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Assessment of older adults by emergency medical services: methodology and feasibility of a care partner Comprehensive Geriatric Assessment (CP-CGA)

Published online by Cambridge University Press:  04 March 2015

Judah Goldstein ,
Andrew Travers ,
Ruth Hubbard ,
Paige Moorhouse ,
Melissa K. Andrew  and
Kenneth Rockwood
Judah Goldstein*
Affiliation:
Division of Geriatric Medicine, Geriatric Medicine Research Unit, Dalhousie University, Halifax, NS
Andrew Travers
Affiliation:
Emergency Health Services Nova Scotia, Halifax, NS
Ruth Hubbard
Affiliation:
Division of Geriatric Medicine, Geriatric Medicine Research Unit, Dalhousie University, Halifax, NS
Paige Moorhouse
Affiliation:
Division of Geriatric Medicine, Geriatric Medicine Research Unit, Dalhousie University, Halifax, NS
Melissa K. Andrew
Affiliation:
Division of Geriatric Medicine, Geriatric Medicine Research Unit, Dalhousie University, Halifax, NS
Kenneth Rockwood
Affiliation:
Division of Geriatric Medicine, Geriatric Medicine Research Unit, Dalhousie University, Halifax, NS
*
Division of Geriatric Medicine, Veterans Memorial Building, 1421-5955 Veterans Memorial Lane, Halifax, NS B3H 2E1; judah.goldstein@dal.ca

Abstract

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Objectives:

The Comprehensive Geriatric Assessment (CGA) is used in geriatric medicine as a means to manage the health care needs of older adults and to grade frailty. We modified the CGA so that it could be completed independently by care partners (usually family) and be used to grade frailty. Our objective was to examine the feasibility of a care partner completing the CGA at the time of the first prehospital encounter.

Methods:

A prospective, observational study was conducted with a convenience sample of patients ≥ 70 years accompanied by a knowledgeable care partner. Feasibility was measured by the time required and percent completeness of items on the form based on completion by the care partner and by paramedic perception of utility.

Results:

Subjects (N 5 104) were enrolled with three postenrolment exclusions due to ineligibility. Most participants were older women living in their own home. The mean time to complete the questionnaire was 18.7 minutes (SD 11.3; median 15 minutes; interquartile range 12-20 minutes). Only 64% of the care partners recorded the time it took. Nineteen percent of paramedics completed a follow-up survey, and all felt screening for frailty was worthwhile and most (> 70%) thought that the CP-CGA may be a useful approach. The study was limited by recruitment bias of potentially eligible patients, a high level of missingness in the outcome measures of interest, and low paramedic participation rates.

Conclusion:

We observed a high rate of item completeness of questionnaires with a mean time to complete of 18.7 minutes in a convenience sample of older patients. A small sample of paramedics universally endorsed the utility of screening for frailty in the prehospital setting, and many thought the CP-CGA was a helpful tool.

Keywords

agedComprehensive Geriatric Assessment(CGA)emergency medical servicesfrail
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 16 , Issue 5 , September 2014 , pp. 370 - 383
Copyright
Copyright © Canadian Association of Emergency Physicians 2013

References

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