Geriatric Assessment - Science topic

Were you able to create a well-being assessment tool and if so I would love to chat with you regarding the assessment tool....

For mental agility the MMSE I agree with the previous posts’ answers that this is a very standarized tool. For geriatric depression, there’s also Beck’s depression inventory and Hamilton depression rating scale.

You can see some of how this is used in research below:

Yang, H. L., Chan, P. T., Chang, P. C., Chiu, H. L., Hsiao, S. T. S., Chu, H., & Chou, K. R. (2018). Memory-focused interventions for people with cognitive disorders: a systematic review and meta-analysis of randomized controlled studies. International journal of nursing studies, 78, 44-51. https://pubmed.ncbi.nlm.nih.gov/29110906/

Chu, H., Yang, C. Y., Lin, Y., Ou, K. L., Lee, T. Y., O’Brien, A. P., & Chou, K. R. (2014). The impact of group music therapy on depression and cognition in elderly persons with dementia: a randomized controlled study. Biological research for Nursing, 16(2), 209-217.

Excellent tools have already been suggested but I’d also suggest the Mini Mental State Examination, which tests memory and cognitive skills, and the four-item Geriatric Depression Scale as other tools may miss dementia and depression on the elderly that is also very important. Here are more information about various assessment tools for the elderly:

For sure you may consider using a combination of BLE sensors combined with a smart phone app ... both MbientLab (https://mbientlab.com) and NOTCH (https://wearnotch.com) provide developer resources and examples ... Im using them to pilot study movement/gait analysis in connection to rehabilitation ... hope this helps ....

Foot placement especially in the lateral direction and medial also may play a role in fall risk during walking. Quantized Dynamical Entropy and Sample Entropy of Human Gait Signals can be used for biomarkers for Fall Risk while walking.

How are you defining "health"?

I'm on a committee for the NONPF that is looking at that issue. If you find an existing tool I would love to know what it is.

Thank you so much 

Elsa!

Your question is a philosophical one. 

The ideal index should be the one that could be used in every scenario. However, such instrument does not exist, especially when talking about frailty.

Several keys should be considered, such as validity, generalizability, stability, repeatability.

It is more important to have a clear objective. If you are aiming to treatment, then use an instrument which is sensitive to change in a short period. If you are aiming to diagnosis, then use an instrument with appropriate sensitivity and specificity. In case you are aiming to measure the economic impact of the diseases, then... ...and so on.

We must keep in mind that a specific objective will have as many advantages as limitations. And everything comes to the researcher choice, considering that limitations should be justified properly.

Dear Jamie, 

I found your question so relevant for SR developers. For me, no matter how many SR I have done, I always have to check relevant information about how to build a comprehensive search strategy. 

I highly recommend two useful resources: 

I hope you find these resources useful for developing your search strategy.

Best, 

Juan

Thank you for your answer.

Hi 

Yes the latest published one is from 2010, however you can find the data from http://qof.digital.nhs.uk/ as gp collects the data around prevalence of hypertension

data : http://www.content.digital.nhs.uk/catalogue/PUB22266

Regards

Have you considered using the Camberwell Assessment of Need in the Elderly?

I can't see the relevance of this study. If the client has the motivation to eat and the skills involved - what is the significance of grip strength after meals? How will your study provide information that is meaningful to clients healthcare outcomes? What are the assumptions/hypotheses underpinning your study?

Dear Mauro,

Thanks for your information. The assessment tools you suggested are very useful not just on my research but also on my daily clinical practice. I will apply it when I need to assess the ADL functions of my clients with dementia.

I'm currently conducting a research on the assessment tools for the physical performance of people with dementia, specifically on functional mobility and exercise tolerance. It would be interesting to see the results.

Many thanks,

Wayne 

The CSNAT has been successfully trialed in Australia and this has been reported in three publications early this year (below). A copy of the tool can be obtained from Gail Ewing: ge200@cam.ac.uk

Aoun SM, Grande G, Howting D, Deas K, Toye C, Stajduhar K, Ewing G. The

impact of the Carer Support Needs Assessment

Tool (CSNAT) in community palliative care

using a Stepped Wedge Cluster Trial. PLos One

2015;10(4):e0123012. DOI:10.1371/

journal.pone.0123012

Aoun SM, Deas K, Toye C, Ewing G, Grande G,

Stajduhar K. Supporting family carers to

identify their own needs in end of life care:

Qualitative findings from a stepped wedge

cluster trial. Palliative Medicine 2015;29(6):

508–17. DOI:10.1177/0269216314566061

Aoun SM, Toye C, Deas K, Howting D, Ewing G, Grande G, Stajduhar K. Enabling a family carer-led assessment of support needs in homebased

palliative care: Potential translation into

practice. Palliative Medicine 2015 April 20; Epub

ahead of print. DOI:10.1177/0269216315583436

Thank you for that invaluable information, Marcia. I will definitely look into it! 

sorry I do not have the expertise to answer this question.

Regards

I would be reflecting on the goal in the long term care. Is it a case of benefit or burden?, given the age of the patient and the frailty index that sits above them. If there are 2 or more strong clinical indicators for frailty, where is the sequence of clinical assessment and what are the multi system failures occurring. 

Taking a palliative approach to long term care is about providing a quality of life to the person, and providing them with choices and enabling the decisions around goals to be supported. 

Sarcopenia is clinically indicated and usually correlated with geriatric atrophy in an older cohort (over 85). A specialised nursing process would provide the clinical and holistic  assessments that focus on the Advanced Care Directive, the Palliative directives, and the ability for the frail to resist the forces of nature. Calorie supplements do have their place in aged care and wound healing , however the evidence of the lived experience is often reported as having no benefit, cost negative and burden a client with compliance issues. 

Each case needs to be managed from a multidisciplinary approach and best practice in geriatric care would benefit the whole team including the family.

Thanks everyone for your answers. Hope we can start quickly and publish soon the results! I am crossing my fingers!

In Australia, with a proportion of illiterate indigenous peoples, a test based on common visual stimuli was developed and validated called the KICA-Cog (Kimberley Indigenous Cognitive Assessment Tool). This concept could be developed for the Portuguese population.

I think the answer mainly depends of your objectives and goals. For example, if you want to screen patients for frailty, the 6 meters walking test is one of the most useful. If it is for waking disorders in general, the seat test is very interesting. For screening fallers, I use the one leg balance test.

there is no test to prevent falls. there are plenty to differentiate fallers from non fallers. but you have exercises and rehab technics to reduce the risk of falling. and finally the best one is still to exercise regularly for general population. Falls according to some specific condition is a different situation which needs some disease driven therapy by physiotherapist.

This is in relation to Butler's Life Review research, Anthony. 

Hi, Yong-jun!

All the contributions that had been made by the other colleagues are very important. I would like to share with you that I had the opportunity of working with the 24-hours recall (24hR) database of the National Health and Nutritional Survey 2012 in Mexico. In my personal opinion, the 24hR has a lot of bias independently of the age of the respondent. As Vasudevan mentioned, in the elder people the cognitive status becomes diminished, thus the memory bias gets increased. The day the 24hR is carried out is another limitation for its validity, just because it is not the same what you eat on weekend than on a weekday. Like these factors, there are other sources of bias that have to do with methodological issues when taking about the 24hR. Therefore, due to the fact that older adults are a special population, we have to be very careful with the interpretation of the results we obtain from the 24hR and try to compare them with similar analysis around the world, if possible.

However, if you trust on the quality of the 24hR, you can estimate the quantity of macro and micronutrients, and compare them with the recommended intakes for this age group. The latter implies that you already have a database of macro- micro-nutrient-reference (per unit or portion) of each row food (or food preparation) so you can match it with the consumed food by the person. And to get the final estimation of nutrients intake and energy is really a very hard work!

Concerning the “food frequency intake”, it is an easier way to have a description of the dietary intake from a person. This kind of questionnaires ask about the frequency in the last month (the evaluation is usually per month) the person ate a list of foods. So, applying a graded scale you answer: all days, once a week, three times a week, never, and so on. The outcome of this analysis is limited to the frequency percentages of food intake, just that. Thus, as you can realize from this brief explanation, these means of getting nutritional information are to some extent not too accurate. But, in the epidemiological setting it is the suitable way. And contrary with Vasudevan’s opinion, both, 24hR and food frequency intake, can be hold either clinical or epidemiological settings. In Mexico, due to the importance of the quality and quantity of Mexicans’ dietary intake, and its association with the obesity-related diseases, the 24hR is a better option.

In the last years, a couple of studies has been using anthropometric indicators of the nutritional status in older adults. In fact, the Mini Nutritional Assessment (MNA) referred by Ki Young Son, use the calf girth with a cutoff point of less than 31 cm, to identify risk of undernutrition in this age group. Maybe your national survey measured this variable and could be useful for you. Calf girth in this sense talks about a muscle depletion that is correlated with a deficient energy-protein intake, physical function, and strength.

I found out a paper “Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International working group on sarcopenia” by Fielding et al (2011). Also I attach the MNA, Korean version.

Cheers.

I discuss a mathematical model of a cellular mechanism for this in the attached paper. If the attachment does not link correctly, you can also find "Accounting for chance in the calculus of autoimmune disease" in my profile or at pubmed.

We have been doing this for quite some years now as a matter of routine. One of my colleagues Nimit Singhal published the data on the 1st 200 patients triaged with his tool in J Geriatric Oncology in 2010 I the public sector the screening tool is nurse administered, in the prviate it varies: I do it myself (it doesnt take long once you know the tools). An overview was published a couple of years ago by M Puts et al in JNCI in 2012 and more recntly in Annals of Oncology this year showing several tools to be predictive of outcomes of interest (mortality,toxicity). I dont know about the economics aspect although a priori if you avoid adverse effects by better patient selection with a pretty inexpensive tool it sounds unlikely to fail the cost:benefit ratio.

Dear Lisa

I spent a year following the stories of frail older people in hospital waiting for a bed in a nursing home. I visited them during this time and collected stories full of humour, resilience and despair. These people were 'bed blockers' and we still have this in the UK

 

Hi Clarissa

Have you already read about the IADL Involvement (Capacity/Performance) Scale or the IADL Clinical Assessment Protocol (CAP)?

 

 

Get up and go! Best utility and known validity and reliability.

¡Thank you very much Pilar!

This reference is very helpfull!

La mejor forma de saber cual es la salud general de la población anciana es preguntando sobre su situación funcional. Podemos utilizar cualquier escala sobre actividades básicas de la vida diaria como el índice de Barthel o el índice de Katz y actividades instrumentales como el índice de Lawton. Un anciano con buena situación funcional es probablemente un anciano sano.

En referencia a la salud emocional podemos utilizar escalas de sreening de deterioro cognitivo como el Mini-Mental de Folstein ( en España utilizamos una versión adaptada el Mimi-Mental de Lobo ) o el test de Pfeiffer. Para conocer el riesgo de sufrir depresión solemos utilizar la Escala de Depresión Geriatrica de Yesavage.

There are several health related QOL scale which is applicable for different age qruops s/a RAND-36 (SF-36), SIP, MOSHR-QOL scale etc. The Older people QOL questionnaire (OPQOL) is specific for general geriatric population, and EORTC QLQ-C30 is specific for cancer.

I asked a colleague, in exercise science, Robert Boyce, who provided the following information:

Rockport one-mile Fitness Walk Test

It is a rough measure of fitness but it can do the job. If the persons are too old or out of shape it could max them out. If you do before and after training intervention tests one must be very careful to have the same environmental conditions such as heat and humidity. I am just sending you the first sites that I saw on Google. It looks like it will give you what you need but I have never tired this site before.

Take care

Another approach would be to further define evaluative well-being (i.e. overall life satisfaction) and experienced well-being (i.e. moment-to-moment happiness, positive or negative affect). The first can be assess with questions like mentioned by Prof Andersen-Ranberg or through the WHOQoL assessment tool. The second can be assessed through Danny Kahneman's or Arthur Stone's work with the Day Reconstruction Method or the Experienced Sampling Method.

WHO's Study on global AGEing and adult health (SAGE) includes life satisfaction and WHOQoL data for China, Ghana, India, Mexico, Russia and South Africa (similar to SHARE, HRS and ELSA) - through www.who.int/healthinfo/sage.

A very recent article about WHOQOL AGE from SAGE sister study COURAGE in Europe at: www.hqlo.com/content/11/1/177 (Validation of an instrument to evaluate quality of life in the aging population: WHOQOL-AGE).

It also provides data on happiness using the Day Reconstruction Method for the same six countries. A recent publication here:

www.plosone.org/article/info:doi/10.1371/journal.pone.0061534 (Multi-Country Evaluation of Affective Experience: Validation of an Abbreviated Version of the Day Reconstruction Method in Seven Countries).

The available data also includes measures of mobility, health conditions and many other co-variates that you can use to explore the other issues raised by other colleagues to your question.

Jean-Paul,

You can use the ‘dual baseline' or "pre-baseline" approach [1,2] to partly cut off early practice effects. Assuming that the most learning occurs from first to second assessment, the second may serve as baseline for subsequent assessments.

1.McCaffrey RJ, Duff K, Westervelt HJ: Practitioner's guide to evaluating change with neuropsychological assessment instruments. New York: Kluwer Academic/Plenum Publishers; 2000.

2.McCaffrey RJ, Westervelt HJ: Issues associated with repeated neuropsychological assessments. Neuropsychol Rev 1995, 5:203-221.

I am not convince at all by the two latest answers, which dealt with physical fitness measurements rather than physical activity. If the focus is on physical activity (you should be clear about what is question), then even a self-reported technique may be more pertinent than a fitness test. However, you should also acknowledge that self-reported physical activity PA data are prone to measurement errors due to recall bias, social desirability, and so on. Should I give an advice will be to suggested the use of a validated motion sensor (e.g. pedometer or accelerometer). Once again, physical fitness is not a synonymous of physical activity. Good luck in your research.