[Five years experience at a community-based comprehensive geriatric assessment unit in southern Israel]

The health care of the growing number of older people in the population is predominantly provided by the family physician, who is usually faced with time limitations. A community-based Comprehensive Geriatric Assessment (CGA) unit has the potential to provide the family physician with the necessary support required in managing older patients.

To describe and review the structure and clinical experience of a community-based CGA unit over a period of five years.

The CGA unit comprises a multidisciplinary team that utilizes a comprehensive array of assessment instruments. Specific emphasis is placed on comorbidity, polypharmacy, cognitive and affective status, social support and daily function.

Over a period of five years, 456 older patients were evaluated. The mean age was 76.7 +/- 6.1 years and 36.2% were women. A total of 6.57 +/- 2.72 new diagnoses were made, the most common being dementia (60.1%), recurrent falls (43.9%) and social problems (32.5%). There were an average of 7 recommendations provided to the family physician, the majority relating to preventive medicine, fall prevention, improving mobility and social interventions. Based on a sample of files evaluated some six months later, we found that these recommendations had been carried out by family physicians to varying degrees. Prescriptions for new medications were provided for 55.6% of those recommended, 45.5% drugs were discontinued as suggested, and 44.4% investigations were performed. Preventive medicine recommendations were carried out in only 11.4% of patients.