorded. Of these patients, 233 (15.4%) were readmitted within 30 days. Those who were readmitted presented with higher comorbidity numbers and poorer performance of CGA, including gait ability, activities of daily living (ADL), and nutritional status. Multivariate regression analysis showed that male gender and moderately impaired gait ability were independently correlated with 30-day hospital readmissions, while other components such as functional impairment (as ADL) and nutritional status were not associated with 30-day rehospitalization. The receiver operating characteristics for the LACE index and HOSPITAL score showed that both predicting scores performed poorly at predicting 30-day hospital readmission (C-statistic = 0.59) and did not perform better in any of the subgroups. (4) Conclusions: Our study showed that only some components of CGA, mobile disability, and gender were independently associated with increased risk of readmission. However, the LACE index and HOSPITAL score had a poor discriminating ability for predicting 30-day hospitalization in all and subgroup patients. Further identifiers are required to better estimate the 30-day readmission rates in this patient population.

Comprehensive geriatric assessment (CGA) in perioperative care: a systematic review of a complex intervention

ObjectivesComprehensive geriatric assessment (CGA) is a complex intervention applied to older people with evidence of benefit in medical populations. The aim of this systematic review was to describe how CGA...

A higher incidence of diabetic peripheral neuropathy may be associated with decreased sleep and increased depression in older adults

Aim: Diabetes mellitus (DM) tends to increase with aging. Nearly half of the patients with DM develop neuropathy (DPN). Despite its high burden and morbidity, the conditions that DPN may be associated with have not been adequately studied in older adults. We aimed to identify sleep duration and comprehensive geriatric assessment components that may be associated with DPN.
 Material and Method: This is a cross-sectional retrospective study. DPN diagnosed with a medical history, neurologic examination, and electromyography (EMG). 125 diabetic older patients were included. All comprehensive geriatric assessment tests and questions about sleep quality and time were performed. We divided the patients into two groups those without neuropathy and with neuropathy and compared them.
 Results: The median age of 125 patients was 72 (min-max; 64-94). 58.8% of them were women. The percentage of married people and living with their spouse and slept for 6 hours or more had a lower percentage in the DPN group. Polypharmacy and the percentage of heart failure were significantly higher in the DPN group. Lawton-Brody score, which shows instrumental daily living activities (IADL) and geriatric depression score (GDS) was higher in the DPN group. In logistic regression, we found that depression scores were higher and sleep duration was shorter in the DPN group (respectively, odd ratio:265 p:.012; odd ratio:.1.917 p:.045)
 Conclusions: DPN in older adults may affect the functionality and be associated with fewer sleep hours and depression. Not only blood glucose regulation but also other factors such as sleep duration and depressed mood may be associated with DPN in older adults.

Can Syndecan-1 Be Used As A Biomarker In Alzheimer’s Disease?

Background: Syndecan-1 (SDC-1) is a member of the syndecan family, which includes heparan sulfate proteoglycans. SDC-1 is important for cell-cell and cell-matrix interactions. The aim of this study is to examine the relationship between serum SDC-1 levels and mild cognitive impairment (MCI) and Alzheimer’s disease (AD). Methods: Eighty-two patients aged 65 years and over were included in the study. The Mini-Mental State Examination (MMSE) was used to evaluate the cognitive functions of the patients. Comprehensive geriatric assessment components were administered to the patients. Serum SDC-1 levels were measured with an enzyme-linked immunosorbent assay kit. Results: When patients were grouped as control, MCI and AD, significant decreases were observed in Katz daily living activity (p<0.001), Lawton instrumental daily living activity (p=0.001), Mini-nutritional assessment (p=0.001), MMSE (p=0.001) scores. SDC-1 level was 154.88±22.85 in the control group, 157.95±19.45 in the MCI group, and 159.54±14.04 ng/mL in the AD group, and no significant correlation was observed (p=0.677). When correlation analyzes were performed with SDC-1, a negative correlation was found with the Yesavage geriatric depression scale score (Spearman rho: -0.223 p=0.044). Conclusion: No correlation was found between SDC-1 level and AD, and it showed a negative correlation with depression. Clarifying the pathogenetic processes more clearly will guide the development of new treatment strategies.

Comprehensive Geriatric Assessment in Older Patients with Diabetes Mellitus in Hanoi, Vietnam

Introduction: Comprehensive geriatric assessment (CGA) of older diabetic patients is thought to be of value, but there have been limited studies on the prevalence of impairments in the components of a CGA as well as the relationship between CGA and diabetic control in this group. Objective: This study aimed to evaluate the prevalence of components of CGA in older patients with diabetes in National Geriatric Hospital, Hanoi, Vietnam, and determine the association among domains of CGA with measures of diabetic control. Methods: A cross-sectional study of diabetic outpatients aged ≥60 years at National Geriatric Hospital in Hanoi, Vietnam, recruited over 3 months. The CGA questionnaire includes different assessments consisting of cognitive impairment (using Mini-Cog test), depression (using the 15-item Geriatric Depression Scale), urinary incontinence (using the 3-Incontinence questions), Activities of Daily Living (ADL) dependence, Instrumental Activities of Daily Living (IADL) dependence, high fall risk (using Hendrich II Fall Risk Model), hearing loss (using Whisper test), low visual acuity (using Snellen test), polypharmacy, malnutrition (using the Mini-Nutritional Assessment Short Form), and multiple geriatric conditions (patients had 2 or more geriatric conditions). Multiple logistic regression was used to analyze the association between demographic factors and CGA components with measures of diabetes control. Results: A total of 412 patients were recruited (56.6% female, mean age 71.9 [7.6] years). Prevalence of impairment in components of the CGA was high and highest for vision impairment (94.2%) and multiple geriatric conditions (89.3%). Age <75 years, cognitive impairment, depressive symptom, IADL impairment, and high fall risk were significantly associated with both poor fasting plasma glucose control (>130 mg/dL) and poor HbA1c control (≥7%). Conclusions: This study highlights that geriatric syndromes are common in older diabetic patients and associated with poorer diabetic control. It suggests CGA may be important to conduct in this group by establishing an interdisciplinary Geriatric health care team.

Gynecological aspects as a component of comprehensive geriatric assessment: A study of self-rated symptoms of pelvic organ prolapse among community-dwelling elderly women in Japan

ObjectivesDespite the reported ‘male-female health-survival paradox’, no components of the comprehensive geriatric assessment (CGA) routinely used in the field of geriatrics focus on female-specific symptoms. To investigate the impact of gynecological factors among elderly women, we noted the gynecological history and examined the association between self-rated symptoms of pelvic organ prolapse (POP) and CGA. Study designThis community-based, cross-sectional study in Japan included 164 community-dwelling women aged ≥75 years. Main outcome measuresThe main outcome measures were the Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6), activities of daily living (ADL), and Timed Up and Go (TUG) test. Self-rated symptoms of POP were assessed using POPDI-6, and the participants were dichotomized into POPDI-6 >0 (symptom group) and POPDI-6 = 0 (no-symptom group). Several components of the CGA were compared between the groups with and without symptoms of POP and the association with POPDI-6 score was analyzed by multiple logistic regression analysis. ResultsCompared with the no-symptom group, the symptom group had significantly longer TUG test time (≥13.5 s) (P = 0.024) and difficulty in basic ADL (score <21) (P = 0.02). In multiple logistic regression analysis, basic ADL <21 and TUG time ≥13.5 s were significantly associated with POPDI-6 >0 (odds ratio [OR] = 2.78; 95% confidence interval [CI] = 1.10–7.06 and OR = 3.45; 95% CI = 1.01–1.24). ConclusionsSelf-rated POP symptoms were associated with CGA components among community-dwelling elderly women. Evaluating POP symptoms as part of the CGA could be meaningful for improving physical and psychological health in elderly women.

Designing a nurse-led assessment and care planning intervention to support frail older people in primary care: An e-Delphi study.

AimTo identify and establish expert consensus on important and feasible components of a nurse‐led, comprehensive geriatric assessment (CGA)‐based intervention for community‐dwelling older people who live with frailty.DesignA three‐round modified e‐Delphi survey.MethodsAn expert panel of 33 UK specialist older people's, primary and community care nurses participated in the three‐round e‐Delphi survey over a 12‐month period in 2017–2018. Data from round 1 were analysed using content analysis. Descriptive statistics were used in the subsequent two rounds to demonstrate convergence of panel opinion and consensus.ResultsIn round 1, experts proposed 30 CGA components that were combined with six additional components from a literature review and clustered into six domains. In round 2, components were rated for importance and feasibility. Rating scores for importance were high across all domains, with lower scores for feasibility. Round 3 revealed that 36 components achieved consensus on importance and 11 out of 36 components reached consensus on feasibility.ConclusionBased on expert panel opinion, the content of a nurse‐led CGA‐based intervention was established, with the aim of future feasibility testing in a randomized controlled trial.ImpactThis study provides feasible components of a CGA‐based intervention that can be implemented in clinical practice by nurses in partnership with older people who live with frailty. Following further testing and evaluation, the components have the potential to improve clinical outcomes, maximize independence and improve the quality of life for community‐dwelling frail older people.

Multidimensional Prognostic Index and Outcomes in Older Patients Undergoing Transcatheter Aortic Valve Implantation: Survival of the Fittest.

Selecting patients with a high chance of endured benefit from transcatheter aortic valve implantation (TAVI) is becoming relevant with changing indications and increasing number of TAVI being performed. The aim of our study was to investigate the association of the multidimensional prognostic index (MPI) based on a comprehensive geriatric assessment (CGA) on survival. The TAVI Care & Cure program is a prospective, observational registry of patients referred for TAVI at the Erasmus MC University Medical Center. Consecutive patients who underwent a complete CGA and TAVI were included. CGA components were used to calculate the MPI score. The impact of the MPI score on survival was evaluated using Cox regression. Furthermore, 376 patients were included, 143 (38.0%) patients belonged to the MPI-1 group and 233 (61.9%) patients to the MPI-2–3 group. After 3 years, 14.9% of the patients in the MPI-1 group and 30.5% of the patients in the MPI-2–3 group died (p = 0.001). Patients in MPI-1 had increased chances of overall survival in comparison with patients in MPI group 2–3 Hazard Ratio (HR) 0.57, (95% Confidence Interval (CI) 0.33–0.98)). In this study we found that the MPI tool could be useful to assess frailty and to predict which patient will have a higher chance of enduring benefit from a TAVI procedure.

524 QUALITY IMPROVEMENT PROJECT: INCORPORATING COMPREHENSIVE GERIATRIC ASSESSMENT INTO COMMUNITY HOSPITAL CLERKING

Abstract Elderly patients transferred to community hospitals often have complex medical, social, psychological, functional and pharmacological backgrounds that require careful assessment in order to create and deliver a high quality, patient-centred care plan. Unfortunately, time pressures experienced by staff in acute hospitals can make Comprehensive Geriatric Assessment (CGA) unfeasible for every patient. Moreover, junior members of the medical team may be unsure as to which aspects of a patient’s background and presentation constitute important elements of a CGA. Failure to recognise and document pertinent issues can lead to prolonged admissions, disjointed care and failed discharges. Admission to a community hospital presents a convenient ‘checkpoint’ in the patient’s hospital journey at which to undertake a CGA. Recording the relevant information in an effective clerking proforma when the patient is admitted ensures that this information is displayed clearly and in a way that is accessible to all members of the multidisciplinary team. The pre-existing clerking proforma at Amersham Community Hospital omitted several important elements of CGA (such as examination of feet and gait, assessment of mood, FRAX-UK score, creation of a problem list etc.) The aim of this quality improvement project was to create a thorough, yet user-friendly and time-efficient clerking proforma which incorporated the important components of CGA. Using BGS guidance and NICE quality standards, alongside suggestions from the medical team, the existing clerking proforma was adapted and reformed. After one month, feedback from the team was used to further improve the clerking proforma, ensuring that it was user-friendly, whilst meeting the standards set out by NICE and BGS. This was repeated as part of a second PDSA cycle. The improved clerking proforma enables junior doctors to undertake a thorough and holistic assessment, promoting efficient detection of issues and the delivery of a higher quality of care.