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Belgian Minimum Geriatric Screening Toolsfor 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.
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
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
Function (continence)
FallsDementia, deliriumDepressionComplexityMalnutritionPainLength of stay
Part III: 2005 BGMST feasibility, efficacy, quality assurance
1. to assess the feasibility of a BMGSTwithin 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.
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’SouzaR, 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 AAcknowledgments: 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
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
Frailty
ISAR score
No
of o
bs
0
16
32
48
64
80
96
112
-1 0 1 2 3 4 5 6 7
90% of patients atrisk of frailty
% of screened geriatric problems
• ADL I-ADL• Incontinence• Falls• Cognition• Depression• Social• Nutrition• Pain
• 26%
Domains before: after BMGST:
89%
Dependence for ADL (Katz)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
bathing clothing transfer toilet cont inence eat ing
completepart ialabsent
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 therapeut ics f inances
43210
% of screened geriatric problems
• ADL I-ADL• Incontinence• Falls• Cognition• Depression• Social• Nutrition• Pain
• 26%• 4%
89%60%
Domains before: after BMGST:
Dependence for ADL (Katz)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
bathing clothing transfer toilet cont inence eat ing
completepart ialabsent
60% incontinence(partial or complete)
% of screened geriatric problems
• ADL I-ADL• Incontinence• Falls• Cognition• Depression• Social• Nutrition• Pain
• 26%• 4%• 35%
89%60%46%
Domains before: after BMGST:
% of screened geriatric problems
• ADL I-ADL• Incontinence• Falls• Cognition• Depression• Social• Nutrition• Pain
• 26%• 4%• 35%• 34%
89%60%46%68%
Domains before: after BMGST:
% of screened geriatric problems
• ADL I-ADL• Incontinence• Falls• Cognition• Depression• Social• Nutrition• Pain
• 26%• 4%• 35%• 34%• 3%
89%60%46%68%49%
Domains before: after BMGST:
% of screened geriatric problems
• ADL I-ADL• Incontinence• Falls• Cognition• Depression• Social• Nutrition• Pain
• 26%• 4%• 35%• 34%• 3%• 7%
89%60%46%68%49%50%
Domains before: after BMGST:
% of screened geriatric problems
• ADL I-ADL• Incontinence• Falls• Cognition• Depression• Social• Nutrition• Pain
• 26%• 4%• 35%• 34%• 3%• 7%• 17%
89%60%46%68%49%50%65%
Domains before: after BMGST:
% of screened geriatric problems
• ADL I-ADL• Incontinence• Falls• Cognition• Depression• Social• Nutrition• Pain
• 26%• 4%• 35%• 34%• 3%• 7%• 17%• 8%
89%60%46%68%49%50%65%43%
Domains before: after BMGST:
% of screened geriatric problems
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
funct ion incont inence falls cognit ion depression malnut rit ion pain social
withoutwith*
*
*
*
*
**
* p < 0 . 0 0 0 1
Mean of screened geriatric problemsbefore or after BMGST
Min-Max25%-75%Median value
p<0.0001
num
ber o
f ger
iatri
c pr
oble
ms
-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%
89%60%46%68%49%50%65%43%
63%*56%*11%34%*46%*43%*48%*35%*
*p<0.0001
Domains before: after: gain:
BMGST gain (plus-value)
63%
56%
11%
38%
45%49%
35%
43%
0%
10%
20%
30%
40%
50%
60%
70%
funct ion incont inence falls cognit ion depression malnut rit ion pain social
« BMGST»a new score for frailty ?
,0000006,711317,349357326ISAR (points),0017883,164574,215315208LOS (days),0910231,695625,098744294AGE (yrs)p-level t(N-2) R N
Age
±Std. Dev.±Std. Err.Mean
Hospital No
Age
(yrs
)
68
74
80
86
92
98
01
23
45
67
89
1011
1213
1415
1617
1819
2021
2223
2425
2627
2829
3031
3233
34
Dependence ADL (Katz)
±Std. Dev.±Std. Err.Mean
Hospital No
KA
TZ (p
oint
s)
2
6
10
14
18
22
26
30
12
34
56
78
910
1112
1314
1516
1718
1920
2122
2324
2526
2728
2930
3132
33
IADL (Lawton)
±Std. Dev.±Std. Err.Mean
Hospital No
Law
ton
scor
e
-5
0
5
10
15
20
25
30
35
12
34
56
78
910
1112
1314
1516
1718
1920
2122
2324
2526
2728
2930
3132
33
Risk of falls (Stratify)
±Std. Dev.±Std. Err.Mean
Hospital No
STR
ATI
FY
-1
0
1
2
3
4
5
12
34
56
78
910
1112
1314
1516
1718
1920
2122
2324
2526
2728
2930
3132
33
Risk of depression (GDS)
±Std. Dev.±Std. Err.Mean
Hospital No
GD
S (p
oint
s)
-1
0
1
2
3
4
5
12
34
56
78
910
1112
1314
1516
1718
1920
2122
2324
2526
2728
2930
3132
33
Risk of malnutrition (MUST)
±Std. Dev.±Std. Err.Mean
Hospital No
MU
ST
-2
-1
0
1
2
3
4
5
6
7
12
34
56
78
910
1112
1314
1516
1718
1920
2122
2324
2526
2728
2930
3132
33
Social complexity A
±Std. Dev.±Std. Err.Mean
Hospital No
Soc
ios
A (n
o ch
ange
s)
-0,4
-0,2
0,0
0,2
0,4
0,6
0,8
1,0
1,2
1,4
12
34
56
78
910
1112
1314
1516
1718
1920
2122
2324
2526
2728
2930
3132
33
Social complexity B
±Std. Dev.±Std. Err.Mean
Hospital No
Soc
ios
B
-0,4
-0,2
0,0
0,2
0,4
0,6
0,8
1,0
1,2
1,4
12
34
56
78
910
1112
1314
1516
1718
1920
2122
2324
2526
2728
2930
3132
33
Social complexity C
±Std. Dev.±Std. Err.Mean
Hospital No
Soc
ios
C
-0,3
-0,1
0,1
0,3
0,5
0,7
0,9
12
34
56
78
910
1112
1314
1516
1718
1920
2122
2324
2526
2728
2930
3132
33
Frailty ISAR
±Std. Dev.±Std. Err.Mean
Hospital No
ISA
R
-1
0
1
2
3
4
5
6
7
8
12
34
56
78
910
1112
1314
1516
1718
1920
2122
2324
2526
2728
2930
3132
33
Suspected geriatric problemsbefore BMGST
±Std. Dev.±Std. Err.Mean
Hospital No
susp
ecte
d ge
riatri
c pr
oble
ms
with
out B
GM
ST
-1
0
1
2
3
4
5
12
34
56
78
910
1112
1314
1516
1718
1920
2122
2324
2526
2728
2930
3132
33
Suspected geriatric problemsafter BMGST
±Std. Dev.±Std. Err.Mean
Hospital No
susp
ecte
d ge
riatri
c pr
oble
ms
with
BG
MS
T
1
2
3
4
5
6
7
8
9
12
34
56
78
910
1112
1314
1516
1718
1920
2122
2324
2526
2728
2930
3132
33
« added-value » (BMGST gain)
±Std. Dev.±Std. Err.Mean
Hospital No
New
ger
iatri
c pr
oble
m(s
) det
ecte
d by
BG
MS
T
-1
0
1
2
3
4
5
6
7
8
12
34
56
78
910
1112
1314
1516
1718
1920
2122
2324
2526
2728
2930
3132
33
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, VanslembrouckI, 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,PublicHealth 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.
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