Belgian Minimum Geriatric Screening Tools for Comprehensive Geriatric Assessment
Part III 2005
Thierry Pepersack, on behalf of the College for Geriatrics:
Baeyens JP, Daniels H, Lambert M, Pepersack T, Pepinster A, Pétermans J, Swine C, van den Noortgate N.
Introduction
Let’s remember…
BMGST: 3 parts program
1. 2003 questionnaire 2. 2004 consensus
3. 2005 registration
feasibility
BMGST: 3 parts program
1. 2003 questionnaire 2. 2004 consensus
3. 2005 registration
feasibility
Part I: 2003 questionnaire
quality of questionnaire not enough CGA
lack of uniformity CGA
~ no consensus response rate
geriatricians : interested in CGA transparency of geriatric units
BMGST: 3 parts program
1. 2003 questionnaire 2. 2004 consensus
3. 2005 registration feasibility
Part II: 2004 Consensus/ BGMST
• ADL I-ADL
• Mobility
• Cognition
• Depression
• Social
• Nutrition
• Pain
• Fragilité
• Katz, Lawton
• Stratify
• Clock DT
• GDS, Cornell
• SOCIOS
• MUST
• VAS, Checklist
• ISAR
Domains Scales Alerts/Procedures
¾ Function (continence)
¾ Falls
¾ Dementia, delirium
¾ Depression
¾ Complexity
¾ Malnutrition
¾ Pain
¾ Length of stay
BMGST: 3 parts program
1. 2003 questionnaire 2. 2004 consensus
3. 2005 registration feasibility
Part III: 2005 BGMST feasibility, efficacy, quality assurance
1. to assess the feasibility of a BMGST within the teams of Belgian geriatric units;
2. to assess the efficacy of a BMGST on the detection rate of the geriatric problems of the admitted subjects;
3. to analysis quality variables within the
data collected.
BGMST 2005: methodology
• Study design: prospective observational survey followed by bench marking (feed back).
• Each Belgian geriatric unit will be asked
to use the BMGST for 10 consecutive
admissions between March and May
2005.
BGMST 2005: methodology
• In a first time; within the 48h after admission and without any BMGST procedure, the teams should encode:
– admission’s cause
– and the active geriatric problems suspected for which a geriatric intervention is
programmed.
• Then, in a second time and within the week, a complete BMGST will be
performed.
Results
participation
*College:, : Baeyens JP, Daniels H, Lambert M, Pepersack T, Pepinster A, Pétermans J, Dr Swine Ch, van den Noortgate N.
Participants: Baeyens H, Baeyens JP; Banka M, Benoît F, Berg N, Beyer I, Claeys C, Coenen A, Decorte L, Dejaeger E, Dewinter P, Di Panfilo, D’Souza R, Fournier A, Janssens W, Kennes B, Lemper JC, Lambert M, Lampaert J, Laporta T, Maton JP, Mulkens K, Pepersack T, Pepinster A, Pétermans, J, Petrovic M, Pieters R, Praet JP, Sépulchre D, Simonetti C, Stercken G, Swine C, Van Camp F, Vandenbon C, Vandenbroeck K, Van Parys C,
Vanslembrouck I, Verbeke G Verbiest R, Verhaeverbeek I.
Experts of the consensus conference: Baeyens JP, Daniels H, Dargent G, De Vriendt P, Gazzotti G, E Gorus, Lambert M, Pepersack T, Pepinster A,
Pétermans J, Sachem C, Swine C,Vandekerkhof H, van den Noortgate N, Velghe A
Acknowledgments: We are indebted to A Perissino, M Haelterman, P Hellinckx and P Meeus (Health Care Quality Management Policy Unit, Ministry of Social Affairs,Public Health and the Environment) for their help during this project management. Grant: The management of the project was supported by the Belgian Ministry of Social Affairs,Public Health and the Environment.
participation
• 33 centers/ 104… (32%)
• 326 registrations
• Mean age 83,3 (6,8), median: 83,3; range
64-102
Age (Yrs)
No of obs
0 12 24 36 48 60 72 84
55 60 65 70 75 80 85 90 95 100 105 110
Residences of the patients
ho me 68%
institutio n 24%
o ther units 3%
o ther ho spital 5%
Total comorbidity
0% 10% 20% 30% 40% 50% 60% 70%
heart Infection Incontinence hypertension vascular respiratory digestive liver renal muscles stroke Parkinson anemia diabetes cancer vision audition dementia delirium depression
Non controlled morbidity
0% 5% 10% 15% 20% 25% 30%
heart Infection Incontinence hypertension vascular respiratory digestive liver renal muscles stroke Parkinson anemia diabetes cancer vision audition dementia delirium depression
Polypharmacy
No of drugs
No of obs
0 10 20 30 40 50 60 70
-4 -2 0 2 4 6 8 10 12 14 16 18 20 22 24
Frailty
ISAR score
No of obs
0 16 32 48 64 80 96 112
-1 0 1 2 3 4 5 6 7
90% of patients at risk of frailty
« Added-value » of the
BGMST
% of screened geriatric problems
• ADL I-ADL
• Incontinence
• Falls
• Cognition
• Depression
• Social
• Nutrition
• Pain
• 26%
Domains before: after BGMST:
¾ 89%
Dependence for ADL (Katz)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
bathing clothing transfer toilet continence eating
complete partial absent
IADL (Lawton)
from lowest (0) to highest dependence (4)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
phone use shopping meals housework washing transport therapeutics finances
4 3 2 1 0
% of screened geriatric problems
• ADL I-ADL
• Incontinence
• Falls
• Cognition
• Depression
• Social
• Nutrition
• Pain
• 26%
• 4%
¾ 89%
¾ 60%
Domains before: after BGMST:
Dependence for ADL (Katz)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
bathing clothing transfer toilet continence eating
complete partial absent
60% incontinence (partial or complete)
% of screened geriatric problems
• ADL I-ADL
• Incontinence
• Falls
• Cognition
• Depression
• Social
• Nutrition
• Pain
• 26%
• 4%
• 35%
¾ 89%
¾ 60%
¾ 46%
Domains before: after BGMST:
STRATIFY scores
No of obs
0 16 32 48 64 80 96 112
-1 0 1 2 3 4 5
46% of patients at risk of falls
% of screened geriatric problems
• ADL I-ADL
• Incontinence
• Falls
• Cognition
• Depression
• Social
• Nutrition
• Pain
• 26%
• 4%
• 35%
• 34%
¾ 89%
¾ 60%
¾ 46%
¾ 68%
Domains before: after BGMST:
Clock Drawing Test
failure 68%
success 32%
% of screened geriatric problems
• ADL I-ADL
• Incontinence
• Falls
• Cognition
• Depression
• Social
• Nutrition
• Pain
• 26%
• 4%
• 35%
• 34%
• 3%
¾ 89%
¾ 60%
¾ 46%
¾ 68%
¾ 49%
Domains before: after BGMST:
GDS
No of obs
0 14 28 42 56 70 84 98
-1 0 1 2 3 4 5
49% of patients at risk of depression
% of screened geriatric problems
• ADL I-ADL
• Incontinence
• Falls
• Cognition
• Depression
• Social
• Nutrition
• Pain
• 26%
• 4%
• 35%
• 34%
• 3%
• 7%
¾ 89%
¾ 60%
¾ 46%
¾ 68%
¾ 49%
¾ 50%
Domains before: after BGMST:
Social complexity (SOCIOS)
A 55%
B 40%
C 5%
45% of patients at risk of social
complexity
% of screened geriatric problems
• ADL I-ADL
• Incontinence
• Falls
• Cognition
• Depression
• Social
• Nutrition
• Pain
• 26%
• 4%
• 35%
• 34%
• 3%
• 7%
• 17%
¾ 89%
¾ 60%
¾ 46%
¾ 68%
¾ 49%
¾ 50%
¾ 65%
Domains before: after BGMST:
Risk of malnutrition
low 35%
medium 7%
high 58%
% of screened geriatric problems
• ADL I-ADL
• Incontinence
• Falls
• Cognition
• Depression
• Social
• Nutrition
• Pain
• 26%
• 4%
• 35%
• 34%
• 3%
• 7%
• 17%
• 8%
¾ 89%
¾ 60%
¾ 46%
¾ 68%
¾ 49%
¾ 50%
¾ 65%
¾ 43%
Domains before: after BGMST:
% of screened geriatric problems
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
function incontinence falls cognition depression malnutrition pain social
without
* with
*
*
*
*
*
*
*p < 0 . 0 0 0 1
Mean of screened geriatric problems before or after BGMST
Min-Max 25%-75%
Median value p<0.0001
number of geriatric problems
-1 1 3 5 7 9
without with MGST
% of screened geriatric problems
• ADL I-ADL
• Incontinence
• Falls
• Cognition
• Depression
• Social
• Nutrition
• Pain
• 26%
• 4%
• 35%
• 34%
• 3%
• 7%
• 17%
• 8%
¾ 89%
¾ 60%
¾ 46%
¾ 68%
¾ 49%
¾ 50%
¾ 65%
¾ 43%
& 63%*
& 56%*
& 11%
& 34%*
& 46%*
& 43%*
& 48%*
& 35%*
*p<0.0001
Domains before: after: gain:
BGMST gain (plus-value)
63%
56%
11%
38%
45% 49%
35%
43%
0%
10%
20%
30%
40%
50%
60%
70%
function incontinence falls cognition depression malnutrition pain social
« BGMST»
a new score for frailty ?
,000000 6,711317
,349357 326
ISAR (points)
,001788 3,164574
,215315 208
LOS (days)
,091023 1,695625
,098744 294
AGE (yrs)
p-level t(N-2)
R N
Units comparisons
Age
±Std. Dev.
±Std. Err.
Mean
Hospital No
Age (yrs)
68 74 80 86 92 98
0 1 2
3 4 5 6
7 8 910
1112 1314
1516 1718
1920 2122
2324 2526
2728 2930
3132 3334
Dependence ADL (Katz)
±Std. Dev.
±Std. Err.
Mean Hospital No
KATZ (points)
2 6 10 14 18 22 26 30
1 2 3 4 5
6 7 8 9
1011 1213
1415 1617
1819 2021
2223 2425
2627 2829
3031 3233
IADL (Lawton)
±Std. Dev.
±Std. Err.
Mean Hospital No
Lawton score
-5 0 5 10 15 20 25 30 35
1 2 3 4 5
6 7 8 9
1011 1213
1415 1617
1819 2021
2223 2425
2627 2829
3031 3233
Risk of falls (Stratify)
±Std. Dev.
±Std. Err.
Mean Hospital No
STRATIFY
-1 0 1 2 3 4 5
1 2 3 4 5
6 7 8 9
1011 1213
1415 1617
1819 2021
2223 2425
2627 2829
3031 3233
Risk of depression (GDS)
±Std. Dev.
±Std. Err.
Mean Hospital No
GDS (points)
-1 0 1 2 3 4 5
1 2 3 4 5
6 7 8 9
1011 1213
1415 1617
1819 2021
2223 2425
2627 2829
3031 3233
Risk of malnutrition (MUST)
±Std. Dev.
±Std. Err.
Mean Hospital No
MUST
-2 -1 0 1 2 3 4 5 6 7
1 2 3 4 5
6 7 8 9
1011 1213
1415 1617
1819 2021
2223 2425
2627 2829
3031 3233
Social complexity A
±Std. Dev.
±Std. Err.
Mean Hospital No
Socios A (no changes)
-0,4 -0,2 0,0 0,2 0,4 0,6 0,8 1,0 1,2 1,4
1 2 3 4 5
6 7 8 9
1011 1213
1415 1617
1819 2021
2223 2425
2627 2829
3031 3233
Social complexity B
±Std. Dev.
±Std. Err.
Mean Hospital No
Socios B
-0,4 -0,2 0,0 0,2 0,4 0,6 0,8 1,0 1,2 1,4
1 2 3 4 5
6 7 8 9
1011 1213
1415 1617
1819 2021
2223 2425
2627 2829
3031 3233
Social complexity C
±Std. Dev.
±Std. Err.
Mean Hospital No
Socios C
-0,3 -0,1 0,1 0,3 0,5 0,7 0,9
1 2 3 4 5
6 7 8 9
1011 1213
1415 1617
1819 2021
2223 2425
2627 2829
3031 3233
Frailty ISAR
±Std. Dev.
±Std. Err.
Mean Hospital No
ISAR
-1 0 1 2 3 4 5 6 7 8
1 2 3 4 5
6 7 8 9
1011 1213
1415 1617
1819 2021
2223 2425
2627 2829
3031 3233
Suspected geriatric problems before BGMST
±Std. Dev.
±Std. Err.
Mean Hospital No
suspected geriatric problems without BGMST -1 0 1 2 3 4 5
1 2 3 4 5
6 7 8 9
1011 1213
1415 1617
1819 2021
2223 2425
2627 2829
3031 3233
Suspected geriatric problems after BGMST
±Std. Dev.
±Std. Err.
Mean Hospital No
suspected geriatric problems with BGMST
1 2 3 4 5 6 7 8 9
1 2 3 4 5
6 7 8 9
1011 1213
1415 1617
1819 2021
2223 2425
2627 2829
3031 3233
« added-value » (BGMST gain)
±Std. Dev.
±Std. Err.
Mean Hospital No
New geriatric problem(s) detected by BGMST -1 0 1 2 3 4 5 6 7 8
1 2 3 4 5
6 7 8 9
1011 1213
1415 1617
1819 2021
2223 2425
2627 2829
3031 3233
Feed back
• Results are sent to all participants and
non-participants anonymously (except for
their own data) in order to offer them the
opportunity to compare their results.
Conclusions (i)
• Except for the assessment for the risk of falls, the MGST might be of value to
identify other geriatric problems (functional, continence, cognition, depression, nutrition, pain, social).
• “Added-value” of MGST is variable
according the centres
Conclusions (ii)
• After identifying deficiencies in quality of care provided to older persons, we planned this
program in order to sensitize the geriatric teams to the comprehensive geriatric assessment.
• The gain associated with a simple minimal
geriatric screen for common geriatric problems is impressive.
• This study concerns geriatric interventions that are safe, cheap, and sensible and that can help to identify vulnerable older patients.
• Moreover, this approach might have additional value for education and quality assurance.
acknowledgements
• Participants: Baeyens H, Baeyens JP; Banka M, Benoît F, Berg N, Beyer I,
Claeys C, Coenen A, Decorte L, Dejaeger E, Dewinter P, Di Panfilo, D’Souza R, Fournier A, Janssens W, Kennes B, Lemper JC, Lambert M, Lampaert J,
Laporta T, Maton JP, Mulkens K, Pepersack T, Pepinster A, Pétermans J, Petrovic M, Pieters R, Praet JP, Sépulchre D, Simonetti C, Stercken G, Swine C, Van Camp F, Vandenbon C, Vandenbroeck K, Van Parys C, Vanslembrouck I, Verbeke G Verbiest R, Verhaeverbeek I
• Experts of the consensus conference: Baeyens JP, Daniels H, Dargent G, De Vriendt P, Gazzotti G, E Gorus, Lambert M, Pepersack T, Pepinster A,
Pétermans J, Sachem C, Swine C,Vandekerkhof H, van den Noortgate N, Velghe A
• We are indebted to A Perissino, M Haelterman, P Hellinckx and P Meeus (Health Care Quality Management Policy Unit, Ministry of Social Affairs,Public Health and the Environment) for their help during this project management.
• Grant: The management of the project was supported by the Belgian Ministry of Social Affairs,Public Health and the Environment.
