What is Comprehensive Geriatric Assessment (CGA)? An umbrella review

Parker, Stuart G.; McCue, Patricia; Phelps, Kay; McCleod, A.; Arora, Sandeepa; Nockels, Keith; Kennedy, Sheila Suess; Roberts, Helen; Conroy, Simon

doi:10.1093/ageing/afx166

Cited by 380 publications

(312 citation statements)

References 20 publications

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“…Among the risk factors for functional decline, geriatric syndromes are least familiar to the dialysis provider and more likely to be under recognized. Developed as a tool for identification of older patients at risk for nursing home placement, comprehensive geriatric assessment (CGA) is the gold standard for identifying functional decline and other geriatric syndromes that can contribute to functional decline . The standard CGA is characterized by a multidisciplinary team (eg, a geriatrician, nurse, and social worker) that conducts a comprehensive multidimensional evaluation .…”

Section: Identifying Dialysis Patients At Risk Of Functional Declinementioning

confidence: 99%

“…16 and other geriatric syndromes that can contribute to functional decline. 27 The standard CGA is characterized by a multidisciplinary team (eg, a geriatrician, nurse, and social worker) that conducts a comprehensive multidimensional evaluation. 8,28 The essential dimensions include functional status, cognition, comorbidities, mood, falls, polypharmacy, nutrition, social support, and financial well-being.…”

Section: Comorbidity Disability and Low Physical Activitymentioning

confidence: 99%

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Breaking the cycle of functional decline in older dialysis patients

Hall

McAdams‐DeMarco

2018

Seminars in Dialysis

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Currently, older adults comprise nearly one-third of prevalent US dialysis patients, and this proportion will increase as the population ages. Older dialysis patients experience greater morbidity and mortality than nondialysis patients of the same age, and in part, it is related to progressive functional decline. Progressive functional decline, characterized by need for assistance with more than 2 activities of daily living, contributes to risk of hospitalization, further functional decline, and subsequent nursing home placement when a patient no longer functions independently at home. Progressive functional decline may appear to be unavoidable for older dialysis patients; however, comprehensive geriatric assessment (CGA) may alleviate the prevalence and severity of functional decline. This editorial summarizes common risk factors of functional decline and introduces CGA as a potentially transformative approach to breaking the cycle of functional decline in older dialysis patients.

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Section: Identifying Dialysis Patients At Risk Of Functional Declinementioning

confidence: 99%

Section: Comorbidity Disability and Low Physical Activitymentioning

confidence: 99%

Breaking the cycle of functional decline in older dialysis patients

Hall

McAdams‐DeMarco

2018

Seminars in Dialysis

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“…Currently, the comprehensive geriatric assessment (CGA) is considered as a gold standard to diagnose frailty, which is associated with poor outcomes and higher risks of treatment; therefore, it assesses the biological age, rather than the chronological age per se to identify for treatment (un)suitable patients . A CGA is a multidimensional and interdisciplinary assessment through evaluating physical, psychological, functional, and social capabilities and limitations of the onco‐geriatric patient . Although CGA is the most valid and reliable method, it is very time intensive.…”

Section: Introductionmentioning

confidence: 99%

“…9,10 A CGA is a multidimensional and interdisciplinary assessment through evaluating physical, psychological, functional, and social capabilities and limitations of the onco-geriatric patient. 10 Although CGA is the most valid and reliable method, it is very time intensive. Alternatively, frailty questionnaires are used to identify patients who should undergo a full CGA, 11 which are also time intensive even though it is a shorter procedure.…”

Section: Introductionmentioning

confidence: 99%

CT‐measured skeletal muscle mass used to assess frailty in patients with head and neck cancer

Zwart

Hoorn

Ooijen

et al. 2019

J cachexia sarcopenia muscle

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Background Skeletal muscle depletion or sarcopenia is related to multiple adverse clinical outcome. However, frailty questionnaires are currently applied in the daily practice to identify patients who are potentially (un)suitable for treatment but are time consuming and straining for patients and the clinician. Screening for sarcopenia in patients with head and neck cancer (HNC) could be a promising fast biomarker for frailty. Our objective was to quantify sarcopenia with pre‐treatment low skeletal muscle mass from routinely obtained neck computed tomography scans at level of third cervical vertebra in patients diagnosed with HNC and evaluate its association with frailty. Methods A total of 112 HNC patients with Stages III and IV disease were included from a prospective databiobank. The amount of skeletal muscle mass was retrospectively defined using the skeletal muscle index (SMI). Correlation analysis between SMI and continuous frailty data and the observer agreement were analysed with Pearson's r correlation coefficients. Sarcopenia was present when SMI felt below previously published non‐gender specific thresholds (<43.2 cm2/m2). Frailty was evaluated by Geriatrics 8 (G8), Groningen Frailty Indicator, Timed Up and Go test, and Malnutrition Universal Screening Tool. A univariate and multivariate logistic regression analysis was performed for all patients and men separately to obtain odds ratios (ORs) and 95% confidence intervals (95% CIs). Results The cohort included 82 men (73%) and 30 women (27%), with a total mean age of 63 (±9) years. The observer agreement for cross‐sectional measurements was excellent for both intra‐observer variability (r = 0.99, P < 0.001) and inter‐observer variability (r = 0.98, P < 0.001). SMI correlated best with G8 frailty score (r = 0.38, P < 0.001) and did not differ per gender. Sarcopenia was present in 54 (48%) patients, whereof 25 (46%) men and 29 (54%) women. Prevalence of frailty was between 5% and 54% depending on the used screening tool. The multivariate regression analysis for all patients and men separately isolated the G8 questionnaire as the only independent variable associated with sarcopenia (OR 0.76, 95% CI 0.66–0.89, P < 0.001 and OR 0.76, 95% CI 0.66–0.88, P < 0.001, respectively). Conclusions This is the first study that demonstrates that sarcopenia is independently associated with frailty based on the G8 questionnaire in HNC patients. These results suggest that in the future, screening for sarcopenia on routinely obtained neck computed tomography scans may replace time consuming frailty questionnaires and help to select the (un)suitable patients for therapy, which is highly clinically relevant.

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“…Studies have shown that frail and disabled elderly patients with substantial multimorbidity are likely to benefit from hospital care provided in a more holistic approach 93 . The CGA is now the accepted "gold standard" in caring for frail elderly patients in hospitals 155 . However, in the literature, there are discussions about who a CGA will benefit most 102,155,156 .…”

Section: Aspects Of Importance Within Cgamentioning

confidence: 99%