Comprehensive geriatric assessment: a meta-analysis of controlled trials

Stuck, Andreas E.; Siu, Albert L.; Wieland, G. Darryl; Rubenstein, Laurence Z.; Adams, Janet

doi:10.1016/0140-6736(93)92884-v

Cited by 1,697 publications

(1,023 citation statements)

References 31 publications

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“…Multidimensional evaluation, carefully planned therapeutic and rehabilitative interventions and medical and nursing teamwork can lead to significant improvements in functional status in old hospitalized patients (5,6). Several studies (4, 7) have evaluated risk factors for functional decline in different settings, but few have examined very old and frail hospitalized subjects.…”

Section: Introductionmentioning

confidence: 99%

Risk factors of functional decline during hospitalization in the oldest old

et al. 2009

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Section: Introductionmentioning

confidence: 99%

Risk factors of functional decline during hospitalization in the oldest old

et al. 2009

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“…There is evidence to support the use of comprehensive geriatric assessment (CGA) for older people. 176,177 A Cochrane review of CGA concluded that older people were more likely to be alive and in their own home after CGA. 178 The authors suggested that wards designed for CGA seem to be more effective than mobile teams.…”

Section: Multidisciplinary Assessmentmentioning

confidence: 99%

Comorbidity and dementia: a mixed-method study on improving health care for people with dementia (CoDem)

Bunn

Burn

Goodman

et al. 2016

Health Serv Deliv Res

116

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BackgroundAmong people living with dementia (PLWD) there is a high prevalence of comorbid medical conditions but little is known about the effects of comorbidity on processes and quality of care and patient needs or how services are adapting to address the particular needs of this population.ObjectivesTo explore the impact of dementia on access to non-dementia services and identify ways of improving the integration of services for this population.DesignWe undertook a scoping review, cross-sectional analysis of a population cohort database, interviews with PLWD and comorbidity and their family carers and focus groups or interviews with health-care professionals (HCPs). We focused specifically on three conditions: diabetes, stroke and vision impairment (VI). The analysis was informed by theories of continuity of care and access to care.ParticipantsThe study included 28 community-dwelling PLWD with one of our target comorbidities, 33 family carers and 56 HCPs specialising in diabetes, stroke, VI or primary care.ResultsThe scoping review (n = 76 studies or reports) found a lack of continuity in health-care systems for PLWD and comorbidity, with little integration or communication between different teams and specialities. PLWD had poorer access to services than those without dementia. Analysis of a population cohort database found that 17% of PLWD had diabetes, 18% had had a stroke and 17% had some form of VI. There has been an increase in the use of unpaid care for PLWD and comorbidity over the last decade. Our qualitative data supported the findings of the scoping review: communication was often poor, with an absence of a standardised approach to sharing information about a person’s dementia and how it might affect the management of other conditions. Although HCPs acknowledged the vital role that family carers play in managing health-care conditions of PLWD and facilitating continuity and access to care, this recognition did not translate into their routine involvement in appointments or decision-making about their family member. Although we found examples of good practice, these tended to be about the behaviour of individual practitioners rather than system-based approaches; current systems may unintentionally block access to care for PLWD. Pathways and guidelines for our three target conditions do not address the possibility of a dementia diagnosis or provide decision-making support for practitioners trying to weigh up the risks and benefits of treatment for PLWD.ConclusionsSignificant numbers of PLWD have comorbid conditions such as stroke, diabetes and VI. The presence of dementia complicates the delivery of health and social care and magnifies the difficulties that people with long-term conditions experience. Key elements of good care for PLWD and comorbidity include having the PLWD and family carer at the centre, flexibility around processes and good communication which ensures that all services are aware when someone has a diagnosis of dementia. The impact of a diagnosis of dementia on pre-existing conditions should be incorporated into guidelines and care planning. Future work needs to focus on the development and evaluation of interventions to improve continuity of care and access to services for PLWD with comorbidity.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…The MNA is intended for use in communitydwelling and hospitalised older people and assesses four areas of nutritional relevance -anthropometric measurements, dietary intake, global health and self-perception of health status. This assessment tool can be used to identify older people (65+ years) at risk of malnutrition and has two components: screening and assessment (Pirlich and Lochs, 2001;Stuck et al, 1993;Vellas et al, 1999). A score of ≤11 on the screen indicates a possible nutritional problem and the need to complete the assessment portion.…”

Section: Mini-nutritional Assessmentsmentioning

confidence: 99%

Nutritional status of Irish older people in receipt of meals‐on‐wheels and the nutritional content of meals provided

O’Dwyer

Corish²,

Timonen

2009

J Human Nutrition Diet

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Background: Research has suggested that meals-on-wheels recipients can be at risk for poor nutritional status. Despite this, few countries have statutory minimum requirements for the nutrient content of meals-on-wheels. This study examined both the nutritional status of a sample of Irish recipients and the nutrient content of a sample of meals provided to determine whether Irish recipients would benefit from statutory minimum nutritional standards.Methods: The study had two phases. Firstly, a nutritional assessment was carried out in order to analyse the nutritional status of a sample of Irish meals-on-wheels recipients (MNA and 24-hour dietary recall with 63 self-selected respondents).Secondly, an assessment of the nutrient content of a sample of 46 meals from 8 mealson-wheels services was undertaken in order to characterise the nutritional content of the meals.Results: Over one-third of recipients (38.5%) were malnourished or at-risk of malnutrition and over half (52.3%) were overweight or obese. The mean energy (kcalorie) content of the meals assessed was 719 kcalories (SD 119.1), contributing 35-40% of the RDA for males aged 65 years and over and 42-45% of the RDA for females aged 65 years and over. In the meals assessed, the levels of vitamin C (25.3%), vitamin D (11.6%), folate (24.8%) and calcium (20.9%) were below onethird of the Irish RDA for these nutrients.Conclusions: Irish recipients may not be receiving adequate micronutrients from meals-on-wheels. Legislation that sets out minimum standards for the nutrient content of meals-on-wheels and greater variation in the portion sizes offered, may benefit recipients.

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Comprehensive geriatric assessment: a meta-analysis of controlled trials

Cited by 1,697 publications

References 31 publications

Risk factors of functional decline during hospitalization in the oldest old

Risk factors of functional decline during hospitalization in the oldest old

Comorbidity and dementia: a mixed-method study on improving health care for people with dementia (CoDem)

Nutritional status of Irish older people in receipt of meals‐on‐wheels and the nutritional content of meals provided

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