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Published on: September 30, 2020
Changes in under-treatment after comprehensive geriatric assessment: an observational study
Linda R Tulner1, Jos P C M van Campen, Suzanne V Frankfort
1Department of Geriatric Medicine, Slotervaart Hospital, Amsterdam, the Netherlands. geltu@slz.nl
Drugs & Aging
|October 2, 2010
Summary
Comprehensive geriatric assessment (CGA) significantly reduces under-treatment in older patients. This approach also increases polypharmacy due to new diagnoses, even when medications are discontinued.
Area of Science:
- Geriatric Medicine
- Pharmacology
- Clinical Assessment
Background:
- Geriatric patients frequently experience under-treatment due to multiple comorbidities and polypharmacy.
- Contraindications to indicated medications are common in this population.
Purpose of the Study:
- To determine the prevalence of under-treatment for indicated medications before and after comprehensive geriatric assessment (CGA).
- To assess the prevalence of contraindications to these medications in geriatric outpatients.
Main Methods:
- Analysis of data from a 2004 prospective descriptive study of geriatric outpatients.
- Comparison of under-treatment rates (defined as omission of indicated drugs for 13 conditions) before and after CGA.
- Independent classification of comorbidities by geriatricians to identify contraindications.
Main Results:
- Under-treatment decreased from 32.9% before CGA to 22.3% after CGA in 516 patients.
- Contraindications were present in 19.8% of patients and were more common in under-treated individuals.
- Mean drug use and polypharmacy increased post-CGA, with more new drugs initiated for new diagnoses than for correcting under-treatment.
Conclusions:
- Comprehensive geriatric assessment effectively reduces under-treatment in older adults.
- Contraindications are associated with higher rates of under-treatment.
- CGA can lead to increased polypharmacy due to newly diagnosed conditions, despite medication discontinuation.
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