Systematic Assessment and Appraisal of Older Peoples’ Health Conditions in Family Medicine
DOI: 10.3238/zfa.2013.0461-0467german translation / full article
Background: What can older patients and their general practitioners expect from a comprehensive geriatric assessment (CGA)? Is the specific “basic assessment” (GBA) that is conducted in family practice comparable to the CGA? How suitable are the assessment instruments provided by the GBA?
Methods: Systematic literature search in Medline and Ultramed between 2000–2013.
Results: The CGA aims to create an overview of individual health problems enabling an integral and holistic treatment plan for older patients. In contrast, the just updated GBA is to be offered to a target group with high care needs and focusses on functional issues. The GBA is reimbursed by health insurance companies and for that reason prevails in German family practices. Effects of the GBA have not yet been studied. However, there are a number of randomised controlled trials that examine the effects of CGA in primary care. Because of their complex interventions they are not easily comparable, and meta-analyses and systematic reviews present heterogeneous results. On the whole, CGA increases the likelihood of older people remaining in their own homes. The effects on survival are not consistent. The new GBA contains recommendations for assessment instruments. Their critical appraisal of the validity leads to the suggestion of alternative instruments for the population of older family practice patients.
Discussion: The new GBA pursues a different objective than the CGA. The GBA aims to reward the high workload associated with the care of „geriatric“ patients. The psychometric properties of some recommended assessment instruments are superior for patients in secondary care, which highlights the importance of tailoring and applying instruments to their specific target groups.