Comprehensive geriatric assessments are designed to keep frail older adults healthy and out of hospitals and nursing homes; a recent article described the the components that make up an assessment and how they can apply to a physiotherapy evaluation.
A recent article described how physiotherapists can use a comprehensive geriatric assessment (CGA) to create personalized interventions to keep older individuals healthy and living at home despite certain limitations and barriers.
A CGA is meant to avoid hospitalizations and nursing home care in frail older adults and to prevent problems from occurring, and it is designed to foster safe aging in place (SAIP). The major obstacle to SAIP is falls, which carry high costs and risk of disability. In addition, one fall may lead to others, due to an increased fear of falling and decreased confidence when performing ordinary activities.
The authors said research points to one-third of individuals 65 years and older falling annually; nearly 40% of falls will require medical treatment, with costs ranging from $3038 for an emergency department visit to $38,412 for hospitalizations.
A CGA examines 9 areas of functional status: psychological, physical environment, medical, socioeconomic, quality of life, physical, gait/balance, cognitive, and behavioral.
Writing in Archives of Physiotherapy, the authors outlined some advantages and possible shortcomings of outcome measures and interventions that were most cognizant of time and resource limits and were uncomplicated to administer in the community. A total list of all the assessments a physiotherapist could conceivably administer could take nearly 3.5 hours with dozens of items to review, according to a chart included with the study.
For addressing physical function, the authors cited the Short Physical Performance Battery, the Timed-Up-and-Go, the 30-second chair rise test, and the Four Test Balance Scale.
They also recommended using measures from the heath domain, such as the Functional Comorbidity Index, and the environmental domain, like Home FAST.
Even with the measures that are available, there are limits. For instance, neither the Functional Comorbidity Index (FCI) or the Charlson Comorbidity Index (CCI) include hypertension in their score; given the relationship of hypertension to other health issues, a physiotherapist should include blood pressure in assessments, the researchers said.
The CCI predicts the 10-year survival in someone with multiple comorbidities (19 are included), with severity weighted from 1 to 6. The FCI, a list of 18 common diagnoses, does not consider the severity of a disease.
For assessing polypharmacy, the authors note that physiologists may have varying knowledge about the effects of 5 or more medications in a patient. They suggested 2 resources to consult: the CDC’s Stopping Elderly Accidental Death and Injury (STEADI) Medications Linked to Falls guide, and the American Geriatrics Society’s Beers Criteria.
Physiotherapists should also assess cognition and mood because mental state will impact the ability of the individual to carry out recommended physical activity and exercises. The authors highlighted 3 cognition assessments and 2 depression screens. For cognition, the Mini Mental State Exam (MMSE), the Mini-Cog, and the Trail Making Test (TMT) all have good reliability and validity.
Another assessment, the Physical Therapy Healthy Lifestyle Appraisal, asks individuals to describe their typical behavior regarding healthy eating, physical activity (aerobic), sleep, stress management, and tobacco use. Their statement is linked to stages of behavior change, giving the physiotherapist an idea of the person’s readiness to change.
To measure frailty, the most common is the Fried Frailty Index, which includes 5 criteria: self-selected gait speed over 4.6 m (15 ft); frequency and duration of regular physical activity; handgrip strength; self-perceived feeling of exhaustion; and unintentional weight loss of more than 4.5 kg (10 lb) in the last year.
Regarding the assessment of home safety, “There is a notable lack of valid, reliable, objective measures of home safety risk,” the authors said. There is the Home Falls and Accident Tool (Home FAST), which comes in 2 versions, one that is self-administered and one that is administered by a professional. Notably, however, there was only 52% agreement on the assessment items when comparing the 2 versions.
Wilson CM, Arena SK, Boright LE. State of the art physiotherapist-led approaches to safe aging in place. Arch Physiother. Published online August 1, 2022. doi:10.1186/s40945-022-00142-5