Division of Geriatrics, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil.
Division of Geriatrics, University of California, San Francisco, California.
J Am Geriatr Soc. 2018 Apr;66(4):748-754. doi: 10.1111/jgs.15303. Epub 2018 Feb 23.
To develop and examine the validity and reliability of a targeted geriatric assessment (TaGA) for busy healthcare settings.
The TaGA was developed through the consensus of experts (Delphi technique), and we investigated its construct validity and reliability in a cross-sectional study.
Geriatric day hospital specializing in acute care in Brazil.
Older adults (N = 534) aged 79.5 ± 8.4, 63% female, consecutively admitted to the geriatric day hospital.
The Frailty Index (FI), Physical Frailty Phenotype, and Identification of Seniors at Risk (ISAR) were used to explore the TaGA's validity. External scales were used to investigate the validity of each matched TaGA domain. The interrater reliability and time to complete the instrument were tested in a 53-person subsample.
In 3 rounds of opinion, experts achieved consensus that the TaGA should include 10 domains (social support, recent hospital admissions, falls, number of medications, basic activities of daily living, cognitive performance, self-rated health, depressive symptoms, nutritional status, gait speed). They arrived at sufficient agreement on specific tools to assess each domain. A single numerical score from 0 to 1 expressed the cumulative deficits across the 10 domains. The TaGA score was highly correlated with the FI (Spearman coefficient = 0.79, 95% confidence interval (CI)=0.76-0.82) and discriminated between frail and nonfrail individuals better than the ISAR (area under the receiver operating characteristic curve 0.84 vs 0.72; P < .001). The TaGA score also had excellent interrater reliability (intraclass correlation coefficient = 0.92, 95% CI=0.87-0.95). Mean TaGA administration time was 9.5 ± 2.2 minutes.
The study presents evidence supporting the TaGA's validity and reliability. This instrument may be a practical and efficient approach to screening geriatric syndromes in fast-paced healthcare settings. Future research should investigate its predictive value and effect on care.
开发并检验一种适用于忙碌医疗环境的针对性老年评估（TaGA）的有效性和可靠性。
通过专家共识（德尔菲技术）开发 TaGA，并在横断面研究中调查其结构有效性和可靠性。
巴西专注于急性护理的老年日医院。
年龄 79.5±8.4 岁的老年人（N=534），女性占 63%，连续入住老年日医院。
使用虚弱指数（FI）、身体虚弱表型和老年人风险识别（ISAR）来探索 TaGA 的有效性。外部量表用于调查每个匹配 TaGA 域的有效性。在 53 人的子样本中测试了评分者间信度和完成工具所需的时间。
在 3 轮意见中，专家们达成共识，认为 TaGA 应包括 10 个领域（社会支持、最近住院、跌倒、药物数量、日常生活活动、认知表现、自我报告的健康状况、抑郁症状、营养状况、步态速度）。他们就评估每个领域的特定工具达成了充分的一致。从 0 到 1 的单一数值表示 10 个领域累积的缺陷。TaGA 评分与 FI 高度相关（Spearman 系数=0.79，95%置信区间（CI）=0.76-0.82），并且比 ISAR 更好地区分虚弱和非虚弱个体（接受者操作特征曲线下面积 0.84 与 0.72；P<.001）。TaGA 评分也具有极好的评分者间信度（组内相关系数=0.92，95%置信区间=0.87-0.95）。平均 TaGA 管理时间为 9.5±2.2 分钟。
该研究提供了支持 TaGA 有效性和可靠性的证据。该工具可能是在快节奏医疗环境中筛查老年综合征的实用、高效方法。未来的研究应调查其预测值和对护理的影响。
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