Use of a Structured Functional Assessment Format in a Geriatric Consultative Service

Abstract

Interdisciplinary team assessment may not be feasible in the consultative setting because of scarce institutional resources. We explored the extent to which a physician-administered multifaceted assessment could meet the needs of a geriatric consultative service and also provide for the comprehensive functional assessment of elderly patients. Fifty-one consecutive patients, mean age 78, were evaluated. Domains measured included physical and mental health, socioeconomic resources, and activities of daily living. Despite a majority of consult requests for transfer of seemingly stable patients, unrecognized remediable problems were identified in most cases. Compliance with the consultant's recommendations was consistently poor, averaging less than 33% for all of the domains assessed. Nine of the study patients subsequently were transferred to the care of an interdisciplinary team on the geriatric assessment unit. Numbers and types of problems identified by the geriatric consultation using a structured assessment format allows for the comprehensive and efficient disclosure of pertinent management issues. Improved compliance with consultant recommendations may be effected by better education of care providers to the special needs of the geriatric population.

Liaison referrals to a department of psychiatry for the elderly 1984–5

“…Liaison work is a large and important aspect of our service with opportunities for further research. In this study the compliance of referring doctors with the psychiatrist's recommendations was not examined (although it has been shown by Katz et al (1985) to be poor), nor was the satisfaction of referring doctors with the outcome of the consultation. These aspects would repay future study.…”

Impacts of Geriatric Evaluation and Management Programs on Defined Outcomes: Overview of the Evidence

“…Another important difference between effective and ineffective GEM programs may be the extent of continuity of care or case management that can be provided. Follow‐up with indicated treatment can be a problem for any GEM programs relying heavily on the compliance of other health and social service providers 41,45,56 . The interventions suggested by assessment in some inpatient consultation programs were weakened by the lack of program follow‐up.…”

MODELS OF GERIATRICS PRACTICE: A University‐Affiliated Community Hospital Inpatient Geriatrics Program Functioning in an Administrative and Educational Capacity*

“…A major factor limiting the success of geriatric assessment programs has been lack of compliance by primary care physicians in implementing recommendations made by consultative teams. In previously reported studies, adherence rates have ranged from 33% for physician‐administered multifaceted assessment 7 to 71.7% for a consultative comprehensive geriatric assessment team 8 . This model is also consultative in that the assessment team is not able to implement recommendations although substantial efforts are made to inform the primary care physician of the team's findings.…”