Integration of geriatric assessment into the community

The integration of geriatric assessment into the community calls for more than effective communication. There should be a defined approach to comprehensive care, of which the assessment service is a regular part, and the assessment process should have a predictable influence on further care decisions. Three types of integrating approaches are described: the "recognized specialty" approach, which is typical of several other developed countries; the "consolidated model," such as the On Lok program in San Francisco; and the "brokerage" model, such as the ACCESS program in Rochester, New York. Each approach has strengths and limitations. We may expect further evolution toward fully integrated programs.