A comprehensive assessment for community-based, person-centered care for older adults

Abstract

Background: Many health and social needs can be assessed and met in community settings, where lower-cost, person-centered, preventative and proactive services predominate. This study reports on the development and implementation of a person-centered care model integrating dental, social, and health services for low-income older adults at a community dental clinic co-located within a senior wellness center. Methods: A digital comprehensive geriatric assessment (CGA) and referral system linking medical, dental, and psychosocial needs by real-time CGA-derived metrics for 996 older adults (age ≥ 60) was implemented in 2016-2018 as part of a continuous quality improvement project. This study aims to describe: 1) the development and content of a new CGA; 2) CGA implementation, workflows, triage, referrals; 3) correlations between CGA domains, and adjusted regression models, assessing associations with self-reported recent hospitalizations, emergency department (ED) visits, and clinically-assessed dental urgency. Results: The multidisciplinary team from the senior wellness and dental centers planned and implemented a CGA that included standard medical history along with validated instruments for functional status, mental health and social determinants, and added oral health. Care navigators employed the CGA with 996 older adults, and made 1139 referrals (dental = 797, care coordination = 163, social work = 90, mental health = 32). CGA dimensions correlated between oral health, medical status, depressive symptoms, isolation, and reduced quality of life (QoL). Pain, medical symptoms, isolation and depressive symptoms were associated with poorer self-reported health, while general health was most strongly correlated with lower depressive symptoms, and higher functional status and QoL. Isolation was the strongest correlate of lower QoL. Adjusted odds ratios identified social and medical factors associated with recent hospitalization and ED visits. General and oral health were associated with dental urgency. Dental urgency was most strongly associated with general health (AOR = 1.78,95%CI [1.31, 2.43]), dental symptoms (AOR = 2.39,95%CI [1.78, 3.20]), dental pain (AOR = 2.06,95%CI [1.55-2.74]), and difficulty chewing (AOR = 2.80, 95%CI [2.09-3.76]). Dental symptoms were associated with recent ED visits (AOR = 1.61, 95%CI [1.12-2.30]) or hospitalizations (AOR = 1.47, 95%CI [1.04-2.10]).

Self‐rated oral health and frailty index among older Americans

“…36 However, CGAs concentrate primarily on medical context and unfortunately do not include oral health measures and components. 14 Even though previous studies have demonstrated the benefits of integrating oral health screening with general health screening for older adults. [37][38][39] This is might be hard to implement due to lack of dental staff and limited recourses.…”

“…The CGAs concentrate on the whole person approach and evaluate multiple components of older adults’ general health, which allows a comprehensive judgement on the overall health and the complex needs of older adults 36 . However, CGAs concentrate primarily on medical context and unfortunately do not include oral health measures and components 14 . Even though previous studies have demonstrated the benefits of integrating oral health screening with general health screening for older adults 37‐39 .…”

“…With the increased interest of studying and understanding important ageing outcomes, such as frailty, including oral health examination might not always be feasible due to the cost or the lack of resources and personnel. Furthermore, comprehensive geriatric assessments do not include oral health measures 14 . Therefore, it is important to investigate the association between self‐rated oral health and frailty index using a national representative sample to validate and promote its use in future epidemiological research related to frailty among older adults.…”

“…Furthermore, comprehensive geriatric assessments do not include oral health measures. 14 Therefore, it is important to investigate the association between self-rated oral health and frailty index using a national representative sample to validate and promote its use in future epidemiological research related to frailty among older adults. This study aimed to assess the association between self-rated oral health and frailty index among a nationally representative sample of older American adults.…”

Costs and effects of comprehensive geriatric assessment in primary care for older adults with high risk for hospitalisation

“…The positive effects of CGA include slowing down functional decline and reduction of hospitalisations and admissions to nursing homes [ 15 , 16 ]. CGA has been modified and adapted to various settings; a wide range of CGAs using different instruments with different intensity has been studied in primary care [ 14 , 16 – 18 ]. In spite of a great number of intervention studies, there is insufficient evidence for effectiveness of CGA in primary care regarding reduced mortality or inpatient care [ 11 , 17 ].…”