Outcomes from Team-based Comprehensive Assessment in a Geriatric Clinic

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2022

Authors

Morkos, Johny

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Abstract

Purpose: Comprehensive geriatric assessment (CGA) is a pivotal evaluation in an ambulatory setting because it can allow physicians to identify early issues that can alter a patient's quality of life. Nonetheless, CGA evaluations can be inconsistent due to the workflow in a primary care setting, especially where the majority of patients have a language barrier. The aim of this project was to examine the outcomes of a collaborative geriatric assessment intervention implemented at the HSC Health Center for Older Adults geriatric clinic from January 2021 to May 2021, particularly for the Spanish-speaking population. Methods: A geriatric primary care clinic collaborated with an Area Agency on Aging (AAA), a governmental organization that coordinates community services, to provide an intervention for Spanish-speaking older adult patients visiting the clinic either as a new patient or for their Annual Wellness Visit (AWVs). Patients are seen by a Spanish-fluent AAA social service coordinator who administered the comprehensive geriatric assessment in the patients' first language. The comprehensive assessment included an evaluation of the patient cognitive function using the Montreal Cognitive Assessment (MoCA), a geriatric depression scale (GDS), and discussion and review of advanced care planning documents. Additionally, the social service coordinator assessed their activities of daily living (ADLs) as well as instrumental activities of daily living (IADLs). Using a retrospective chart review of the electronic medical record (EMR), we examined patient demographics, clinical characteristics, community-based service referrals, and screenings completed over a six-month period during which the intervention was implemented. Results: Most of the participants (n=41) were Hispanic females between the ages of 70 to 79. Thirty percent (30%) reported elementary school level or no formal education, but 53% did not report their educational attainment. A majority (70%) of the patients lived with family such as a spouse or child, and 43% were married. Additionally, 83% of patients had a geriatric depression screening score in the normal range. Almost half of the participants received a MoCA score of less than 19, which indicates moderate cognitive impairment. Lastly, 70% of the patients reported that they have not completed their advanced care planning. About 10% of the patients were able to enroll with the Area Agency on Aging and received services based on their needs, including but not limited to personal assistance, respite care, and durable medical equipment (DME) services. The remainder of the patients were either ineligible or did not follow up with the referral information provided at the clinic visit. Conclusion: Although only a few patients were able to benefit from enrollment with AAA, the partnership was instrumental in improving the utilization of screenings to help primary care providers identify the needs of older adult patients, especially in the Spanish-speaking population, as this was one of the challenges that healthcare providers faced. These results show that primary care and community partnerships have the potential to enhance geriatric assessments and improve education and awareness of resources for patients from underserved populations.

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