Cork University Hospital, Cork, Ireland.
Galway University Hospital, Galway, Ireland.
Eur Geriatr Med. 2024 Aug;15(4):1007-1015. doi: 10.1007/s41999-024-00973-4. Epub 2024 Apr 22.
Comprehensive geriatric assessment (CGA) is the cornerstone of high-quality care for older adults. There is no current gold standard to guide what should be included as the baseline measure for CGAs. We examined what metrics are being captured in CGA baseline assessments completed by community based integrated care teams in Ireland.
CGA's care pathways in Ireland are usually initiated with a written document that establish patients baseline in various assessment areas. These documents were the focus of this study. We completed a cross-sectional study of the components captured in CGA baseline assessments completed in a community setting. We contacted operational leads in each of the community health organisations in Ireland and requested a copy of their current initial baseline screening document for CGA.
We reviewed 16 individual CGA baseline documents for analysis in this study. Common assessment areas in all documents included frailty (with the Rockwood Clinical frailty scale used in 94%, n = 15), cognition (4AT-56% of CGAs, MMSE-25%, MOCA-25%, AMTS-19%, AD8-19%, Addenbrookes-13%, 6CIT-13%, mini cog-6%), mobility (100%, n = 16), falls (100%, n = 16), continence (100% n = 16), nutrition (100% n = 16). Mood (94%, n = 15), pain (44%, n = 7), bone health (63%, n = 10), sleep (62%, n = 10) and skin integrity (56%, n = 9). Formal functional assessment was completed in 94% (n = 15) of CGAs with the Barthel index being the tool most used 81% (n = 13). Half of the CGAs included a section describing carer strain (50%, n = 8). The majority of CGAs included a patient centred question which was some variation of 'what matters most to me' (75% n = 11). 87.5% of assessments included a care plan summary (n = 14).
This report highlights that the core tenets of CGA are being assessed across different community based initial CGA screening instruments. There was significant variability in the discussion of challenging topics such as carer strain and social well-being. Our results should prompt a discussion about whether a minimum dataset should be developed for inclusion in nationwide initial baseline CGA document, aiming to improve standardisation of assessments, which will impact areas highlighted for intervention and ultimately guide population health policy.
综合老年评估（CGA）是为老年人提供高质量护理的基石。目前尚无指导 CGA 基线测量应包含哪些内容的金标准。我们研究了爱尔兰社区综合护理团队完成的 CGA 基线评估中正在捕获的指标。
爱尔兰的 CGA 护理途径通常通过一份书面文件启动，该文件确定了患者在各个评估领域的基线。这些文件是本研究的重点。我们对在社区环境中完成的 CGA 基线评估中捕获的组件进行了横断面研究。我们联系了爱尔兰每个社区卫生组织的运营负责人，并要求他们提供当前 CGA 初始基线筛查文件的副本。
我们对本研究中分析的 16 份单独的 CGA 基线文件进行了审查。所有文件中常见的评估领域包括虚弱（使用 Rockwood 临床虚弱量表的占 94%，n=15）、认知（4AT-56%的 CGA、MMSE-25%、MOCA-25%、AMTS-19%、AD8-19%、Addenbrookes-13%、6CIT-13%、mini cog-6%）、移动能力（100%，n=16）、跌倒（100%，n=16）、失禁（100%，n=16）、营养（100%，n=16）。情绪（94%，n=15）、疼痛（44%，n=7）、骨骼健康（63%，n=10）、睡眠（62%，n=10）和皮肤完整性（56%，n=9）。94%（n=15）的 CGA 完成了正式的功能评估，其中使用最广泛的工具是巴氏量表 81%（n=13）。一半的 CGA 包括一节描述照顾者压力（50%，n=8）的内容。大多数 CGA 包括一个以“对我来说最重要的是什么”为主题的患者为中心的问题（75%，n=11）。87.5%的评估包括护理计划摘要（n=14）。
本报告强调，不同的社区初始 CGA 筛查工具都在评估 CGA 的核心原则。在讨论照顾者压力和社会福祉等具有挑战性的话题方面存在显著差异。我们的结果应该引发关于是否应该开发一个包含在全国范围内初始基线 CGA 文档中的最小数据集的讨论，旨在提高评估的标准化，这将影响干预的重点领域，并最终指导人口健康政策。
