Comprehensive geriatric assessment: recognition of identified geriatric conditions by community-dwelling older persons

ObjectiveTo evaluate the cost-effectiveness of nurse-led multifactorial care to prevent or postpone new disabilities in community-living older people in comparison with usual care.MethodsWe conducted cost-effectiveness and cost-utility analyses alongside a cluster randomized trial with one-year follow-up. Participants were aged ≥ 70 years and at increased risk of functional decline. Participants in the intervention group (n = 1209) received a comprehensive geriatric assessment and individually tailored multifactorial interventions coordinated by a community-care registered nurse with multiple follow-up visits. The control group (n = 1074) received usual care. Costs were assessed from a healthcare perspective. Outcome measures included disability (modified Katz-Activities of Daily Living (ADL) index score), and quality-adjusted life-years (QALYs). Statistical uncertainty surrounding Incremental Cost-Effectiveness Ratios (ICERs) was estimated using bootstrapped bivariate regression models while adjusting for confounders.ResultsThere were no statistically significant differences in Katz-ADL index score and QALYs between the two groups. Total mean costs were significantly higher in the intervention group (EUR 6518 (SE 472) compared with usual care (EUR 5214 (SE 338); adjusted mean difference €1457 (95% CI: 572; 2537). Cost-effectiveness acceptability curves showed that the maximum probability of the intervention being cost-effective was 0.14 at a willingness to pay (WTP) of EUR 50,000 per one point improvement on the Katz-ADL index score and 0.04 at a WTP of EUR 50,000 per QALY gained.ConclusionThe current intervention was not cost-effective compared to usual care to prevent or postpone new disabilities over a one-year period. Based on these findings, implementation of the evaluated multifactorial nurse-led care model is not to be recommended.

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“…[31, 32] Possible interventions were referral to a GP, referral to a paramedic, giving advice, or follow-up visit by the CCRN. [34]…”

Section: Methodsmentioning

confidence: 99%

Cost-effectiveness of nurse-led multifactorial care to prevent or postpone new disabilities in community-living older people: Results of a cluster randomized trial

et al. 2017

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“…Implementasi CGA dapat memperbaiki status fungsional; menurunkan angka disabilitas, angka hospitalisasi, serta angka kematian. [16][17][18] Penelitian untuk mencari faktor yang berhubungan dengan sarkopenia telah banyak dilakukan sebelumnya. Namun mayoritas penelitian tersebut dilakukan di negara lain yang memiliki perbedaan wilayah demografis serta sosial ekonomi yang berbeda dengan Indonesia.…”

Section: Pendahuluanunclassified

“…(5,5) 14(82,4) 3(17,6) Keterangan: *persentase dari total subjek; **persentase dari kategori variabel…”

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Hubungan Komponen Comprehensive Geriatric Assessment dan Sarkopenia pada Usia Lanjut

Wardhana¹,

Widajanti

Ichwani

2020

JPDI

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Pendahuluan. Sarkopenia merupakan penurunan massa dan kekuatan otot skeletal serta fungsinya dan berdampak meningkatkan angka hospitalisasi, angka kematian, serta beban kesehatan yang dapat terjadi karena kondisi multifaktorial pada proses menua. Untuk menilai kondisi multifaktorial pada lanjut usia dapat dilakukan dengan menggunakan metode comprehensive geriatric assessment (CGA) yang didalamnya terdapat domain sosiodemografis, medis, psikologis, dan fungsional. Penelitian ini bertujuan menganalisis komponen CGA sebagai faktor yang berhubungan dengan kejadian sarkopenia pada komunitas usia lanjut di Surabaya. Metode. Penelitian komunitas ini bersifat analitik observasional menggunakan rancangan potong lintang. Subjek penelitian adalah seluruh lansia yang datang ke lima pos pelayanan terpadu (posyandu) lansia terpilih selama waktu penelitian, yang memenuhi kriteria inklusi dan eksklusi. Sejumlah 308 data telah terkumpul kemudian dilakukan analisis bivariat dan multivariat untuk mengetahui komponen yang berhubungan dengan sarkopenia. Analisis bivariat dilakukan pada komponen usia, jenis kelamin, status nutrisi, komorbid, status kognitif, status mental, dan status fungsional. Variabel yang masuk dalam analisis multivariat adalah usia, jenis kelamin, status nutrisi, komorbid, status kognitif, dan status fungsional.

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“…Following the same theoretical foundation as the health production function, this study subsequently explores the marginal influence of FR and HD factors on the post-discharge mortality rate (MR) in older adults during the study period. The setting for the empirical model was as follows [26,35,36]:…”

Section: Theoretical Foundation and Empirical Modelmentioning

confidence: 99%

A Study of Frailty, Mortality, and Health Depreciation Factors in Older Adults

Lin

Kao

Weng³

et al. 2019

IJERPH

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This study used 23 factors (eight interval variables and 15 dummy variables) as proxies for health depreciation. We used 1248 older adults from the Center for Geriatrics and Gerontology of Taichung Veterans General Hospital (Taiwan) to examine the association among frailty, health depreciation, and mortality in older adults. This study found that a significant positive correlation existed between frailty and mortality in older adults. Further, we applied a recursive bivariate probit model to examine the association between health depreciation factors, frailty, and mortality. Our results showed that health depreciation factors, such as Charlson’s comorbidity index, diabetes and hyperlipidemia, significantly increased older adults’ frailty; in contrast, albumin and mini nutritional assessment significantly decreased older adults’ frailty. Through the frailty regression, we confirmed not only that health depreciation factors significantly influenced mortality, but also that creatinine, myocardial infarction, and malignant tumors could directly and significantly increase older adults’ mortality.

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Comprehensive geriatric assessment: recognition of identified geriatric conditions by community-dwelling older persons

Cited by 16 publications

References 26 publications

Cost-effectiveness of nurse-led multifactorial care to prevent or postpone new disabilities in community-living older people: Results of a cluster randomized trial

Cost-effectiveness of nurse-led multifactorial care to prevent or postpone new disabilities in community-living older people: Results of a cluster randomized trial

Hubungan Komponen Comprehensive Geriatric Assessment dan Sarkopenia pada Usia Lanjut

A Study of Frailty, Mortality, and Health Depreciation Factors in Older Adults

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