1997 OPEN FORUM Abstracts
Assessing the Aging Adult
John Carlson, M.D., Saturday, December 6, 1997.
Geriatric assessment has been defined as "a medical, functional, and psychosocial evaluation of the frail patient with an emphasis on problems prevalent in the elderly and goals that include coordination of care, promotion of adaptation to chronic illness, and facilitation of maximum independence." Ideally geriatric assessment is multidisciplinary, involving physicians, nurses, social workers, mental health professionals, pharmacists, dieticians, and therapists from several disciplines. The assessment consists of an evaluation of medical and psychiatric illness, the appraisal of physical, cognitive, and social functioning, and the development of a comprehensive management plan. The rationale for this specialized approach arises from the high medical complexity, atypical presentation of illness, frequent neuropsychiatric and functional impairment, vulnerability to iatrogenesis, social isolation, economic deprivation, and premature institutionalization often exhibited by frail older adults.
Outcomes of geriatric assessment have been studied on specialized hospital units, with consultation services, in day-hospitals and clinics, and at home with mixed results. Positive outcomes include improved patients' satisfaction with care, patients' physical function, and detection of new health problems. Decreases in the rate of admission to nursing homes, the number of visits to emergency rooms, and patient mortality have also been demonstrated. However assessments that do not include active interventions or management by the assessment team appear to be ineffective. Additionally the process of assessment may increase health care utilization in some areas including increases in the initial length of stay and more physician visits.
The experience gained in the development of formalized geriatric assessment as a "new technology" can be applied in a less formal manner to individual older patients. All health care providers can apply some of the principles of assessment to improve their approach to older adults.
AARC 50th Anniversary, December 6 - 9, 1997, New Orleans, Louisiana.