Comprehensive Geriatric Assessment: Application and correlations in a real-life cross-sectional study

Abstract

BackgroundThe assessment process of elderly people considers all aspects of an individual’s life, including physical, mental, and social aspects. Frailty refers to a decline in physiological functions or strengths leading to increased vulnerability to stressors and decreased ability to cope with them. Comprehensive Geriatric Assessment (CGA) is a validated and useful tool in this context to holistically study elderly people. The primary aim of this study was to determine the prevalence of impaired health status in a large geriatric population turning to outpatient service, based on the components of the CGA, and thus to describe its usefulness in real-life clinical practice. The secondary aim of this study was the evaluation of the association between nutritional status, assessed with Mini Nutritional Assessment (MNA)—within the CGA—and cognitive-affective and functional capacities, and multimorbidity.Materials and methodsThis real-life, retrospective cross-sectional study included subjects consecutively evaluated from January 2009 to December 2020 at the Geriatric Outpatient Service, University Hospital of Monserrato, Cagliari, Italy. A sum of 3,260 patients were subjected to CGA.ResultsOnly a small proportion of the sample (2.24%) showed an absence of impairment in cognitive-affective, functional, and nutritional domains. Moderate correlations were found between MNA and several other CGA variables, namely, Geriatric Depression Scale (GDS; ϱ = −0.41, p < 0.0001), Barthel Index of Independence in Activities of Daily Living (ADL) (ϱ = 0.51, p < 0.0001), Instrumental Activities of Daily Living (IADL) (ϱ = 0.43, p < 0.0001), and Performance-Oriented Mobility Assessment (ϱ = 0.44, p < 0.0001). A multiple regression also highlighted these variables as significant regressors of MNA. Finally, malnutrition showed a significant association with depression (odds ratio [OR]: 4.97), dependence on ADL (OR: 19.8) and IADL (OR: 7.04), and falling risk (OR: 5.16).ConclusionThis study has figured out the complex situation in which geriatric care finds itself the complexity and severe impairment of elderly people. The possibilities of intervention are often limited, but the literature confirms the benefits of good nutritional status on the general health status. The data that emerged from our study fit into this assumption, highlighting the close association between the nutritional domain and the other CGA domains.

Mini-Mental State Examination: Optimal Cut-Off Levels for Mild and Severe Cognitive Impairment

“…The aims of the study were to analyze MMSE’s accuracy in identifying cognitive impairment by comparing it with a more sensitive neuropsychological battery (RBANS) and to describe cut-off levels offering the optimal sensitivity and specificity in identifying different degrees of cognitive impairment due to the need to identify a greater number of patients with cognitive impairment [ 4 ]. Given the close relationship between cognitive impairment and impairment in other domains [ 22 ], the widespread use of MMSE, in particular, requires improvements in its use as a first-level screening tool.…”

Frailty and comorbidity burden in Atrial Fibrillation

“…The increasing elderly population is often frail and multimorbid ( 10 ), and CGA ( 6 ) can early recognize and categorize such common conditions. Among age-related pathologies, one of the most represented is AF, associated with higher risk of hospitalization and mortality ( 23 , 24 ).…”

“…In fact, even if aging can be slowed down by lifestyle, it cannot be stopped ( 4 , 5 ). A noble aim could be to early intercept mild deficits, and Comprehensive Geriatric Assessment (CGA) represent the specialistic tool which has the objective of achieving that ( 3 ), finding out how much support an elderly person needs for day-to-day living and helping to diagnose any health conditions they may have, by enquiring cognitive impairment, mood deflection, functional and nutritional status, other than comorbidities and quality of life ( 6 – 9 ).…”

Comprehensive Geriatric Assessment for younger outpatients with severe mental illness: protocol for a feasibility study

“…To diagnose and manage frailty, the Best Practice Guidelines, issued by the British Geriatrics Society, Age UK and the Royal College of General Practitioners, recommend Comprehensive Geriatric Assessment (CGA) 15. CGA is a validated tool which offers a holistic assessment process of all aspects of an individual’s life, including physical, mental and social aspects, and has been found helpful in the context of older adults health research 16. The key elements of CGA include: a comprehensive evaluation by a geriatrician to identify medical, social and functional needs, optimisation of medication prescribing and (if needed) referrals to a multidisciplinary team 17 18.…”