10-Minute Targeted Geriatric Assessment Predicts Disability and Hospitalization in Fast-Paced Acute Care Settings

Abstract

Background Limited time and resources hinder the use of comprehensive geriatric assessment in acute contexts. We investigated the predictive value of a 10-minute targeted geriatric assessment (10-TaGA) for adverse outcomes over 6 months among acutely ill older outpatients. Methods Prospective study comprising 819 acutely ill outpatients (79.2 ± 8.4 years; 63% women) in need of intensive management (eg, intravenous therapy, laboratory test, radiology) to avoid hospitalization. The 10-TaGA provided a validated measure of cumulative deficits. Previously established 10-TaGA cutoffs defined low (0–0.29), medium (0.30–0.39), and high (0.40–1) risks. To estimate whether 10-TaGA predicts new dependence in activities of daily living and hospitalization over the next 6 months, we used hazard models (considering death as competing risk) adjusted for standard risk factors (sociodemographic factors, Charlson comorbidity index, and physician estimates of risk). Differences among areas under receiver operating characteristic curves (AUROC) examined whether 10-TaGA improves outcome discrimination when added to standard risk factors. Results Medium- and high-risk patients, according to 10-TaGA, presented a higher incidence of new activities of daily living dependence (21% vs 7%, adjusted subhazard ratio [aHR] = 2.4, 95% CI = 1.3–4.5; 40% vs 7%, aHR = 5.0, 95% CI = 2.8–8.7, respectively) and hospitalization (27% vs 13%, aHR = 2.0, 95% CI = 1.2–3.3; 37% vs 13%, aHR = 2.9, 95% CI = 1.8–4.6, respectively) than low-risk patients. The 10-TaGA remarkably improved the discrimination of models that incorporated standard risk factors to predict new activities of daily living dependence (AUROC = 0.76 vs 0.71, p < .001) and hospitalization (AUROC = 0.71 vs 0.68, p < .001). Conclusions The 10-TaGA is a practical and efficient comprehensive geriatric assessment tool that improves the prediction of adverse outcomes among acutely ill older outpatients.

A fuller picture of COVID-19 prognosis: the added value of vulnerability measures to predict mortality in hospitalised older adults

“…Thus, the early recognition of those who have a higher risk of mortality is challenging and depends on the adequate assessment of a broad spectrum of vulnerabilities (i.e. social, functional, cognitive and psychological issues) that often influence how older patients react to an infectious disease [ 11 , 25 ]. Although the healthcare workers are already attentive to the elements of risk, such as physiological parameters, which are included in screening tools like the NEWS [ 8 ], they should capture elements of underlying vulnerability as well [ 9 , 26 ].…”

A comprehensive prognostic tool for older adults: Predicting death, ADL disability, and walking disability simultaneously

“…Currently, a few validated calculators predict life expectancy and long‐term mortality risk in the general older adult population, 6,8,9 but long‐term calculators for disability are lacking. Existing short‐term disability prediction models predict 2‐year disability in adults ≥70, 24 6‐month disability in acutely ill older adults, 25 and NH placement among older adults with caregivers 26 . However, for long‐term planning, it is crucial to have information on >5‐year risks of ADL disability and walking disability.…”

Prospective GERiatric Observational (ProGERO) Study: cohort design and preliminary results

“…The 10-minute Targeted Geriatric Assessment (10-TaGA) [14] is a validated multidomain hands-on instrument that was developed to screen geriatric syndromes and estimate the global impairment of patients, using the cumulative de cit model. In previous research, 10-TaGA provided adequate validity and good accuracy in discriminating between frail and non-frail individuals and good predictive power for one-year mortality, disability and hospitalization [14,16,17]. This quick and easy-to-administer CGA-based tool assembles objective measures and selfreported information in an e cient method that evaluates ten health domains: (1) social support (living arrangements and availability of help) [18]; (2) emergency department visits and hospitalizations in the previous six months; (3) the number of falls in previous 12 months; (4) the number of medications; (5) dependence in activities of daily living (ADLs) (Katz index) [19]; (6) 10-point Cognitive Screener (10-CS) [20]; (7) self-rated health; (8) 4-item Geriatric Depression Scale (GDS-4) score [21]; (9) nutritional status (weight loss in the previous 12 months, BMI and calf circumference); (10) gait speed [14].…”

“…Each domain is categorized and scored as normal (0 points), mild impairment (0.5 points), or severe impairment (1 point), based on validated cut-off points against conventional and more extended instruments that are widely used in practice to assess each geriatric condition [14]. While 10-TaGA captures health de cits in multiple domains using rapid geriatric measures, which might be considered super cial, the tool proved to be a practical and e cient method to introduce the CGA in busy clinical settings where time-consuming instruments are unfeasible [14,16,17]. Based on previous work demonstrating the good predictive power of 10-TaGA for one-year mortality, we classi ed participants as having low (0-0.24), medium (0.25-0.49), or high (0.50-1) risk of death [17].…”