Impact of a geriatric assessment clinic on organizational interventions in primary health-care facilities at a university hospital

Abstract

Aim: (i) To uncover geriatric problems and syndromes in multiple domains, including medical, functional, social and psychological aspects; and (ii) to evaluate the impact of a geriatric assessment clinic on practice management from the perspective of the family practitioner. Methods: 177 patients were approached in a geriatric assessment clinic by a multidisciplinary team of geriatricians, nurses, clinical pharmacists, social workers and clinical psychologists. A cross-sectional study survey was conducted after the clinic had been established for 18months to evaluate the impact of the clinic in three areas: knowledge, system and attitude improvement. Results: In the medical domain, the three most common disorders found were poor vision (81.5%), drug related problems (67.8%) and dental problems (30.5%). Prevention and screening had rarely been afforded patients. Eighty-seven percent were never given stool occult tests or an influenza vaccination. The three most common geriatric syndromes found were dementia/mild cognitive impairment (MCI) (60.4%), depression (29.9%) and gait problems (30.5%). Each patient had roughly three syndromes. Regarding social domains, we found that 21.7% were caregiver burdens, 24% experienced family conflicts and 16.1% were subjected to elderly abuse. The impact of the geriatric assessment clinic on various satisfaction levels for care benefits as perceived by patients and caregivers was reported as high. Physicians reported high levels of satisfaction with respect to the holistic approach to primary care, although they also reported low levels of satisfaction with perceived knowledge gained from the clinic. Conclusion: A geriatric assessment clinic has been shown to be effective in discovering geriatric problems in several domains and enhancing the overall primary health-care system. © 2010 Japan Geriatrics Society.