Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-22T01:42:42.583Z Has data issue: false hasContentIssue false
  • English
  • Français

Assessment of older adults by emergency medical services: methodology and feasibility of a care partner Comprehensive Geriatric Assessment (CP-CGA)

Published online by Cambridge University Press:  04 March 2015

Judah Goldstein ,
Andrew Travers ,
Ruth Hubbard ,
Paige Moorhouse ,
Melissa K. Andrew  and
Kenneth Rockwood
Judah Goldstein*
Affiliation:
Division of Geriatric Medicine, Geriatric Medicine Research Unit, Dalhousie University, Halifax, NS
Andrew Travers
Affiliation:
Emergency Health Services Nova Scotia, Halifax, NS
Ruth Hubbard
Affiliation:
Division of Geriatric Medicine, Geriatric Medicine Research Unit, Dalhousie University, Halifax, NS
Paige Moorhouse
Affiliation:
Division of Geriatric Medicine, Geriatric Medicine Research Unit, Dalhousie University, Halifax, NS
Melissa K. Andrew
Affiliation:
Division of Geriatric Medicine, Geriatric Medicine Research Unit, Dalhousie University, Halifax, NS
Kenneth Rockwood
Affiliation:
Division of Geriatric Medicine, Geriatric Medicine Research Unit, Dalhousie University, Halifax, NS
*
Division of Geriatric Medicine, Veterans Memorial Building, 1421-5955 Veterans Memorial Lane, Halifax, NS B3H 2E1; judah.goldstein@dal.ca

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objectives:

The Comprehensive Geriatric Assessment (CGA) is used in geriatric medicine as a means to manage the health care needs of older adults and to grade frailty. We modified the CGA so that it could be completed independently by care partners (usually family) and be used to grade frailty. Our objective was to examine the feasibility of a care partner completing the CGA at the time of the first prehospital encounter.

Methods:

A prospective, observational study was conducted with a convenience sample of patients ≥ 70 years accompanied by a knowledgeable care partner. Feasibility was measured by the time required and percent completeness of items on the form based on completion by the care partner and by paramedic perception of utility.

Results:

Subjects (N 5 104) were enrolled with three postenrolment exclusions due to ineligibility. Most participants were older women living in their own home. The mean time to complete the questionnaire was 18.7 minutes (SD 11.3; median 15 minutes; interquartile range 12-20 minutes). Only 64% of the care partners recorded the time it took. Nineteen percent of paramedics completed a follow-up survey, and all felt screening for frailty was worthwhile and most (> 70%) thought that the CP-CGA may be a useful approach. The study was limited by recruitment bias of potentially eligible patients, a high level of missingness in the outcome measures of interest, and low paramedic participation rates.

Conclusion:

We observed a high rate of item completeness of questionnaires with a mean time to complete of 18.7 minutes in a convenience sample of older patients. A small sample of paramedics universally endorsed the utility of screening for frailty in the prehospital setting, and many thought the CP-CGA was a helpful tool.

Keywords

agedComprehensive Geriatric Assessment(CGA)emergency medical servicesfrail
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 16 , Issue 5 , September 2014 , pp. 370 - 383
Copyright
Copyright © Canadian Association of Emergency Physicians 2013

References

REFERENCES

1. Louria, DB. Extraordinary longevity: individual and societal issues. J Am Geriatr Soc 2005;53(9 Suppl):S317-9, doi:10.1111/j.1532-5415.2005.53499.x.Google Scholar
2. Canadian Institute for Health Information. Understanding emergency department wait times: who is using emergency departments and how long are they waiting? 2005. Available at: (accessed February 26, 2008).Google Scholar
3. Shah, MN, Bazarian, JJ, Lerner, B, et al. The epidemiology of emergency medical services use by older adults: an analysis of the National Hospital Ambulatory Medical Care Survey. Acad Emerg Med 2007;14:441–8.CrossRefGoogle ScholarPubMed
4. Aminzadeh, F, Dalziel, WB. Older adults in the emergency department: a systematic review of patterns of use, adverse outcomes, and effectiveness of interventions. Ann Emerg Med 2002;39:238–47, doi:10.1067/mem.2002.121523.Google Scholar
5. Rockwood, K, Fox, RA, Stolee, P, et al. Frailty in elderly people: an evolving concept. CMAJ 1994;150:489–95.Google Scholar
6. Hogan, DB, MacKnight, C, Bergman, H. Models, definitions, and criteria of frailty. Aging Clin Exp Res 2003;15(3 Suppl):1–29.Google Scholar
7. Song, X, Mitnitski, A, Rockwood, K. Prevalence and 10-year outcomes of frailty in older adults in relation to deficit accumulation. J Am Geriatr Soc 2010;58:681–7, doi:10.1111/j.1532-5415.2010.02764.x.Google Scholar
8. Schuurmans, H, Steverink, N, Lindenberg, S, et al. Old or frail: what tells us more? J Gerontol A Biol Sci Med Sci 2004; 59:M962-5, doi:10.1093/gerona/59.9.M962.Google Scholar
9. Rockwood, K, Mitnitski, A, Song, X, et al. Long-term risks of death and institutionalization of elderly people in relation to deficit accumulation at age 70. J Am Geriatr Soc 2006;54:975–9, doi:10.1111/j.1532-5415.2006.00738.x.Google Scholar
10. Goldstein, JP, Andrew, MK, Travers, A. Frailty in older adults using pre-hospital care and the emergency department: a narrative review. Can Geriatr J 2012;15:16–22.Google Scholar
11. Mitnitski, AB, Mogilner, AJ, Rockwood, K. Accumulation of deficits as a proxy measure of aging. Sci World J 2001;1:323–36, doi:10.1100/tsw.2001.58.Google Scholar
12. Searle, SD, Mitnitski, A, Gahbauer, EA, et al. A standard procedure for creating a frailty index. BMC Geriatr 2008;8:24.Google Scholar
13. Rockwood, K, Mitnitski, A. Limits to deficit accumulation in elderly people. Mech Ageing Dev 2006;127:494–6, doi:10.1016/j.mad.2006.01.002.CrossRefGoogle ScholarPubMed
14. Rockwood, K, Mitnitski, A. How might deficit accumulation give rise to frailty? J Frailty Aging 2012;1(1):7–10.Google Scholar
15. Hastings, NS, Purser, JL, Johnson, KS, et al. Frailty predicts some but not all adverse outcomes in older adults discharged from the emergency department. J Am Geriatr Soc 2008;56:1651–7, doi:10.1111/j.1532-5415.2008.01840.x.Google Scholar
16. Jones, DM, Song, X, Rockwood, K. Operationalizing a frailty index from a standardized comprehensive geriatric assessment. J Am Geriatr Soc 2004;52:1929–33, doi:10.1111/j.1532-5415.2004.52521.x.CrossRefGoogle ScholarPubMed
17. Rockwood, K, Stadnyk, K, Carver, D, et al. A clinometric evaluation of specialized geriatric care for rural dwelling, frail older people. J Am Geriatr Soc 2000;48:1080–5.Google Scholar
18. Stuck, AE, Siu, AL, Wieland, GD, et al. Comprehensive geriatric assessment: a meta-analysis of controlled trials. Lancet 1993;342:1032–6, doi:10.1016/0140-6736(93)92884-V.Google Scholar
19. Ellis, G, Whitehead, MA, Robinson, D, et al. Comprehensive geriatric assessment for older adults admitted to hospital: meta-analysis of randomized controlled trials. BMJ 2011;343:d6553, doi:10.1136/bmj.d6553.Google Scholar
20. Samaras, S, Chevalley, T, Samaras, D, Gold, G. Older patients in the emergency department: a review. Ann Emerg Med 2010;56:261–9, doi:10.1016/j.annemergmed.2010.04.015.CrossRefGoogle ScholarPubMed
21. Emergency Health Services Nova Scotia. Annual report 2007/08. Available at: (accessed January 1, 2009).Google Scholar
22. Rockwood, K, Mitnitski, A. Frailty defined by deficit accumulation and geriatric medicine defined by frailty. Clin Geriatr Med 2011;27:17–26, doi:10.1016/j.cger.2010.08.008.CrossRefGoogle ScholarPubMed
23. Rockwood, K, Song, X, MacKnight, C, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ 2005;173:489–95, doi:10.1503/cmaj.050051.Google Scholar
24. Goldstein, J, Hubbard, RE, Moorhouse, P, Andrew, MK. Feasibility of using information derived from a care partner to develop a frailty index based on comprehensive geriatric assessment. J Frailty Ageing 2013;2:15–21.Google Scholar
25. Fried, LP, Tangen, CM, Walston, J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001;56A:146–56, doi:10.1093/gerona/56.3.M146.CrossRefGoogle ScholarPubMed
26. Gobbens, RJJ, Van Assen, MALM, Luijkx, KG, et al. The predictive validity of the Tilburg frailty indicator: disability, health care utilization, and quality of life in a population at risk. Gerontologist 2012;1–13.Google Scholar
27. Steverink, N, Slaets, JPJ, Schuurmans, H, et al. Measuring frailty, development and testing of the Groningen Frailty Indicator (GFI). Gerontologist 2001;41:236–7.Google Scholar
28. Rutschmann, OT, Chevalley, T, Zumwald, Z, et al. Pitfalls in the emergency department triage of frail elderly patients without specific complaints. Swiss Med Wkly 2005;135: 145–50.Google Scholar
29. Lowthian, JA, Jolley, DJ, Curtis, AJ, et al. The challenges of population ageing: accelerating demand for emergency ambulance services by older patients, 1995-2015. Med J Aust 2011;194:574–8.Google Scholar
30. Rockwood, K, MacKnight, C, Bergman, H. Measuring frailty in geriatric patients [letter]. CMAJ 2006;174:353–4, doi:10.1503/cmaj.1050249.Google Scholar
31. Conroy, S. Emergency room geriatric assessment – urgent, important or both? Age Aging 2008;36:612–3, doi:10.1093/ageing/afn215.Google Scholar
32. Moorhouse, P, Mallery, L. PATH: a new approach to endof-life care. Can Rev Alzheimers Other Dementias 2010;13:4–8.Google Scholar