Skip to main content
SpringerLink
Log in

Development of the Brief Geriatric Assessment for the General Practitioner

  • Published:
The journal of nutrition, health & aging

Abstract

Objectives

The study aimed to develop a brief geriatric assessment (BGA) tool for the general practitioner to evaluate geriatric syndromes in community-dwelling older adults.

Design

A cross-sectional study.

Setting

58 communities from four aging cities in Taiwan.

Participants

1,258 community-dwelling older adults aged 65 years and above.

Measurements

The BGA targeted physical function impairment, cognitive impairment, and mood impairment. The cutoff values of physical function tests (handgrip strength and 6-meter walk test [6MWT]) were estimated by receiver operating characteristic analysis. Second, the diagnostic validity of the BGA was calculated in terms of sensitivity, specificity, and predictive values, which were compared to corresponding comprehensive geriatric assessment (CGA) items. Third, the associated risk factors of geriatric syndromes were selected using stepwise logistic regression. Finally, we combined items selected from literature and CGA and then proposed a practical BGA framework.

Results

The proposed BGA comprised dominant handgrip strength, 6MWT, self-report personal birthday, address, and telephone number, question ‘Do you have depressive mood for the past two weeks?’, Rinne tuning-fork tests, Snellen scale, and body mass index. It evaluated multidimensional aspects of geriatrics syndromes including physical, cognitive, mood, and sensory impairment, sarcopenia, and nutrition status. Sensitivities in the Taiwan BGA items ranged from 48% for dominant handgrip strength to 97.6% for 6MWT corresponding to physical impairment; 58.3% for cognitive impairment corresponding to Short Portable Mental Status Questionnaire; 62.7% for mood impairment corresponding to Geriatric Depression Scale. The Taiwan BGA for the general practitioner takes less than 10 minutes and is suitable in the community setting.

Conclusion

Early management of geriatric syndromes in the community is important. The current study demonstrated a practical BGA tool for the general practitioner to comprehensively assess geriatric syndromes in community-dwelling older adults.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2

Similar content being viewed by others

References

  1. Flacker JM. What is a geriatric syndrome anyway? J Am Geriatr Soc. 2003;51(4):574–6.

    Article  Google Scholar 

  2. Inouye SK, Studenski S, Tinetti ME, Kuchel GA. Geriatric syndromes: clinical, research, and policy implications of a core geriatric concept. J Am Geriatr Soc. 2007;55(5):780–91.

    Article  Google Scholar 

  3. Tinetti ME, Inouye SK, Gill TM, Doucette JT. Shared risk factors for falls, incontinence, and functional dependence. Unifying the approach to geriatric syndromes. Jama. 1995;273(17):1348–53.

    Article  CAS  Google Scholar 

  4. Wang SY, Shamliyan TA, Talley KM, Ramakrishnan R, Kane RL. Not just specific diseases: systematic review of the association of geriatric syndromes with hospitalization or nursing home admission. Archives of gerontology and geriatrics. 2013;57(1):16–26.

    Article  Google Scholar 

  5. Cheung JTK, Yu R, Wu Z, Wong SYS, Woo J. Geriatric syndromes, multimorbidity, and disability overlap and increase healthcare use among older Chinese. BMC Geriatrics. 2018;18(1):147.

    Article  Google Scholar 

  6. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. The journals of gerontology Series A, Biological sciences and medical sciences. 2001;56(3):M146–56.

    Article  CAS  Google Scholar 

  7. Morley JE. The Importance of Geriatric Syndromes. Mo Med. 2017;114(2):99–100.

    PubMed  PubMed Central  Google Scholar 

  8. Stuck AE, Siu AL, Wieland GD, Adams J, Rubenstein LZ. Comprehensive geriatric assessment: a meta-analysis of controlled trials. Lancet. 1993;342(8878):1032–6.

    Article  CAS  Google Scholar 

  9. Ng TP, Feng L, Nyunt MS, Feng L, Niti M, Tan BY, et al. Nutritional, Physical, Cognitive, and Combination Interventions and Frailty Reversal Among Older Adults: A Randomized Controlled Trial. Am J Med. 2015;128(11):1225–36.e1.

    Article  Google Scholar 

  10. Pilotto A, Cella A, Pilotto A, Daragjati J, Veronese N, Musacchio C, et al. Three Decades of Comprehensive Geriatric Assessment: Evidence Coming From Different Healthcare Settings and Specific Clinical Conditions. Journal of the American Medical Directors Association. 2017;18(2):192.e1–.e11.

    Article  Google Scholar 

  11. Senn N, Monod S. Development of a Comprehensive Approach for the Early Diagnosis of Geriatric Syndromes in General Practice. Frontiers in medicine. 2015;2:78.

    Article  Google Scholar 

  12. Barkhausen T, Junius-Walker U, Hummers-Pradier E, Mueller CA, Theile G. “It’s MAGIC”—development of a manageable geriatric assessment for general practice use. BMC family practice. 2015;16:4.

    Article  Google Scholar 

  13. Mueller YK, Monod S, Locatelli I, Büla C, Cornuz J, Senn N. Performance of a brief geriatric evaluation compared to a comprehensive geriatric assessment for detection of geriatric syndromes in family medicine: a prospective diagnostic study. BMC Geriatrics. 2018;18(1):72.

    Article  Google Scholar 

  14. Lin Y-Y, Huang C-S. Aging in Taiwan: Building a Society for Active Aging and Aging in Place. The Gerontologist. 2015;56(2):176–83.

    Article  Google Scholar 

  15. Hsiao Y-H, Tsai H-C, Chen H-C, Wang Y-F, Tai C-J, Hsu Y-N, et al. Concept, Model and Pilot Project of the Integration of Health and Welfare. Journal of Medicine and Health. 2017;6(2):1–16.

    Google Scholar 

  16. Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. The Gerontologist. 1969;9(3):179–86.

    Article  CAS  Google Scholar 

  17. Chiu CJ, Wray LA, Ofstedal MB. Diabetes-related change in physical disability from midlife to older adulthood: evidence from 1996–2003 Survey of Health and Living Status of the Elderly in Taiwan. Diabetes Res Clin Pract. 2011;91(3):413–23.

    Article  Google Scholar 

  18. Ministry of Health and Welfare T. The regulation and management of disability card 2018 [Available from: https://dep.mohw.gov.tw/DONAHC/cp-1032-5186-104.html.

  19. Tiedemann A, Shimada H, Sherrington C, Murray S, Lord S. The comparative ability of eight functional mobility tests for predicting falls in community-dwelling older people. Age and Ageing. 2008;37(4):430–5.

    Article  Google Scholar 

  20. Chen LK, Liu LK, Woo J, Assantachai P, Auyeung TW, Bahyah KS, et al. Sarcopenia in Asia: consensus report of the Asian Working Group for Sarcopenia. Journal of the American Medical Directors Association. 2014;15(2):95–101.

    Article  Google Scholar 

  21. Paul DJ, Nassis GP. Testing strength and power in soccer players: the application of conventional and traditional methods of assessment. J Strength Cond Res. 2015;29(6):1748–58.

    Article  Google Scholar 

  22. Pfeiffer E. A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr Soc. 1975;23(10):433–41.

    Article  CAS  Google Scholar 

  23. Alley DE, Crimmins EM, Karlamangla A, Hu P, Seeman TE. Inflammation and rate of cognitive change in high-functioning older adults. The journals of gerontology Series A, Biological sciences and medical sciences. 2008;63(1):50–5.

    Article  Google Scholar 

  24. Esiwe C, Baillon S, Rajkonwar A, Lindesay J, Lo N, Dennis M. Screening for depression in older adults on an acute medical ward: the validity of NICE guidance in using two questions. Age and Ageing. 2015;44(5):771–5.

    Article  Google Scholar 

  25. Peters R, Pinto E, Beckett N, Swift C, Potter J, McCormack T, et al. Association of depression with subsequent mortality, cardiovascular morbidity and incident dementia in people aged 80 and over and suffering from hypertension. Data from the Hypertension in the Very Elderly Trial (HYVET). Age and Ageing. 2010;39(4):439–45.

    Article  Google Scholar 

  26. Ruopp MD, Perkins NJ, Whitcomb BW, Schisterman EF. Youden Index and optimal cut-point estimated from observations affected by a lower limit of detection. Biometrical journal Biometrische Zeitschrift. 2008;50(3):419–30.

    Article  Google Scholar 

  27. Lemon SC, Roy J, Clark MA, Friedmann PD, Rakowski W. Classification and regression tree analysis in public health: Methodological review and comparison with logistic regression. Annals of Behavioral Medicine. 2003;26(3):172–81.

    Article  Google Scholar 

  28. Ahn KS, Kang CH, Cho SB, Cho KH, Han KD, Park YG, et al. Height Loss Was Associated With Osteoporosis in Korean Elderly Men, Not in Women: The Korea National Health and Nutrition Examination Survey 2008–2010. Journal of clinical densitometry: the official journal of the International Society for Clinical Densitometry. 2019;22(1):59–66.

  29. Krege JH, Kendler D, Krohn K, Genant H, Alam J, Berclaz PY, et al. Relationship Between Vertebral Fracture Burden, Height Loss, and Pulmonary Function in Postmenopausal Women With Osteoporosis. Journal of clinical densitometry: the official journal of the International Society for Clinical Densitometry. 2015;18(4):506–11.

    Article  Google Scholar 

  30. Abe K, Tamaki J, Kadowaki E, Sato Y, Morita A, Komatsu M, et al. Use of anthropometric indicators in screening for undiagnosed vertebral fractures: a cross-sectional analysis of the Fukui Osteoporosis Cohort (FOC) study. BMC Musculoskelet Disord. 2008;9:157.

    Article  Google Scholar 

  31. Davis SR, Kirby C, Weekes A, Lanzafame A, Piterman L. Simplifying screening for osteoporosis in Australian primary care: the Prospective Screening for Osteoporosis; Australian Primary Care Evaluation of Clinical Tests (PROSPECT) study. Menopause (New York, NY). 2011;18(1):53–9.

    Article  Google Scholar 

  32. Lawrence V. Independence and the pernicious threat of multimorbidity. Age and Ageing. 2019;48(4):472–3.

    Article  Google Scholar 

  33. Yamada M, Nishiguchi S, Fukutani N, Tanigawa T, Yukutake T, Kayama H, et al. Prevalence of sarcopenia in community-dwelling Japanese older adults. Journal of the American Medical Directors Association. 2013;14(12):911–5.

    Article  Google Scholar 

  34. Clegg A, Rogers L, Young J. Diagnostic test accuracy of simple instruments for identifying frailty in community-dwelling older people: a systematic review. Age and Ageing. 2014;43(suppl_2):ii10–ii1.

    Article  Google Scholar 

  35. Weyerer S, Eifflaender-Gorfer S, Wiese B, Luppa M, Pentzek M, Bickel H, et al. Incidence and predictors of depression in non-demented primary care attenders aged 75 years and older: results from a 3-year follow-up study. Age and Ageing. 2013;42(2):173–80.

    Article  Google Scholar 

  36. Counsell SR, Callahan CM, Buttar AB, Clark DO, Frank KI. Geriatric Resources for Assessment and Care of Elders (GRACE): a new model of primary care for low-income seniors. J Am Geriatr Soc. 2006;54(7):1136–41.

    Article  Google Scholar 

  37. Schubert CC, Myers LJ, Allen K, Counsell SR. Implementing Geriatric Resources for Assessment and Care of Elders Team Care in a Veterans Affairs Medical Center: Lessons Learned and Effects Observed. J Am Geriatr Soc. 2016;64(7):1503–9.

    Article  Google Scholar 

  38. Liang Y, Rausch C, Laflamme L, Moller J. Prevalence, trend and contributing factors of geriatric syndromes among older Swedes: results from the Stockholm County Council Public Health Surveys. BMC Geriatr. 2018;18(1):322.

    Article  Google Scholar 

Download references

Acknowledgements

We thank our colleagues from Pingtung Hospital, Tainan Hospital, Changhua Hospital, and Miaoli Hospital, Ministry of Health and Welfare, Taiwan, for their support in completing the survey. We also thank the statistical experts from Directorate-General of Budget, Accounting and Statistics, Executive Yuan, Taiwan. Importantly, we thank all experts of the TIHW group as follows: Prof. Hui-Sheng Lin from Division of Study and Survey in Populations, National Health Promotion Administration; Prof. Ching-Yi Wang from School of Physical Therapy, Prof. Shu-Hsin Lee from School of Nursing, Prof. Chih-Jung Yeh from School of Public Health, Prof. Tsu-Ann Kuo from Department of Medical Sociology and Social Work, College of Medicine, and Prof. Te-Jen Lai from School of Medicine, Chung Shan Medical University; Dr. Yu-Chun Wang from Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital; Dr. Wei-Min Chu from Department of Family Medicine, Taichung Veterans General Hospital; Prof. Chun-Te Lee from Department of Psychiatry and Dr. Chi-Hua Yen from Department of Geriatrics, Chung Shan Medical University Hospital; Dr. Chien-Yi Wu from Department of Family Medicine, Kaohsiung Medical University Hospital; Dr. Tai-Chuan Shih from Linluo Township Public Health Center; Prof. Fu-Wen Liang from School of Public Health, Kaohsiung Medical University; Dr. Yi-Chung Chen from Department of Occupational Medicine, Pingtung Hospital; Prof. Wen-Chun Liao from School of Nursing, China Medical University; Dr. Yao-Pan Liao from Department of Family Medicine, Chang-Hua Hospital; Dr. Chun-Cheng Liao from Department of Family Medicine, Taichung Armed Forces General Hospital; Dr. Miao-Yu Liao from Department of Family Medicine and Dr. Wei-Sheng Chung from Department of Chest Medicine, Taichung Hospital. This work was supported by the Ministry of Health and Welfare, Taiwan (Grant number: M06M2346 and M09M7269). The study sponsor participated in the study design, but played no role in participant recruitment, data analysis, or paper preparation.

Author information

Authors and Affiliations

  1. Department of Family Medicine, Pingtung Hospital, Ministry of Health and Welfare, Pingtung, Taiwan

    C.-J. Tai & C.-Y. Huang

  2. Graduate Institute of Natural Products, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan

    C.-J. Tai

  3. National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan

    Y.-H. Yang

  4. Department of Nursing, Pingtung Hospital, Ministry of Health and Welfare, Pingtung, Taiwan

    S.-C. Pan

  5. Department of Family Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan

    Y.-H. Hsiao & Meng-Chih Lee

  6. Department of Public Health, Chung Shan Medical University, Taichung, Taiwan

    Y.-H. Hsiao

  7. College of Management, Chaoyang University of Technology, Taichung, Taiwan

    Y.-H. Hsiao & Meng-Chih Lee

  8. Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

    Tzyy-Guey Tseng

  9. Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan

    Meng-Chih Lee

  10. Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, Tzyy-Guey Tseng, No.100, Shin-Chuan 1st Road, Sanmin Dist., Kaohsiung City, 80708, Taiwan (R.O.C.)

    Tzyy-Guey Tseng

  11. Department of Family Medicine, Taichung Hospital, Ministry of Health and Welfare, Taiwan, No. 199, Sec. 1, Sanmin Rd., West Dist., Taichung City, 403, Taiwan (R.O.C.)

    Meng-Chih Lee

Authors
  1. C.-J. Tai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Y.-H. Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C.-Y. Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S.-C. Pan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Y.-H. Hsiao
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tzyy-Guey Tseng
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Meng-Chih Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Author contributions: Study concept and design: Chi-Jung (C.-J.) Tai, Yi-Hsin (Y.-H.) Yang, Meng-Chih (M.-C.) Lee; Acquisition of data: Ching-Ya (C.-Y.) Huang, Shu-Chuan (S.-C.) Pan, Yu-Han (Y.-H.) Hsiao; Analysis and interpretation of data: C.-J. Tai, Y.-H. Yang, Tzyy-Guey (T.-G.) Tseng, M.-C. Lee; Drafting the manuscript: C.-J. Tai and T.-G. Tseng; Substantively revise the manuscript: Y.-H. Yang and M.-C. Lee; All authors approved the submitted version of the manuscript, and ensured the accuracy and integrity of this work.

Corresponding authors

Correspondence to Tzyy-Guey Tseng or Meng-Chih Lee.

Ethics declarations

Ethics declaration: The study protocol was approved by the Antai Medical Care Cooperation Antai-Tian-Sheng Memorial Hospital Institutional Review Board (Protocol Number: 17–030-B1; Approval Date: March 22, 2017). All included participants received a proper explanation about the study and provided informed consent for inclusion in the study.

Conflict of interests: All authors declare that they have no competing interests.

Financial disclosure: All authors have no financial disclosure.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tai, CJ., Yang, YH., Huang, CY. et al. Development of the Brief Geriatric Assessment for the General Practitioner. J Nutr Health Aging 25, 134–140 (2021). https://doi.org/10.1007/s12603-020-1456-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12603-020-1456-7

Key words

Search

Navigation