The abbreviated comprehensive geriatric assessment (aCGA): a retrospective analysis
Introduction
A comprehensive geriatric assessment (CGA) is an evaluation typically conducted on older people by a multidisciplinary team organized to detect limitations of health and social support. The notion of CGA refers to the practice of investigating the health of older persons from perspectives beyond the scope of a traditional history and physical examination. Depending on the motivating factor(s) that drives the use of a CGA (clinical assessment or research) and the type of assessment setting (primary care clinic, oncology clinic, mental health setting) the components may differ. Solomon et al. [1] suggests that a CGA can uncover, describe and explain strengths and limitations that can then determine potential and actual need for services. The Senior Adult Care Task Force and the National Institute of Health reports CGA to be a standard component of the assessment process of the elder with cancer [2].
The CGA will be defined as a multidimensional assessment consisting of functional, emotional and cognitive components. The CGA as defined by this particular research will be a clinical CGA, focused on a few of the many possible domains that are often reflected in the geriatric and gerontology literature. The notion of “Comprehensive” in the CGA is somewhat misleading in that no assessment can cover all possible elements of physical, emotional, cognitive, psychosocial, and spiritual health or existence. While a CGA can, and often does, reflect spiritual, social, financial and quality of life issues, the central point to this research was to provide clinicians a practical prescreening CGA to identify those who require further intensive evaluation with the full, multidisciplinary CGA and potentially an interdisciplinary assessment by social service, physical therapy, etc. A premise in this research was that many geriatricians and oncologists, especially in private practice may not have the time and personnel resources to conduct a complete, multidisciplinary CGA. Instead of potentially not assessing a patient for functional, emotional and cognitive limitations, this abbreviated scale would be an option for a quick screening tool. The purpose of this study was to identify the items included in each CGA measure that are most predictive of the total rating score of each scale. The identified items would then be combined to create an abbreviated CGA (aCGA) screening measure. An aCGA used as a screening tool and used synergistically, would help determine which older cancer patients would most likely benefit from the entire CGA and would greatly expedite the CGA evaluation process for clinicians. Patients that score positive for limitations would then require the entire CGA to screen for potentially limiting health problems. The hypothesis tested was that the CGA can be statistically condensed to representative items reflective of the scores of each measure in its entirety. This research is a retrospective analysis conducted to produce a clinical assessment, prescreening instrument.
Section snippets
Components of the CGA
The CGA generally assesses emotional, functional, and cognitive elements in addition to a history and physical examination. It is important to suggest that a CGA can be made up of any of a number of valid and reliable instruments that measure functional, emotional and cognitive status. Each element of the CGA is a distinct aspect of health. Functional status looks at tasks that are required in everyday life that enable independence such as bathing, dressing, ambulating, and toileting [3]. For
Methods
The aCGA was developed in a retrospective research project consisting of a chart review of over 500 patients seen by the Senior Adult Oncology Program (SAOP) at the H. Lee Moffitt Cancer Center at the University of South Florida (Fig. 1). The charts of patients (70 years and over) treated between 1995 and 2001 were reviewed. Patients enrolled in the SAOP had an entire CGA (ADL/IADL, MMSE, GDS) conducted on their initial visit and the results were included in their medical record. Data
Results
The ages of the participants ranged from 70 to 92 with a mean age of 73 (N = 513). Most of the participants were women at 76% and the remaining 24% were men. The majority of participants were married (53%) and the remaining 47% considered themselves widowed or single. The sample was predominately Anglo (95%). Breast cancer patients accounted for 42.9% of the sample population, colon cancer 12%, lymphoma 10%, prostate cancer 10% and the remaining malignancies were less common cancers (Table 1).
The
Discussion
The benefits of CGA have been demonstrated throughout the geriatric literature since the 1980's [8], [16], [17], [18], [19], [20]. The CGA has been shown to be effective in a variety of settings; in-home assessment [9], [21] outpatient, community-dwelling elders [22], [23] and inpatient hospitalized seniors [7]. Historically, it has been difficult for those clinicians not affiliated with an academic institution to conduct a CGA and thus meet the American Geriatric Society recommendation for
Reviewers
Harvey Jay Cohen, MD, Director, Center for Aging and Chief, Division of Geriatrics, Duke University Medical Center, Box 3003, Durham, NC 27710, USA.
Dr. Gilbert Zulian, Centre de Soins Continus (CESCO), Ch. de la Savonnière 11, CH-1245 Collonge-Bellerive/GE, Switzerland.
Dr. Catherine Terret, Department of Medical Oncology, Centre Léon-Bérard, 28 Rue Laënnec, F-69008 Lyon, France.
Acknowledgements
I would like to thank the Senior Adult Oncology Program at the H. Lee Moffitt Cancer Center and Research Institute for their support during this project. Additionally, Dr. Susan McMillan and Dr. Mary E. Evans provided help and guidance throughout this research project.
Janine A. Overcash is currently an Assistant Professor of Nursing at the University of South Florida. In 2001, she completed her Doctorate in anthropology at the University of South Florida that focused on older women with cancer. Dr. Overcash is also a geriatric nurse practitioner specialized in the care of the older cancer patient. She has assisted in the design and management of one of the first geriatric oncology programs located at the H. Lee Moffitt Cancer Center and Research Institute in
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Janine A. Overcash is currently an Assistant Professor of Nursing at the University of South Florida. In 2001, she completed her Doctorate in anthropology at the University of South Florida that focused on older women with cancer. Dr. Overcash is also a geriatric nurse practitioner specialized in the care of the older cancer patient. She has assisted in the design and management of one of the first geriatric oncology programs located at the H. Lee Moffitt Cancer Center and Research Institute in Tampa, FL. A recent book entitled, The Older Cancer Patient: A Guide for Nurses and Related Professionals by Janine Overcash and Lodovico Balducci highlights principles of care for the older person with cancer and has just received book of the year award by the American Journal of Nursing. Dr. Overcash is the recipient of a John A. Hartford Post Doctorate Scholarship for geriatric nursing. Dr. Overcash continues to conduct research dealing with the older cancer patient and screening for co-morbidities.
Sara Cobb RN is currently a student in the BSN to PhD program in nursing at the University of South Florida. She practiced in neonatal and pediatric intensive care units, in home health settings, and in school health systems prior to entering the doctoral program. She was recipient of the national student author of the year award by the American School Health Association in 2003. She performed the conversion of the CGA data from multiple databases into a single SPSS file, and performed the initial statistical analysis of the CGA under the guidance of Dr. Jason Beckstead.
Dr. Jason Beckstead is a associate professor and a statistician at the University of South Florida.
Dr. Martine Extermann is Associate Professor in the Senior Adult Oncology Program (SAOP) at H. Lee Moffitt Cancer Center, University of South Florida (USF).