Comprehensive Geriatric Assessment and the PatientCentered Clinical Method Objectives Describe the effectiveness of CGA Select and use an assessment tool Describe interventions to address functional impairment ID: 689268
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Challenging Patient:Older patient with multiple co-morbidities
Comprehensive Geriatric Assessment and the Patient-Centered Clinical MethodSlide2
Objectives
Describe the effectiveness of CGA
Select and use an assessment tool
Describe interventions to address functional impairment
Consider patient and family goals when developing management planSlide3
Comprehensive Geriatric Assessment: a Meta-analysis of Controlled Trials
Mortality 0.86 (0.75-0.98)
Living at home 1.26 (1.1-1.44)
Hospital admissions 0.88 (0.79-0.98)
Physical Fxn better 1.10 (0.89-1.36)
Cognitive Fxn 1.41 (1.12-1.77)
Stuck et al, Lancet, 1993:23;1032-1036Slide4
What is CGA?
a multidisciplinary evaluation in which the multiple problems of older persons are uncovered, described, and explained, if possible, and in which the resources and strengths of the person are catalogued, need for services assessed, and a coordinated care plan developed to focus interventions on the person
’
s problems.Slide5
The Black Box of CGA
CGASlide6
What happens in the black box?
Multidisciplinary team
Thorough medical evaluation
Medical conditions
Medication
Assess multiple functional domainsValidated instrumentsSlide7
What comes out of the box?
CGA
General medical problems
Depression
Incontinence
Musculoskeletal problems
Hypertension
Functional impairment
Falls, vision and hearingSlide8
Patient-Centered Clinical Method
History
Physical
Lab
Feelings
Ideas
Function
Expectations
1 –
Exploring both disease and illness experience
Cues and prompts
2 –
Understanding the whole person
Disease
Illness
Person
Proximal Context
Distal Context
3 – Finding Common Ground
Problems
Goals
Roles
Mutual decisions
4 – Incorporating prevention and health promotion
6 – Being realistic
5 – Enhancing the patient-physician relationship
Patient-Centered Medicine: Transforming the Clinical Method
, Stewart, M. et al, 2003Slide9
Make it work in practice
The right patient
The right tools, administered the right way
The right people
Common, prioritized goals
Follow-upSlide10
TargetingSlide11
Target - at risk for decline
Age ≥ 75
Fxn
: ≥ 1 ADL def; falls; poor health
Util
: ≥ 1 hosp admission; ≥ 6 visits; ≥ 5 prescription medsMed: CAD, DM, Depression, UISocial: Absence of a caregiverSelf-reported task modificationSlide12
Domains of functionSlide13
The Right InstrumentSlide14
Characteristics of Functional Assessment Instruments
Diagnostic characteristics
Validity
Sensitivity (NPV)/Specificity (PPV)
Ceiling/Floor
Reliability
Ease of administration
Who provides data?
Self-report
Caregiver report
Physical performance test
Sensitivity to changeSlide15
The right people