Ability of a computerized geriatric assessment to predict need for change in living status among elderly living at home.

The objective of this study was to determine the ability of a software program used in a primary care physician's office to predict the need for alternate living arrangement in a cohort of community-dwelling elderly. An analysis was conducted involving 124 consecutive patients between February 10, 1990, and December 20, 1991, in my private medical practice. These patients, all older than 65 years, underwent a computer-assisted geriatric assessment. Two scales--the Geriatric Functional Rating Scale (GFRS) and the Functional Assessment Screening Questionnaire (FASQ)--were compared for their accuracy at predicting change in living status during the 12- to 24-month period following the assessment. Similar analysis of the Tinetti gait and balance test was also performed. Ten and one-half percent of subjects (n = 13) required a change in living status during the study period. Ten went to nursing homes and three joined relatives' households. The GFRS was 62% accurate (8/13) and the FASQ was 54% (7/13) accurate in predicting this change. Abnormality in both gait and balance was predictive 77% (10/13) of the time. Combining all three parameters raised the successful prediction rate to 85% (11/13). Neither GFRS, FASQ, nor gait/balance testing was predictive of death. A computer software program designed to facilitate performance of geriatric assessments in primary care physicians' offices has a high rate of predictive capability relative to future need for change in living status among community-dwelling elderly. Further studies comparing this software program with traditional geriatric assessment protocols are suggested.

A computerized geriatric assessment designed for use in primary care physicians' offices.

Comprehensive geriatric assessments have generally been recognized as beneficial for frail elderly patients. However, the complexity of these evaluations has usually required that they be performed in a multidisciplinary setting. Staffing requirements, time commitment, new skill requirements, and reimbursement problems serve as impediments for primary care physicians performing these examinations. Computer technology may be the solution to these problems. A software program has been developed which allows primary care physicians to perform a sophisticated functional assessment on an outpatient basis without the use of a multidisciplinary team. Problems are identified by the computer-assisted protocol and patients are referred for appropriate management. Thus, the physician maintains a primary role in case management. The program is cost effective because it does not require additional staff to operate it and it effectively uses CPT and ICD9 coding.

Assessment of nutritional status and obesity in elderly patients as seen in general medical practice.

Overweight and obesity are generally considered to have a negative impact on longevity because of their association with many diseases, including hypertension, diabetes, coronary artery disease, osteoarthritis, and certain types of cancer. Nevertheless, some authors, notably Ancel Keys, have concluded that being overweight improves one's chances for longevity. I studied 122 consecutive patients who had comprehensive geriatric assessment with regard to their body mass index, responses to Wolinsky's Nutritional Risk Index, and serum albumin levels. There was a high prevalence of overweight (60% of men and 45.6% of women). This fact, coupled with the observed low prevalence of underweight subjects, tends to support Keys' statement concerning the benefit of being overweight. However, the relative absence of significant obesity supports the impression that significantly obesity reduces prospects for longevity. Although serum albumin measurements were obtained for only 38 subjects, the fact that the value was low in only one instance--in the case of a person who was seriously ill--suggests that obtaining routine serum albumin measurements in ambulatory, community-dwelling elderly people is not cost-effective.

Prevalence of olfactory dysfunction, hearing deficit, and cognitive dysfunction among elderly patients in a suburban family practice.

Olfactory and hearing senses diminish with age, and cognitive dysfunction increases. The association between sensory deficits and cognitive dysfunction has not been well studied. This paper presents the results of testing a group of 50 community-dwelling patients of a family physician who developed a computer-assisted comprehensive geriatric assessment program. Olfactory dysfunction was present in 39% of subjects, with 18% being unable to detect smoke. There was no correlation between olfactory dysfunction and cognitive dysfunction. Hearing deficit, however, was found in 10% of subjects, all of whom also had either an associated olfactory or cognitive dysfunction. This study demonstrates the high prevalence of olfactory and auditory dysfunction in an ambulatory geriatric population, with a possible association between hearing deficit and cognitive dysfunction. The problem of multiple sensory deficits should be addressed in any long-term management decisions regarding elderly patients.

Computer-assisted comprehensive geriatric assessment in a family physician's office.

Family physicians and other medical care providers are beginning to realize the importance of a comprehensive assessment examination for elderly patients. The components of such an examination are well documented, and include not only the standard history and physical examination, but also evaluation of mental health, functional status, and socioeconomic status of the person. A major impediment to a family physician doing such an extensive evaluation is that most offices lack the team approach commonly used in tertiary care medical facilities. In this paper I report the implementation of a computer-assisted program that was developed for use in a private physician's office. The first 22 patients examined using this protocol are discussed. A new diagnosis was uncovered in all but three of the subjects. This finding suggests that performing comprehensive geriatric assessments in a family practice setting might create an immediate benefit in terms of patient management.

Exercise Testing of Obese Subjects.

Obese patients especlally need the boost that exerclse can glve thelr dletlng programs. Dr. DeVore dlscusses the role of stress testlng ln exerclse prescription for obese patients.