Managing geriatric syndromes: what geriatric assessment teams recommend, what primary care physicians implement, what patients adhere to.

OBJECTIVES

To evaluate the responses of primary care physicians and patients to recommendations from a community-based comprehensive geriatric assessment (CGA) program for management of four target conditions: falls, depression, urinary incontinence, and functional impairment.

DESIGN

Case series.

SETTING

Senior centers, meal sites, senior housing, and other community sites as screening locations; and a community-bases academic practice as the location for CGA.

PARTICIPANTS

A total of 150 older patients living in the community who have one or more of the four target conditions and who received CGA.

MEASUREMENTS

Physician implementation and patient adherence rates were ascertained during a face-to-face structured interview with the patient 3 months after CGA.

RESULTS

Two hundred twelve of 528 (40%) CGA recommendations were clearly or possible related to the target or target-related conditions. Of these 212 recommendations, 59% required a physician's order for implementation. The remaining 41% were patient self-care recommendations. Overall physician implementation across conditions was 70%; implementation rates were highest for falls and lowest for functional impairment. Overall patient adherence rate was 85% for physician-implemented recommendations and 46% for self-care recommendations. Patient adherence to recommendations for counseling or support groups and exercise programs was particularly low.

CONCLUSIONS

When examining the process of care of community-based CGA, patient as well as physician adherence must be considered. Although patient adherence to physician-initiated recommendations was high for all conditions, it varied substantially across target conditions and types of recommendations for self-care recommendations.