A TECNOLOGIA NA AVALIAÇAO

GERIATRICA GLOBAL
(COMPREHENSIVE GERIATRIC
ASSESSMENT )
EXPERIENCIA COM IDOSOS DE
COLOMBIA E BRASIL
Fernando Gomez
Geriatric Medicine Section
University of Caldas
Manizales -Colombia
2014
 OUTLINES
1. COMPREHENSIVE GERIATRIC
ASSESSMENT (CGA):
–DEFINITION
2. PHASES OF CGA
3. DOMAINS OF CGA
4. INSTRUMENTS
5. CONCLUSIONS
 1. COMPREHENSIVE GERIATRIC
ASSESSMENT
• DEFINITION
CGA is defined as a multidisciplinary evaluation
in which the multiple problems of older
people are uncovered, described and if
possible explained, and in which the resources
and strengths of the person are catalogued
and a coordinated plan is developed to focus
interventions on the individual person’s
problems.
Solomon D, Brown AS, Brummel-Smith K, et al. National Institutes of Health Consensus Development Conference
statement: geriatric assessment methods for clinical decision-making. J Am Geriatr Soc 1988;36:342–7
 Comprehensive Geriatric Assessment:
Phases

• Mid 1939s 1930-1975: model development.

• From 1975 - 1995: refinement and testing of

clinical geriatric models.

• 1995 – 2014: Integration and consolidation.

Rubenstein LZ, Joseph T. Freeman Award Lecture: Comprehensive Geriatric Assessment: CGA… The Journals of Gerontology; May 2004; 59A, 5;
 Comprehensive Geriatric Assessment

• 1940
“Accomplish an integral,
standarized and
systematic approach to
rehabilitate frail elder
with multiple
problems.” Marjorie Warren

``Geriatric assessment is the heart

Solomon DH. Foreword. In: Osterweil D, Brummel-Smith K, Beck JC,
eds. Comprehensive Geriatric Assessment. New York: McGraw-Hill,
and soul of geriatrics''
2000:787±99.
 EVALUACIÓN GERIÁTRICA
MULTIDIMENSIONAL

Aspectos Capacidad
socio funcional
ambientales
DOMAINS OF CGA
AREAS FOR CGA PROGRAMS
 Evaluación Geriátrica Multidimensional

Kumar S, Bai S, Xin S. Preoperative geriatric assessment: Comprehensive, multidisciplinary and proactive. European
Journal of Internal Medicine 23 (2012) 487–494
SITES FOR CGA PROGRAMS
 Caídas
Visión/audición
Incontinencia GDS
Minimental CES D
Nutrición
PCL Cornell
Polifarmacia
MoCA
Comorbilidad
Afectivo
Cognoscitivo Médico
Soporte
Medio Evaluación social
geriátrica
ambiente Redes
multidimensional
Espacio de vida Percibido
Cuidador

Económico Espiritual Funcional Social

Ingresos AVDf-i Activ física
Satisfacción SPPB Participación
MEBE
 CGA DOMAINS
PHYSICAL HEALTH
 SPAIN COLOMBIA

Disability Comorbidity
n=738
39,3% n=1147
61%
n=125
55%
n=32 n=49
14% 21,5%

n=22
VENN DIAGRAM FOR DISABILITY, 9,6%
COMORBIDITY AND FRAILTY Frailty
n=227
USA Gomez F. et al. Frailty in Colombian elderly. BMC
Castell Alcala MV et al. Prevalence of frailty in an Geriatrics, 2014
elderly Spanish urban population. Relationship with
comorbidity and disability. Aten Primaria. 2010;
42:520–527

Fried LP, et al. Frailty in Older Adults: Evidence for a

Phenotype. J Gerontol A Biol Sci Med Sci. 2001;
56A: M146-56
 CGA DOMAINS
FUNCTIONAL STATUS
 CGA DOMAINS
FUNCTIONAL STATUS
 Medidas compuestas
SPPB Batería corta de ejecución física
Nivel de Sin alteración Limitación de Discapacidad
discapacidad de la movilidad AVD
movilidad
SPPB puntaje 10,11 (1,30) 9,95 (1,86) 8,55 (2,54)
total
SPPB puntaje 3,92 (0,36) 3,7 (0,75) 3,48 (1,00)
de equilibrio
SPPB puntaje 3,54 (0,64) 3,38 (0,59) 2,97 (0,98)
de marcha
SPPB 2,81 (0,94) 2,71 (1,01) 2,09 (1,12)
incorporarse
de una silla
 THE GENDER GAP IN MOBILITY
Figure 1. Low physical performance (SPPB < 8)
30
26.17
24.29
25

20
15.63 MEN WOMEN
15.1
15
11.76
10 8.25 7.32 7.64
6.17
4.94
5

Source: IMIAS, 2012

 CGA DOMAINS
COGNITIVE FUNCTION
MOCA

MONTREAL
COGNITIVE
ASSESSMENT

DCL
S 90%
E 87%
 Prueba cognitiva de Leganés
(PCL)
• Procedente de estudio longitudinal con
población española
• Útil para la detección de demencia en
población mayor con bajo nivel educativo
• Administración: 11 minutos

Punto de corte 22/32

S 93,9%
E 94,7%
CGA DOMAINS
DISABILITY
LIFE SPACE ASSESSMENT

Peel C et al. PHYS THER 2005; 85:1008-1019

 Puntaje 0- 120

Punto de corte 56 (OR 2,18):

riesgo de limitación de AVDi

Espacio de vida restringido:

confinado al vecindario
 Caídas
Visión/audición
Incontinencia GDS
Minimental CES D
Nutrición
PCL Cornell
Polifarmacia
MoCA
Comorbilidad
Afectivo
Cognoscitivo Médico
Soporte
Medio Evaluación social
geriátrica
ambiente Redes
multidimensional
Espacio de vida Percibido
Cuidador

Económico Espiritual Funcional Social

Ingresos AVDf-i Activ física
Satisfacción SPPB Participación
MEBE
 DIFICULTADES
Implementación de recomendaciones
 CONCLUSION
ALL OF THESE ACTIVITIES WILL
HELP TO DEFINE THE OPTIMAL
ROLES OF GERIATRIC MEDICINE
AND CGA –HOPEFULLY IN TIME
TO HELP THE BABY BOOMERS
LIKE ME!
Rubenstein LZ, Joseph T. Freeman Award Lecture: Comprehensive Geriatric Assessment: CGA… The Journals of Gerontology; May 2004; 59A, 5;