Which Comprehensive Geriatric Assessment (CGA) instruments are currently used in Germany: a survey

Abstract

Background: The Comprehensive Geriatric Assessment (CGA) records geriatric syndromes in a standardized manner, allowing individualized treatment tailored to the patient's needs and resources. Its use has shown a beneficial effect on the functional outcome and survival of geriatric patients. A recently published German S1 guideline for level 2 CGA provides recommendations for the use of a broad variety of different assessment instruments for each geriatric syndrome. However, the actual use of assessment instruments in routine geriatric clinical practice and its consistency with the guideline and the current state of literature has not been investigated to date.

Methods: An online survey was developed by an expert group of geriatricians and sent to all licenced geriatricians (n = 569) within Germany. The survey included the following geriatric syndromes: motor function and self-help capability, cognition, depression, pain, dysphagia and nutrition, social status and comorbidity, pressure ulcers, language and speech, delirium, and frailty. Respondents were asked to report which geriatric assessment instruments are used to assess the respective syndromes.

Results: A total of 122 clinicians participated in the survey (response rate: 21%); after data cleaning, 76 data sets remained for analysis. All participants regularly used assessment instruments in the following categories: motor function, self-help capability, cognition, depression, and pain. The most frequently used instruments in these categories were the Timed Up and Go (TUG), the Barthel Index (BI), the Mini Mental State Examination (MMSE), the Geriatric Depression Scale (GDS), and the Visual Analogue Scale (VAS). Limited or heterogenous assessments are used in the following categories: delirium, frailty and social status.

Conclusions: Our results show that the assessment of motor function, self-help capability, cognition, depression, pain, and dysphagia and nutrition is consistent with the recommendations of the S1 guideline for level 2 CGA. Instruments recommended for more frequent use include the Short Physical Performance Battery (SPPB), the Montreal Cognitive Assessment (MoCA), and the WHO-5 (depression). There is a particular need for standardized assessment of delirium, frailty and social status. The harmonization of assessment instruments throughout geriatric departments shall enable more effective treatment and prevention of age-related diseases and syndromes.

Keywords: Activities of daily living; CGA; Cognition; Comorbidities; Comprehensive geriatric assessment; Delirium; Depression; Dysphagia; Frailty; Self-help capability.

Fig. 1

Cleaning process of the collected data sets

Fig. 2

Percentage of usage of assessment instruments for each syndrome

Fig. 3

Motor function assessment instruments. The use of the assessment instruments at the color-coded time points is presented in absolute numbers (blue = standardized on admission; orange = standardized before discharge; gray = standardized during inpatient treatment; yellow = standardized as post/progression/follow-up after inpatient treatment or on readmission; green = in the context of specific treatments/diagnoses). Multiple responses were possible. BBS = Berg-Balance-Scale, BPS = Back Performance Scale, CHARMI = Charité Mobilitäts-Index, DEMMI = De Morton Mobility Index, DGI = Dynamic Gait Index, ETS = Esslinger Transferskala, Exp.-Std. SP = Expertenstandard Sturzprophylaxe, FES-I = Falls Efficacy Scale – International, H&Y = Hoehn & Yahr stages, Maryland = Sturzrisiko nach Maryland, mAS = modified Ashworth Scale, SPPB = Short Physical Performance Battery, TCT = Trunk Control Test, TUG = Timed-up-and-go

Fig. 4

Self-help capability assessment instruments. The use of the assessment instruments at the color-coded time points is presented in absolute numbers (blue = standardized on admission; orange = standardized before discharge; gray = standardized during inpatient treatment; yellow = standardized as post/progression/follow-up after inpatient treatment or on readmission; green = in the context of specific treatments/diagnoses). Multiple responses were possible. ADL = activities of daily living, BI = Barthel index, ePA-AC = ergebnisorientiertes PflegeAssessment Acute Care©, FIM = Functional Independence Measure, Huhn = Sturzrisiko nach Huhn, IADL = instrumental activities of daily living, TTMC = Timed Test of Money Counting

Fig. 5

Cognition assessment instruments. The use of the assessment instruments at the color-coded time points is presented in absolute numbers (blue = standardized on admission; orange = standardized before discharge; gray = standardized during inpatient treatment; yellow = standardized as post/progression/follow-up after inpatient treatment or on readmission; green = in the context of specific treatments/diagnoses). Multiple responses were possible. ACL = Allen Cognitive Level, BAS = Brief Alzheimer Screen, BDST = Bamberger Demenz Screening Test, CDR = Clinical Dementia Rating Questionnaire, CERAD-NAB = Consortium to Establish a Registry on Alzheimer’s Disease—Neuropsychological Assessment Battery, DemTect = Demenz-Detektion, ePA-AC = ergebnisorientiertes PflegeAssessment Acute Care©, KAS = Kölner Apraxie-Screening, MMSE = Mini Mental State Examination, MoCA = Montreal Cognitive Assessment, NAI = Nürnberger Altersinventar, NPI = Neuropsychiatrisches Inventar, QDRS = Quick Dementia Rating System, SOMCT = Short Orientation Memory Concentration Test, SPMSQ = Short Portable mental Status Questionnaire, TFDD = Test zur Früherkennung von Demenz mit Depressionsabgrenzung, TTMC = Timed Test of Money Counting

Fig. 6

Depression assessment instruments. The use of the assessment instruments at the color-coded time points is presented in absolute numbers (blue = standardized on admission; orange = standardized before discharge; gray = standardized during inpatient treatment; yellow = standardized as post/progression/follow-up after inpatient treatment or on readmission; green = in the context of specific treatments/diagnoses). Multiple responses were possible. BDI = Beck Depression Inventory, CSDD = Cornell Scale for Depression in Dementia, DESC = Rasch-basierte Depressionsscreening, DIA-S = Depression im Alter-Skala, ePA-AC = ergebnisorientiertes PflegeAssessment Acute Care©, GDS = Geriatric Depression Scale, HADS = Hospital Anxiety and Depression Scale, MADRS = Montgomery-Asberg Depression Rating Scale, PHQ = Patient Health Questionnaire, WHO-5 = WHO-Five Well-Being Index

Fig. 7

Pain assessment instruments. The use of the assessment instruments at the color-coded time points is presented in absolute numbers (blue = standardized on admission; orange = standardized before discharge; gray = standardized during inpatient treatment; yellow = standardized as post/progression/follow-up after inpatient treatment or on readmission; green = in the context of specific treatments/diagnoses). Multiple responses were possible. BESD = Beurteilung von Schmerzen bei Demenz, BISAD = Beobachtungsinstrument für das Schmerzassessment bei alten Menschen mit Demenz, ePA-AC = ergebnisorientiertes PflegeAssessment Acute Care©, FPS = Faces Pain Scale, NOPPAIN = Non Communicative Pain Assessment Instrument, NPRS = Numeric Pain Rating Scale, PACSLAC = Pain Assessment Checklist for Sensiors with Limited Ability to Communicate, PAINAD = Pain Assessment in Advanced Dementia Scale, SOMS = Screening für somatoforme Störungen, VAS = Visual Analogue Scale, VDS = Verbal Descriptor Pain Scale

Fig. 8

Dysphagia and nutrition assessment instruments. The use of the assessment instruments at the color-coded time points is presented in absolute numbers (blue = standardized on admission; orange = standardized before discharge; gray = standardized during inpatient treatment; yellow = standardized as post/progression/follow-up after inpatient treatment or on readmission; green = in the context of specific treatments/diagnoses). Multiple responses were possible. ADT = Aachener Dysphagie Test, BMI = Body Mass Index, BODS = Bogenhausener Dysphagiescore, DSTG = Dysphagie Screening Tool Geriatrie, FEES = Fiberoptic endoscopic evaluation of swallowing, GUSS = Gugging Swallowing Screen, HRM = High-Resolution-Manometrie, MNA(-SF) = Mini Nutritional Assessment (Short Form), MST = Malnutrition Screening Tool, NRS = Nutritional Risk Screening, SDQ = Swallowing Disturbance Questionaire, SGA = Subjective global Assessment, SSA = standardized swallowing assessment, VFSS = Videofluoroscopy, V-VST = Volume-Viscosity Swallowing Test

Fig. 9

Social status and comorbidity assessment instruments. The use of the assessment instruments at the color-coded time points is presented in absolute numbers (blue = standardized on admission; orange = standardized before discharge; gray = standardized during inpatient treatment; yellow = standardized as post/progression/follow-up after inpatient treatment or on readmission; green = in the context of specific treatments/diagnoses). Multiple responses were possible. CCI = Charlson Comorbidity Index, CIRS = Cumulative Illness Rating Scale, MAGIC = Manageable geriatric assessment

Fig. 10

Pressure ulcers assessment instruments. The use of the assessment instruments at the color-coded time points is presented in absolute numbers (blue = standardized on admission; orange = standardized before discharge; gray = standardized during inpatient treatment; yellow = standardized as post/progression/follow-up after inpatient treatment or on readmission; green = in the context of specific treatments/diagnoses). Multiple responses were possible. ePA-AC = ergebnisorientiertes PflegeAssessment Acute Care©

Fig. 11

Language and speech assessment instruments. The use of the assessment instruments at the color-coded time points is presented in absolute numbers (blue = standardized on admission; orange = standardized before discharge; gray = standardized during inpatient treatment; yellow = standardized as post/progression/follow-up after inpatient treatment or on readmission; green = in the context of specific treatments/diagnoses). Multiple responses were possible. AAT = Aachener Aphasie Test, ACL = Aphasie-Checklist, AKDT = Aphasie/kognitive Dysphasie-Testung, BoDys = Bogenhausener Dysarthrieskalen, BOSU = Bogenhausener Semantikuntersuchung, Goodglass/Kaplan = Kommunikationsskala nach Goodglass und Kaplan, LEMO = Lexikon Modellorientiert, log. exam. = logopedic examination, MVP = Münchner Verständlichkeitsprofil (Munich Intelligibility Profile)

Fig. 12

Delirium assessment instruments. The use of the assessment instruments at the color-coded time points is presented in absolute numbers (blue = standardized on admission; orange = standardized before discharge; gray = standardized during inpatient treatment; yellow = standardized as post/progression/follow-up after inpatient treatment or on readmission; green = in the context of specific treatments/diagnoses). Multiple responses were possible. CAM = Confusion Assessment Method, DOS = Delirium Observation Scale, DRIP = Delirium-Restricted Mobility Infection & Inflammation Psychosomatic, mCAM-ED = modified Confusion Assessment Method for the Emergency Department, MMSE = Mini Mental State Examination, MOTYB = Months-of-The-Year-Backwards, Nu-DESC = Nursing Delirium Screening Scale

Fig. 13

Frailty assessment instruments. The use of the assessment instruments at the color-coded time points is presented in absolute numbers (blue = standardized on admission; orange = standardized before discharge; gray = standardized during inpatient treatment; yellow = standardized as post/progression/follow-up after inpatient treatment or on readmission; green = in the context of specific treatments/diagnoses). Multiple responses were possible. AfGIB = Ärztliche Arbeitsgemeinschaft zur Förderung der Geriatrie in Bayern, AGAST = Arbeitsgemeinschaft Geriatrisches Basisassessment, CFS = Clinical Frailty Scale, Exp.-Std. = Expertenstandard, FI = Frailty Index, Fried = Cardiovascular Health Study Frailty Screening Measure, FTS = Frailty Trait Scale, Gemidas = Geriatrisches Minimum Data Set, HFRS = Hospital Frailty Risk Score, ISAR = Identification of Seniors at Risk, PGBA = Pflegegesetzadaptiertes Geriatrisches Basisassessment, SHARE-FI = Frailty Instrument for Primary Care of the Survey of Health, Ageing and Retirement in Europe