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Geriatric Helper: An mHealth Application to Support Comprehensive Geriatric Assessment.

ABSTRACT: The Comprehensive Geriatric Assessment (CGA) is a multidisciplinary diagnosis approach that considers several dimensions of fragility in older adults to develop an individualized plan to improve their overall health. Despite the evidence of its positive impact, CGA is still applied by a reduced number of professionals in geriatric care in many countries, mostly using a paper-based approach. In this context, we collaborate with clinicians to bring CGA to the attention of more healthcare professionals and to enable its easier application in clinical settings by proposing a mobile application, Geriatric Helper, to act as a pocket guide that is easy to update remotely with up-to-date information, and that acts as a tool for conducting CGA. This approach reduces the time spent on retrieving the scales documentation, the overhead of calculating the results, and works as a source of information for non-specialists. Geriatric Helper is a tool for the health professionals developed considering an iterative, User-Centred Design approach, with extensive contributions from a broad set of users including domain experts, resulting in a highly usable and accepted system. Geriatric Helper is currently being tested in Portuguese healthcare units allowing for any clinician to apply the otherwise experts-limited geriatric assessment.

SUBMITTER: Silva S

PROVIDER: S-EPMC5948578 | biostudies-literature | 2018 Apr

REPOSITORIES: biostudies-literature

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Geriatric Helper: An mHealth Application to Support Comprehensive Geriatric Assessment.

Silva Samuel S Felgueiras Rafael R Oliveira Ilídio C IC

Sensors (Basel, Switzerland) 20180422 4

The Comprehensive Geriatric Assessment (CGA) is a multidisciplinary diagnosis approach that considers several dimensions of fragility in older adults to develop an individualized plan to improve their overall health. Despite the evidence of its positive impact, CGA is still applied by a reduced number of professionals in geriatric care in many countries, mostly using a paper-based approach. In this context, we collaborate with clinicians to bring CGA to the attention of more healthcare professio ...[more]

PMID: 29690569

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Project description:BackgroundFoot problems are common in older adults and associated with poorer physical function, falls, frailty and reduced quality of life. Comprehensive Geriatric Assessment (CGA), a multidisciplinary process that is considered the gold standard of care for older adults, does not routinely include podiatry assessment and intervention in hospitalized older adults.AimsTo introduce foot assessment to inpatient CGA to determine prevalence of foot disease, foot disease risk factors and inappropriate footwear use, assess inter-rater reliability of foot assessments, determine current podiatry input and examine associations between patient characteristics and foot disease risks.MethodsProspective, observational cohort study of older adults on geriatric rehabilitation wards. Foot assessment completed using the Queensland Foot Disease Form (QFDF) in addition to routine CGA.ResultsFifty-two patients (median age [inter-quartile range] 86.4 [79.2-90.3] years, 54% female) were included. Six patients (12%) had foot disease and 13 (25%) had a 'high risk' or 'at risk' foot. Foot disease risk factor prevalence was peripheral arterial disease 9 (17%); neuropathy 10 (19%) and foot deformity 11 (22%). Forty-one patients (85%) wore inappropriate footwear. Inter-rater agreement was substantial on presence of foot disease and arterial disease, fair to moderate on foot deformity and fair on neuropathy and inappropriate footwear. Eight patients (15%) saw a podiatrist during admission: 5 with foot disease, 1 'at risk' and 2 'low risk' for foot disease. Patients with an at risk foot or foot disease had significantly longer median length of hospital stay (25 [13.7-32.1] vs 15.2 [8-22.1] days, p = 0.01) and higher median Malnutrition Screening Test scores (2 [0-3] vs 0 [0-2], p = 0.03) than the low-risk group. Patients with foot disease were most likely to see a podiatrist (p < 0.001).ConclusionFoot disease, foot disease risk factors and inappropriate footwear are common in hospitalized older adults, however podiatry assessment and intervention is mostly limited to patients with foot disease. Addition of routine podiatry assessment to the multidisciplinary CGA team should be considered. Examination for arterial disease and risk of malnutrition may be useful to identify at risk patients for podiatry review.

Project description:BackgroundCancer is common in older patients, who raise specific treatment challenges due to aging-related, organ-specific physiologic changes and the presence in most cases of comorbidities capable of affecting treatment tolerance and outcomes. Identifying comorbid conditions and physiologic changes due to aging allows oncologists to better assess the risk/benefit ratio and to adjust the treatment accordingly. Conducting a Comprehensive Geriatric Assessment (CGA) is one approach developed for this purpose. We reviewed the evidence on the usefulness of CGA for assessing health problems and predicting cancer treatment outcomes, functional decline, morbidity, and mortality in older patients with solid malignancies.MethodsWe searched Medline for articles published in English between January 1, 2000 and April 14, 2014, and reporting prospective observational or interventional studies of CGA feasibility or effectiveness in patients aged ≥65 years with solid malignancies. We identified studies with at least 100 patients, a multivariate analysis, and assessments of at least five of the following CGA domains: nutrition, cognition, mood, functional status, mobility and falls, polypharmacy, comorbidities, and social environment.ResultsAll types of CGA identified a large number of unrecognized health problems capable of interfering with cancer treatment. CGA results influenced 21%-49% of treatment decisions. All CGA domains were associated with chemotoxicity or survival in at least one study. The abnormalities that most often predicted mortality and chemotoxicity were functional impairment, malnutrition, and comorbidities.ConclusionThe CGA uncovers numerous health problems in elderly patients with cancer and can affect treatment decisions. Functional impairment, malnutrition, and comorbidities are independently associated with chemotoxicity and/or survival. Only three randomized published studies evaluated the effectiveness of CGA-linked interventions. Further research into the effectiveness of the CGA in improving patient outcomes is needed.

Project description:Geriatric syndromes are rarely detected in family medicine. Within the AGE program (active geriatric evaluation), a brief assessment tool (BAT) designed for family physicians (FP) was developed and its diagnostic performance estimated by comparison to a comprehensive geriatric assessment.This prospective diagnostic study was conducted in four primary care sites in Switzerland. Participants were aged at least 70 years and attending a routine appointment with their physician, without previous documented geriatric assessment. Participants were assessed by their family physicians using the BAT, and by a geriatriciant who performed a comprehensive geriatric assessment within the following two-month period (reference standard). Both the BAT and the full assessment targeted eight geriatric syndromes: cognitive impairment, mood impairment, urinary incontinence, visual impairment, hearing loss, undernutrition, osteoporosis and gait and balance impairment. Diagnostic accuracy of the BAT was estimated in terms of sensitivity, specificity, and predictive values; secondary outcomes were measures of feasibility, in terms of added consultation time and comprehensiveness in applying the BAT items.Prevalence of the geriatric syndromes in participants (N=85, 46 (54.1%) women, mean age 78 years (SD 6))ranged from 30.0% (malnutrition and cognitive impairment) to 71.0% (visual impairment), with a median number of 3 syndromes (IQR 2 to 4) per participant. Sensitivity of the BAT ranged from 25.0% for undernutrition (95%CI 9.8% - 46.7%) to 82.1% for hearing impairment (95%CI 66.5% - 92.5%), while specificity ranged from 45.8% for visual impairment (95%CI 25.6-67.2) to 87.7% for undernutrition (76.3% to 94.9%). Finally, most negative predictive values (NPV) were between 73.5% and 84.1%, excluding visual impairment with a NPV of 50.0%. Family physicians reported BAT use as per instructions for 76.7% of the syndromes assessed.Although the BAT does not replace a comprehensive geriatric assessment, it is a useful and appropriate tool for the FP to screen elderly patients for most geriatric syndromes.The study was registered on ClinicalTrials.gov on February 20, 2013 ( NCT01816087 ).

Dataset Information

Geriatric Helper: An mHealth Application to Support Comprehensive Geriatric Assessment.

Publications

Geriatric Helper: An mHealth Application to Support Comprehensive Geriatric Assessment.

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