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Primary care guidelines for geriatric assessment

A structured, comparative analysis

Hausärztliche Richtlinien für ein Geriatrisches Assessment

Eine strukturierte, vergleichende Analyse

Abstract

A structured geriatric assessment (GA) improves the quality of health care; however, the quality of GA guidelines has hardly been investigated. Eight guidelines were identified by systematically searching guideline databases, web sites of guideline developers, and PubMed. The methodological quality was assessed by two appraisers using the German Guideline Evaluation Instrument (DELBI). Guideline content was extracted; organizational and medical recommendations were compared. The methodological appraisal revealed a broad range of quality. The domains “Scope and purpose” and “Clarity and presentation” showed good results. The domains “Applicability” and “Editorial independence” had results that were not as good. Medical recommendations agreed to a great extent. GA should be delivered continuously for all older people in their homes by one responsible assessor. In cooperation with relatives, patient-centered therapy goals should be defined. Differences were identified in profession, instruments, aims, and “tailoring.” The quality of primary care guidelines for GA may be improved. Details of organization of a GA require further research.

Zusammenfassung

Ein strukturiertes Geriatrisches Assessment (GA) verbessert die medizinische Versorgungsqualität. Die Qualität von Leitlinien für das GA wurde bisher kaum untersucht. Bei der systematischen Suche in Leitliniendatenbanken sowie auf Websites von Leitlinienentwickler konnten acht Leitlinien zum GA identifiziert werden. Die methodische Beurteilung erfolgte dabei durch zwei Gutachter, die das Deutsche Instrument zur methodischen Leitlinienbewertung (DELBI) einsetzten. Der Inhalt der Leitlinien wurde extrahiert, die organisatorischen sowie medizinischen Empfehlungen wurden verglichen. Diese methodische Herangehensweise offenbarte ein breites Qualitätsspektrum. Die Bereiche „Geltungsbereich und Bedeutung“ wie auch „Übersichtlichkeit und Präsentation“ erzielten gute Ergebnisse, während „Anwendbarkeit“ und „redaktionelle Unabhängigkeit“ schlechter abschnitten. Die medizinischen Empfehlungen stimmten nahezu komplett überein. Das GA sollte wiederholend für alle älteren Menschen in ihren eigenen Wohnungen durch einen einzigen verantwortlichen Beurteiler durchgeführt werden. In Zusammenarbeit mit Verwandten sollten patientenzentrierte Therapieziele definiert werden. Unterschiede Empfehlungen gab es bezüglich der durchführenden Berufsgruppe, Instrumenten, Zielen und eines vorgeschalteten Screenings für ein maßgeschneidertes Assessment. Die Qualität der hausärztlichen Leitlinien für ein GA sollten entsprechend der Ergebnisse verbessert werden. Details für die Organisation des GA sollten weiter untersucht werden.

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Abbreviations

NZGG:

New Zealand Guideline Group

HGG:

Hesse Guideline Group

STEP:

Standardized Assessment of Elderly People in Primary Care

USPSTF:

United States Preventive Services Task Force

AMDA:

American Medical Directors Association

GPAC:

Guidelines & Protocols Advisory Committee

RACGP:

Royal Australian College of General Practitioners

RAI:

Resident Assessment Instrument

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Conflict of interest

Thomas Frese, Martin Franke, Melanie Keyser, Imre Rurik and Hagen Sandholzer have no affiliation with or financial interest in any product mentioned in this article. The corresponding author states that there are no conflicts of interest.

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Correspondence to T. Frese.

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Author contributions

Thomas Frese designed the study, participated in data interpretation and preparation of the manuscript. Martin Franke performed data estimation and participated in preparation of the manuscript. Melanie Keyser participated in data estimation. Imre Rurik supported the preparation of the final manuscript and Hagen Sandholzer reviewed the study design and was responsible for funding.

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Frese, T., Franke, M., Keyser, M. et al. Primary care guidelines for geriatric assessment. Z Gerontol Geriat 45, 224–230 (2012). https://doi.org/10.1007/s00391-011-0219-9

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Keywords

  • Geriatric assessment
  • Guideline
  • Quality of health care
  • Patient-centered care
  • Gerontology

Schlüsselwörter

  • Geriatrisches Assessment
  • Leitlinien
  • Qualität der Gesundheitsversorung
  • Patientenzentrierte Versorgung
  • Gerontologie