Belgian Minimum Data Set for Comprehensive Geriatric Assessment Consensus meeting May seventh, 2004

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Belgian Minimum Data Set for Comprehensive Geriatric Assessment Consensus gathering May seventh, 2004 College of Geriatrics

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presentation consistent enrollment of value factors is a commitment the Ministry means to ask this enlistment  College & BVGG : pick it ourselves !

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BMDS : techniques Questionnaire sent by email; surface mail, downloadable ( utilized and proposed scales for negligible geriatric evaluation areas : ADL; I-ADL; falls; comprehension; depression; social; sustenance; torment; QOL

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comes about 59 polls intense and subacute G beds

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conclusions reaction rate geriatricians : inspired by CGA straightforwardness of geriatric units nature of survey insufficient CGA absence of consistency CGA ~ no agreement

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points of view working gatherings to propose "insignificant" devices of CGA for a Consensus Conference particular, touchy, approved achievable screening apparatuses a reason for further calculations

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Working gatherings ADL-IADL P Devriendt , G Dargent, C Swine Qol P Devriendt , G Dargent, C Swine Mobility JP Baeyens , Ghesquière Cognition M Lambert , E Gorus, C Sachem Depression A Velghe , Th Pepersack Social JP Baeyens , Van de kerkof Nutrition T Pepersack, H Daniels, J Pétermans, C Gazzotti Pain N Vandennoorgate , A Pepinster Frailty C Swine, G Dargent, P Devriendt

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ADL-IADL P Devriendt , G Dargent, C Swine

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ADL (1) Definition (Reuben et al., 1989) 3 levels of working, stratified by and multifaceted nature: Basic: basic capacities, self-mind Intermediate: vital to keep up autonomous living Crucial to live alone Advanced exercises of every day living: extravagance things, past what is should have been free, volitional, infuenced by social and motivational facors Terms: BADL: Basale ADL IADL: Instrumentele ADL AADL: Arbeid en ontspanning

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ADL (2) Important to gauge in G-setting (Reuben, 1989; Gallo et al., 2003): BADL IADL

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ADL: BADL and IADL Criteria for appraisal devices, concurring presentation wintermeeting 2004 and working gathering Specific, delicate, approved Feasible Screening devices For all patients A reason for further calculations What 's officially utilized and proposed by the respondents/geriatricians in the review !! What's to come??

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Used instruments Katz (half) Barthel (6%) Fim (4%) Smaf (2%) Proposed devices Katz (31%) Aggir (9%) Barthel (6%) Fim (4%) BADL-devices

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Used apparatuses Lawton (38%) Smaf (3%) Barthel (3%) Proposed devices Lawton (32%) Aggir (5%) Barthel (5%) IADL-devices

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ADL: BADL and IADL Literature seek: A considerable measure of appraisal - devices "What" they measure Pure BADL: just a couple devices Pure IADL: just a couple devices Combined BADL and IADL or ADL and other (eg. perception, conduct): the most apparatuses Type of patient All patients Condition or illness particular Assessed by Direct perception Self-report ‣ patient of intermediary Interview

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ADL: BADL and IADL: choice of devices concurring the criteria Pure BADL Katz: unique instrument or Belgian rendition Barthel - record Pure IADL Lawton – scale Combined RAI AGGIR FIM SMAF References accessible on the last slides

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ADL: BADL and IADL : proposition (1) Question: Choose an instrument officially utilized or proposed or … Choose an instrument that will be 'the future' commitment rather than the Katz?

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ADL: BADL and IADL : proposition (2) BADL: Katz IADL: Lawton-scale > Already utilized (half and 38%) Alzheimermedication, Elderly Home Proposed (31% and 32%) Feasible: time required: under 5' each (Rubenstein et al., 1988)

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References (1) Katz: Katz et al., Studies of Illness in the Aged, the Index of ADL: a Standardized Measure of Biological and Psychosocial Function, JAMA, sept 21; 1963 Barthel: Mahoney and Barthel, Functional Evaluation: the Barthel Index, Maryland State Medical Journal, 1965; 14(2): 61-5

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References (2) AGGIR FIM Deutsch et al., The Functional Independent Measure (FIM) and the FIM for kids (WeeFIM): then years of improvement; Critical Reviews in Physical Rehabilitation Medicine, 8, 267-281

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References (3) SMAF Hebert et al., The Functional Autonomy estimation framework (SMAF): despcription and approval of an instrument for the estimation of debilitations, Age and Aging, 17, 293-302 Desrosiers et al., Reliability of the revides fucntional self-governance estimation framework (SMAF) for epidemiological research, Age and Aging, 24, 402-406 Hebert et al., Setting the insignificant metrically noticeable change on handicap rating scales, Archieves of Physical Medicine ans Rehabilitation, 78, 1305-1308

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References (4) Lawton-scale Lawton et al., Assessment of more seasoned individuals: Self-keeping up and instrumental exercises of day by day living, Gerontologist, 1969;9:179-186 RAI Achterberg et al., Het Ressident Assessment Instrument (RAI): een overzicht van internationaal onderzoek naar de psychommetrische kwaliteiten en effecten van implementatie in verpleeghuizen, Tijdschrift Gerontologie en Geriatrie, 1999; 30 Frijters et al., Tijdschrift Gerontologie en Geriatrie, 2001; 32: 8 InterRAI SCREENER

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Quality of life P Devriendt , G Dargent, C Swine

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To quantify Quality of Life QoL: Can be viewed as general measure Includes ADL

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Quality of Life Definition: the same number of as there are autors, however in like manner Perception (subjective) Expectations Multidimensional Pschycological Physiological Social Material Cultural Existantial Interdependent Compensatory

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QoL-apparatus Assessment – device: SF – 36; got from the Medical Outcomes Study (MOS) Heahlt related QoL ! 8 subscales: Physical, working, part restrictions because of physical issues, because of passionate issues, substantial agony, general wellbeing discernments, essentialness, social working, psychological well-being 2 synopsis scores Self - report poll (10'), conceivable as meeting User's Manual Good psychometrics

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References MOS SF – 36 Stewart et al., The MOS Short-from General Health Survey: Reliability and legitimacy in a patient populace, Med Care, 1988; 26:724-735 Stewart et al., Functional Status and prosperity of patients with incessant cobnditions: Results from the Medical Outcome Study, JAMA, 1989; 262: 914-919 MC Horney, Measuring and checking general wellbeing status in elderly people: viable and methodological issues in utilizing the SF-36 wellbeing review, Geronotologist, 1996, 36: 571-583

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Mobility JP Baeyens , Ghesquière

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Introduction Assessment of MOBILITY GET-UP-AND-GO test TIMED UP AND GO TEST Assessment of MUSCLE STRENGHT MRC-scale (0-5) HAND DYNAMOMETER of Jamar Evaluation of FALL RISK STRATIFY score

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GET-UP-AND-GO test Version 1 Get Up Standing Go Turning Sit down Scores: 0=impossible 1=with help (manual or instrumental) 2=autonomous

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GET-UP-AND-GO test Version 2 Get up, standing, go, turning and take a seat Score 1 till 5 - 1 no insecurity - 2 gradually execution - 3 faltering, anomalous compensatory developments of body or arms - 4 patient is staggering - 5 changeless danger of fall S.Mathias, U.Nayak, B.Isaacs, 1985, Arch.Phys.Med.Rehab. 67(6), 387-9

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TIMED UP AND GO TEST Id, stroll of 3 meters, however Timed in seconds < 20 sec. : independantly portable > 30 sec. : subject to help for fundamental exchanges D.Podsaldio, S.Richardson, 1991, JAGS, 39(2), 142-8

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STRATIFY score (St.Thomas' Risk Assessment Tool In Falling elderly Inpatients) YES or NO: Patient is conceded with falls, or exhibited falls since confirmation Is he disturbed? Has he debilitated vision? Has he much of the time to go to the latrine Has he an exchange and portability score of under 3 or 4? Oliver et al. 1997

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STRATIFY score (St.Thomas' Risk Assessment Tool In Falling elderly Inpatients) Transfer score 0=impossible 1=help of 1 or 2 people 2=help with words or other fysical bolster 3=autonomous Mobility score 0=motionless 1=autonomous with help of wheelchair 2=march with physical or oral help of 1 individual 3=autonomous

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STRATIFY score (St.Thomas' Risk Assessment Tool In Falling elderly Inpatients) If result is at least 2: Risk of falling inside the week. Retesting by the medical caretaker consistently.

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Cognition M Lambert , E Gorus, C Sachem

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I. presentation -high pervasiveness of psychological issue in elderly -undetected -reversible causes -clinical ramifications e.g. treatment adherence basic leadership limit organization chance for complexities

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II. tests presently utilized cfr. appraisal poll III. writing lots of various accessible tests but… poorly examined or approved unknown not deciphered (Flemish & French) time devouring few worldwide rules for intense geriatric mind

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IV. star's & contra's -MMSE master : short (10 min.) a few subjective capacities broadly utilized approved geriatric populace = high hazard con : cut off-score? age; instruction

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no approved Flemish variant French/German form ? vernacular? ; Walloon? distinctive adaptations : orientation put registration & review: words calculation &/or spelling; word decision language : express 3 phase order copy outline Folstein et al. J Psychiatric Res 1975; 12 Derousné et al. La Presse Med 1999; 28

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-Clock drawing test professional : short (2 min.) basic con : distinctive variants diverse scoring conventions predetermined number machine gear-piece. capacities frequently utilized as a part of blend Shulman et al. Int J Geriatr Psychiatry 1986; 1 Richardson & Glass. JAGS 2002; 50

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-AMTS ace : short & basic recomme