COMPREHENSIVE GERIATRIC ASSESSMENT IN PRACTICE: WHAT DO PATIENTS SAY?
Yıl 2022,
, 236 - 241, 24.03.2022
Tuğba Erdoğan
,
Birkan İlhan
,
Aslı Tufan
,
Gülistan Bahat Öztürk
,
Mehmet Karan
Öz
Objective: Comprehensive Geriatric Assessment (CGA) is one of the cornerstones of geriatric medicine. In this study, we aimed to find out how satisfied patients aged 60 and over with the application of CGA and whether they would express these complaints if geriatric-syndromes were not questioned. Materials and Methods: Patients who applied to the geriatric outpatient-clinic were included. An 18-question survey was applied by the geriatric nurse. The satisfaction and benefit expectations of the patients regarding both the application of CGA and specific sub-areas of CGA (urinary- fecal incontinence, falls, sleep, Mini-Nutritional-Assessment, Mini-Mental-State-Examination) were evaluated. They were asked whether they would express their complaints if these questions were not asked. Results: One-hundred-fifty patients were included in the study. The mean-age was 73.7±7 years. One-hundred-forty-eight patients were satisfied with the CGA and 139 of them thought it was beneficial. Seventy-three (49%) patients had urinary-incontinence, and 29 (19%) patients said that they would not report urinary-incontinence if this question had not been asked. Seventeen patients (11%) had fecal-incontinence and 16% of all patients said that they would not report fecal-incontinence if this question had not been asked. Twenty-nine of 85 patients stated that although they had a history of falling within the last year, they would not have stated this situation if this question was not asked. Ninety-three percent of the patients stated that they were satisfied with the Mini-Mental-State-Examination and that they thought this test would be beneficial for them. Conclusion: Although it takes time and is tiring, CGA is satisfactory for patients and enables the recognition of geriatric-syndromes that may remain hidden.
Destekleyen Kurum
Scientific Research Projects Coordination Unit of Istanbul University
Kaynakça
- 1. Türkiye İstatistik Kurumu Haber Bülteni. İstatistiklerle Yaşlılar 2019. 2020:33712. Available from https://data.tuik. gov.tr/Bulten/Index?p=Istatistiklerle-Yaslilar-2019-33712
- 2. Solomon DH. Geriatric assessment: methods for clinical decision making. JAMA 1988;259(16):2450-2. [CrossRef]
- 3. Beers MH, Berkow R. Comprehensive geriatric assessment. The Merck Manual of Geri- atrics. 3rd ed. Whitehouse Station: Merck Research Laboratories 2000. p.40-6.
- 4. Folstein MF, Folstein SE, McHugh PR. ‘’Mini-mental state’’. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12(3):189-98. [CrossRef]
- 5. Güngen C, Ertan T, Eker E, Yaşar R, Engin F. Reliability and validity of the standardized Mini Mental State Examination in the diagnosis of mild dementia in Turkish population. Turk Psikiyatri Derg 2002;13(4):273-81.
- 6. Babacan YG, Ur ÖE, Kolukısa M, Işık AT, Gürsoy E, Kocaman G, et al. Validity and Reliability Studies of Modified Mini Mental State Examination (MMSE-E) For Turkish Illiterate Patients With Diagnosis of Alzheimer Disease. Turk Psikiyatri Derg 2016;27(1):41-6.
- 7. Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M, et al. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 1982- 1983;17(1):37-49. [CrossRef]
- 8. Ertan T, Eker E. Reliability, validity, and factor structure of the Geriatric Depression Scale in Turkish Elderly: Are there different factor structures for different cultures? Int Psychogeriatr 2000;12(2):163-72. [CrossRef]
- 9. Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B. Screening for undernutrition in geriatric practice: developing the short-form mini-nutritional assessment (MNA-SF). J Gerontol A Biol Sci Med Sci 2001;56(6):M366- 72. [CrossRef]
- 10. Sarikaya D, Halil M, Kuyumcu ME, Kilic MK, Yesil Y, Kara O, et al. Mini nutritional assessment test long and short form are valid screening tools in Turkish older adults. Arch Gerontol Geriatr 2015;61(1):56-60. [CrossRef]
- 11. Ekerstad N, Östberg G, Johansson M, Karlson BW. Are frail elderly patients treated in a CGA unit more satisfied with their hospital care than those treated in conventional acute medical care? Patient Prefer Adherence 2018;12:233-40. [CrossRef]
- 12. Renoux M, Chicoulaa B, Lagourdette C, Escourrou E, Secher M, Oustric S, et al. Patients’ satisfaction after a geriatric assessment into primary care: data from FAP study. Geriatr Psychol Neuropsychiatr Vieil 2018;16(4):391-7. [CrossRef]
- 13. Daure A, Chicoulaa B, Lagourdette C, Escourrou E, Secher M, Oustric S, et al. General practitioners’ satisfaction after a geriatric assessment into primary care: data from FAP study. Geriatr Psychol Neuropsychiatr Vieil 2019;17(1):31-7.
- 14. Iliffe S, Lenihan P, Orrell M, Walters K, Drennan V, Tai SS. The development of a short instrument to identify common unmet needs in older people in general practice. Br J Gen Pract 2004;54(509):914-91.
- 15. Piccoliori G, Gerolimon E, Abholz HH. Geriatric assessment in general practice using a screening instrument: is it worth the effort? Results of a South Tyrol Study. Age Ageing 2008;37(6):647-52. [CrossRef]
- 16. van Rijn M, Suijker JJ, Bol W, Hoff E, Ter Riet G, de Rooij SE, et al. Comprehensive geriatric assessment: recognition of identified geriatric conditions by community-dwelling older persons. Age Ageing 2016;45(6):894-9. [CrossRef]
- 17. Ko Y, Lin SJ, Salmon JW, Bron MS. The impact of urinary incontinence on quality of life of the elderly. Am J Manag Care 2005;11(4 Suppl):S103-11.
- 18. García Cabrera AM, Jiménez Rodríguez RM, Reyes Díaz ML, Vázquez Monchul JM, Ramos Fernández M, Díaz Pavón JM, et al. Fecal incontinence in older patients. A narrative review. Cir Esp 2018;96(3):131-7. [CrossRef]
- 19. Morley JE. Anorexia of aging: Physiologic and pathologic. Am J Clin Nutr 1997;66(4):760-77. [CrossRef]
- 20. Bahat G, Tufan F, Bahat Z, Aydin Y, Tufan A, Akpinar TS, al. Assessments of functional status, comorbidities, polypharmacy, nutritional status and sarcopenia in Turkish community-dwelling male elderly. Aging Male 2013;16(2):67-72. [CrossRef]
- 21. İlhan B, Bahat G, Oren MM, BKılıç C, Durmazoglu S, Karan MA. Reliability and validity of Turkish version of the Simplified Nutritional Appetite Questionnaire (SNAQ). J Nutr Health Aging 2018;22(9):1039-44. [CrossRef]
- 22. İlhan B, Bahat G, Erdoğan T, Kılıç C, Karan MA. Anorexia Is Independently Associated with Decreased Muscle Mass and Strength in Community Dwelling Older Adults. J Nutr Health Aging 2019;23(2):202-6. [CrossRef]
- 23. Agarwal E, Miller M, Yaxley A, Isenring E. Malnutrition in the elderly: a narrative review. Maturitas 2013;76(4):296-302. [CrossRef]
- 24. Abizanda P, Sinclair A, Barcons N, Lizán L, Rodríguez-Mañas L. Costs of Malnutrition in Institutionalized and Community- Dwelling Older Adults: A Systematic Review. J Am Med Dir Assoc 2016;17(1):17-23. [CrossRef]
KLİNİK PRATİKTE KAPSAMLI GERİATRİK DEĞERLENDİRME: HASTALAR NE DÜŞÜNÜYOR?
Yıl 2022,
, 236 - 241, 24.03.2022
Tuğba Erdoğan
,
Birkan İlhan
,
Aslı Tufan
,
Gülistan Bahat Öztürk
,
Mehmet Karan
Öz
Amaç: Kapsamlı-Geriatrik-Değerlendirme (KGD) geriatrinin temel taşlarındandır. Bu çalışmada 60 yaş ve üzeri hastaların KGD’nin uygulanmasından ne kadar memnun olduklarını ve geriatrik sendromlar sorgulanmasaydı; bu şikayetleri ifade edip etmeyeceklerini öğrenmeyi amaçladık. Gereç ve Yöntem: Geriatri polikliniğine başvuran hastalar dahil edildi. Geriatri hemşiresi tarafından 18 soruluk memnuniyet anketi uygulandı. Hastaların, hem KGD uygulanmasıyla ilgili hem de KGD’nin bazı alt-alanlarından özgün olarak (idrar-dışkı inkontinansı, düşme, uyku, Mini-Nütrisyonel-Değerlendirme) memnuniyet ve faydalanım beklentileri değerlendirildi. Kendilerine bu sorular sorulmasaydı şikayetlerini ifade edip etmeyecekleri soruldu. Bulgular: Çalışmaya 150 hasta dahil edildi. Ortalama yaş 73,7±7 yıl idi. Yüz-elli hastanın 148’i KGD’nin yapılmasından memnun olduğunu, 139’u kendileri için faydalı olduğunu düşündüklerini belirtti. Yüz elli hastadan 73’ünün (%49) üriner inkontinansı vardı ve 150 hastanın 29’u (%19) bu soru kendilerine sorulmamış olsaydı idrar inkontinansı olsa dahi belirtmeyeceklerini söylediler. On yedi hastanın (%11) fekal-inkontinansı mevcuttu ve tüm hastaların %16’sı bu soru kendilerine sorulmasaydı fekal-inkontinansı olsa dahi belirtmeyeceklerini söylediler. Düşme hikayesi olan 85 hastanın 29’u son bir yıl içinde düşme hikayesi olmasına rağmen bu soru kendilerine sorulmamış olsa bu durumu belirtmeyeceklerini belirtti. Hastaların %93’ü Mini-Mental-Testin yapılmasından memnun olduklarını ve bu testin kendilerine faydası olacağını düşündüklerini belirttiler. Sonuç: Vakit alması ve yorucu olmasına rağmen KGD hastalar için memnuniyet vericidir ve gizli kalabilecek geriatrik sendromların tanınmasını sağlamaktadır.
Kaynakça
- 1. Türkiye İstatistik Kurumu Haber Bülteni. İstatistiklerle Yaşlılar 2019. 2020:33712. Available from https://data.tuik. gov.tr/Bulten/Index?p=Istatistiklerle-Yaslilar-2019-33712
- 2. Solomon DH. Geriatric assessment: methods for clinical decision making. JAMA 1988;259(16):2450-2. [CrossRef]
- 3. Beers MH, Berkow R. Comprehensive geriatric assessment. The Merck Manual of Geri- atrics. 3rd ed. Whitehouse Station: Merck Research Laboratories 2000. p.40-6.
- 4. Folstein MF, Folstein SE, McHugh PR. ‘’Mini-mental state’’. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12(3):189-98. [CrossRef]
- 5. Güngen C, Ertan T, Eker E, Yaşar R, Engin F. Reliability and validity of the standardized Mini Mental State Examination in the diagnosis of mild dementia in Turkish population. Turk Psikiyatri Derg 2002;13(4):273-81.
- 6. Babacan YG, Ur ÖE, Kolukısa M, Işık AT, Gürsoy E, Kocaman G, et al. Validity and Reliability Studies of Modified Mini Mental State Examination (MMSE-E) For Turkish Illiterate Patients With Diagnosis of Alzheimer Disease. Turk Psikiyatri Derg 2016;27(1):41-6.
- 7. Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M, et al. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 1982- 1983;17(1):37-49. [CrossRef]
- 8. Ertan T, Eker E. Reliability, validity, and factor structure of the Geriatric Depression Scale in Turkish Elderly: Are there different factor structures for different cultures? Int Psychogeriatr 2000;12(2):163-72. [CrossRef]
- 9. Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B. Screening for undernutrition in geriatric practice: developing the short-form mini-nutritional assessment (MNA-SF). J Gerontol A Biol Sci Med Sci 2001;56(6):M366- 72. [CrossRef]
- 10. Sarikaya D, Halil M, Kuyumcu ME, Kilic MK, Yesil Y, Kara O, et al. Mini nutritional assessment test long and short form are valid screening tools in Turkish older adults. Arch Gerontol Geriatr 2015;61(1):56-60. [CrossRef]
- 11. Ekerstad N, Östberg G, Johansson M, Karlson BW. Are frail elderly patients treated in a CGA unit more satisfied with their hospital care than those treated in conventional acute medical care? Patient Prefer Adherence 2018;12:233-40. [CrossRef]
- 12. Renoux M, Chicoulaa B, Lagourdette C, Escourrou E, Secher M, Oustric S, et al. Patients’ satisfaction after a geriatric assessment into primary care: data from FAP study. Geriatr Psychol Neuropsychiatr Vieil 2018;16(4):391-7. [CrossRef]
- 13. Daure A, Chicoulaa B, Lagourdette C, Escourrou E, Secher M, Oustric S, et al. General practitioners’ satisfaction after a geriatric assessment into primary care: data from FAP study. Geriatr Psychol Neuropsychiatr Vieil 2019;17(1):31-7.
- 14. Iliffe S, Lenihan P, Orrell M, Walters K, Drennan V, Tai SS. The development of a short instrument to identify common unmet needs in older people in general practice. Br J Gen Pract 2004;54(509):914-91.
- 15. Piccoliori G, Gerolimon E, Abholz HH. Geriatric assessment in general practice using a screening instrument: is it worth the effort? Results of a South Tyrol Study. Age Ageing 2008;37(6):647-52. [CrossRef]
- 16. van Rijn M, Suijker JJ, Bol W, Hoff E, Ter Riet G, de Rooij SE, et al. Comprehensive geriatric assessment: recognition of identified geriatric conditions by community-dwelling older persons. Age Ageing 2016;45(6):894-9. [CrossRef]
- 17. Ko Y, Lin SJ, Salmon JW, Bron MS. The impact of urinary incontinence on quality of life of the elderly. Am J Manag Care 2005;11(4 Suppl):S103-11.
- 18. García Cabrera AM, Jiménez Rodríguez RM, Reyes Díaz ML, Vázquez Monchul JM, Ramos Fernández M, Díaz Pavón JM, et al. Fecal incontinence in older patients. A narrative review. Cir Esp 2018;96(3):131-7. [CrossRef]
- 19. Morley JE. Anorexia of aging: Physiologic and pathologic. Am J Clin Nutr 1997;66(4):760-77. [CrossRef]
- 20. Bahat G, Tufan F, Bahat Z, Aydin Y, Tufan A, Akpinar TS, al. Assessments of functional status, comorbidities, polypharmacy, nutritional status and sarcopenia in Turkish community-dwelling male elderly. Aging Male 2013;16(2):67-72. [CrossRef]
- 21. İlhan B, Bahat G, Oren MM, BKılıç C, Durmazoglu S, Karan MA. Reliability and validity of Turkish version of the Simplified Nutritional Appetite Questionnaire (SNAQ). J Nutr Health Aging 2018;22(9):1039-44. [CrossRef]
- 22. İlhan B, Bahat G, Erdoğan T, Kılıç C, Karan MA. Anorexia Is Independently Associated with Decreased Muscle Mass and Strength in Community Dwelling Older Adults. J Nutr Health Aging 2019;23(2):202-6. [CrossRef]
- 23. Agarwal E, Miller M, Yaxley A, Isenring E. Malnutrition in the elderly: a narrative review. Maturitas 2013;76(4):296-302. [CrossRef]
- 24. Abizanda P, Sinclair A, Barcons N, Lizán L, Rodríguez-Mañas L. Costs of Malnutrition in Institutionalized and Community- Dwelling Older Adults: A Systematic Review. J Am Med Dir Assoc 2016;17(1):17-23. [CrossRef]