Comprehensive Geriatric Assessment in the Community and in Outpatient Consultation

Abstract

The need to prevent disability and functional decline in later life is growing as the population ages, multi-morbidity increases and healthcare resources are placed under ever-greater strain. Home geriatric assessment has been shown to have consistently beneficial effects on several health outcomes; by contrast, data concerning outpatient geriatric consultation are conflicting. Home geriatric assessment programmes and outpatient geriatric consultation share a preventive viewpoint; their aim is to detect modifiable risk factors and worsening health conditions, in order to prevent or reduce disability, healthcare use and related costs. Despite some differences, most programmes of home assessment and outpatient geriatric assessment involve a visiting nurse trained in geriatric care, a physical therapist, a social worker and, when appropriate, specialty referrals. The progressive refinement of organizational models by means of revisiting past experiences of outpatient geriatric assessment has led to the development of specialized team management programmes integrated within primary care activities and practices. Nevertheless, it remains to be ascertained which components of these programmes are most effective, for which geriatric populations they are most beneficial and at what cost. Despite controversies over the effectiveness of multifactorial interventions, various CGA-based preventive programmes in the community and in general practice are currently implemented in many healthcare systems throughout the Western world. Only new studies with rigorously scientific methodology will allow better interpretation of evidence in the field of the interventions aimed at maintaining self-sufficiency among community-dwelling elderly people.