The Comprehensive Geriatric Assessment and the multidimensional approach. A new look at the older patient with gastroenterological disorders

Best Pract Res Clin Gastroenterol. 2009;23(6):829-37. doi: 10.1016/j.bpg.2009.10.001.

Abstract

The Comprehensive Geriatric Assessment (CGA) is a multidimensional, usually interdisciplinary, diagnostic process intended to determine an elderly person's medical, psychosocial, and functional capacity and problems with the objective of developing an overall plan for treatment and short- and long-term follow-up. The potential usefulness of the CGA in evaluating treatment and follow-up of older patients with gastroenterological disorders is unknown. In the paper we reported the efficacy of a Multidimensional-Prognostic Index (MPI), calculated from information collected by a standardized CGA, in predicting mortality risk in older patients hospitalized with upper gastrointestinal bleeding and liver cirrhosis. Patients underwent a CGA that included six standardized scales, i.e. Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), Short-Portable Mental Status Questionnaire (SPMSQ), Mini-Nutritional Assessment (MNA), Exton-Smith Score (ESS) and Comorbity Index Rating Scale (CIRS), as well as information on medication history and cohabitation, for a total of 63 items. The MPI was calculated from the integrated total scores and expressed as MPI 1=low risk, MPI 2=moderate risk and MPI 3=severe risk of mortality. Higher MPI values were significantly associated with higher short- and long-term mortality in older patients with both upper gastrointestinal bleeding and liver cirrhosis. A close agreement was found between the estimated mortality by MPI and the observed mortality. Moreover, MPI seems to have a greater discriminatory power than organ-specific prognostic indices such as Rockall and Blatchford scores (in upper gastrointestinal bleeding patients) and Child-Plugh score (in liver cirrhosis patients). All these findings support the concept that a multidimensional approach may be appropriate for the evaluation of older patients with gastroenterological disorders, like it has been reported for patients with other pathological conditions.

Publication types

  • Research Support, N.I.H., Intramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Activities of Daily Living
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Comorbidity
  • Female
  • Gastrointestinal Hemorrhage / diagnosis*
  • Gastrointestinal Hemorrhage / mortality
  • Gastrointestinal Hemorrhage / physiopathology
  • Gastrointestinal Hemorrhage / psychology
  • Gastrointestinal Hemorrhage / therapy
  • Geriatric Assessment*
  • Health Services for the Aged
  • Health Status Indicators*
  • Humans
  • Liver Cirrhosis / diagnosis*
  • Liver Cirrhosis / mortality
  • Liver Cirrhosis / physiopathology
  • Liver Cirrhosis / psychology
  • Liver Cirrhosis / therapy
  • Logistic Models
  • Male
  • Marital Status
  • Mental Health
  • Middle Aged
  • Nutrition Assessment
  • Odds Ratio
  • Predictive Value of Tests
  • ROC Curve
  • Risk Assessment
  • Risk Factors
  • Severity of Illness Index
  • Social Support
  • Survival Analysis