THE PERFORMANCE OF SIMPLE INSTRUMENTS IN DETECTING GERIATRIC CONDITIONS AND SELECTING COMMUNITY-DWELLING OLDER-PEOPLE FOR GERIATRIC ASSESSMENT

Background: comprehensive geriatric assessment (CGA) appears to be les s effective when performed in outpatient clinics than in hospital sett ings. The effectiveness of outpatient CGA might be improved by selecti vely targeting frailer community-dwelling elderly people. The purpose of this study was to evaluate the clinical performance of rapidly-admi nistered standard screening measures for geriatric syndromes in select ing community-dwelling older people for outpatient CGA. Methods: urban -dwelling older people were screened for CGA at community sites using a self-administered questionnaire containing standardized measures for each of four geriatric target conditions: depression, urinary inconti nence, falls and functional impairment. The study sample included all 150 consecutive subjects who were screened, failed on one or more of t he four target criteria and completed community-based, academically ad ministered CGA. Diagnostic accuracy of the screening instruments was a ssessed using CGA diagnoses as the 'gold standard'. In addition, patie nts' potential for benefiting from CGA was determined by whether they received major medical recommendations for further evaluation or treat ment. Results: after completing CGA, 60.2% of those failing on functio nal impairment, 53.5% of those failing on depression, 50.7% of those f ailing on falls and 92.7% of those failing on urinary incontinence, we re confirmed as having these or highly related conditions as clinical problems. Overall, 81.3% of the subjects completing CGA received at le ast one major recommendation for further medical intervention; most of these recommendations (79.5%) were for a target-related condition and the remainder (20.5%) addressed another significant medical condition . Conclusion: simple screening instruments used in community settings have variable degrees of accuracy but may be markers for frailty and t hus can identify older people likely to benefit from geriatric assessm ent.