Skip to main content
SpringerLink
Log in
Book cover

Comprehensive Geriatric Assessment pp 133–147Cite as

Comprehensive Geriatric Assessment in Patients with Organ Failure

  • Chapter
  • First Online:

  • 1624 Accesses

Part of the book series: Practical Issues in Geriatrics ((PIG))

Abstract

In this chapter, we discuss the role of comprehensive geriatric assessment (CGA) in some medical conditions common in the older population. The association between frailty and cardiovascular disease (CVD) is one of the hot topics in geriatric medicine because the association between these two conditions is probably bidirectional. Since CVDs are the main cause of death and poor quality of life in Western countries, CGA seems to be of importance to better judge prognosis in older subjects, in order to tailor appropriate diagnostic and therapeutic interventions. Similarly to CVD, kidney failure is another typical disease of the elderly. For this condition, for example, the prognosis may be better defined including CGA-based information integrated with organ-specific parameters, i.e., the estimated renal function. While for CVD and renal failure, the use of CGA is established, for other common conditions (e.g., respiratory and gastrointestinal diseases), a more limited literature supports the role and the usefulness of CGA in characterizing the patient’s needs as well as predicting prognosis compared to more traditional organ-specific tools.

This is a preview of subscription content, log in via an institution.

References

  1. Go AS, Mozaffarian D, Roger VL et al (2013) Heart disease and stroke statistics 2013 update: a report from the American Heart Association. Circulation 127(1):e6–e245

    Article  PubMed  Google Scholar 

  2. Dodson JA, Maurer MS (2011) Changing nature of cardiac interventions in older adults. Aging Health 7:283–295

    Article  PubMed  PubMed Central  Google Scholar 

  3. Afilalo J, Alexander KP, Mack MJ et al (2014) Frailty assessment in the cardiovascular care of older adults. J Am Coll Cardiol 63(8):747–762

    Article  PubMed  Google Scholar 

  4. Bell SP, Saraf A (2014) Risk stratification in very old adults: How to best gauge risk as the basis of management choices for patients aged over 80. Prog Cardiovasc Dis 57(2):197–203

    Article  PubMed  PubMed Central  Google Scholar 

  5. Veronese N, Cereda E, Stubbs B et al (2017) Risk of cardiovascular disease morbidity and mortality in frail and pre-frail older adults: results from a meta-analysis and exploratory meta-regression analysis. Ageing Res Rev 35:63–73. doi:10.1016/j.arr.2017.01.003

    Article  PubMed  Google Scholar 

  6. Savela SL, Koistinen P, Stenholm S et al (2013) Leisure-time physical activity in midlife is related to old age frailty. J Gerontol Ser A 68:1433–1438. doi:10.1093/gerona/glt029

    Article  Google Scholar 

  7. Stenholm S, Strandberg TE, Pitkalal K, Sainio PI, Heliavaara M, Koskinen S (2014) Midlife obesity and risk of frailty in old age during a 22-year follow-up in men and women: The mini-Finland follow-up survey. J Gerontol Ser A 69:73–78. doi:10.1093/gerona/glt052

    Article  Google Scholar 

  8. Afilalo J, Eisenberg MJ, Morin JF et al (2010) Gait speed as an incremental predictor of mortality and major morbidity in elderly patients undergoing cardiac surgery. J Am Coll Cardiol 56:1668–1676

    Article  PubMed  Google Scholar 

  9. Clegg A, Young J, Iliffe S et al (2013) Frailty in elderly people. Lancet 381:752–762

    Article  PubMed  Google Scholar 

  10. Phan HM, Alpert JS, Fain M (2008) Frailty, inflammation, and cardiovascular disease: evidence of a connection. Am J Geriatr Cardiol 17:101–107

    PubMed  Google Scholar 

  11. Sergi G, Veronese N, Fontana L et al (2015) Pre-frailty and risk of cardiovascular disease in elderly men and women: the pro.V.A. study. J Am Coll Cardiol 65:976–983. doi:10.1016/j.jacc.2014.12.040

    Article  PubMed  Google Scholar 

  12. von Haehling S, Anker SD, Doehner W, Morley JE, Vellas B (2013) Frailty and heart disease. Int J Cardiol 168:1745–1747. doi:10.1016/j.ijcard.2013.07.068

    Article  Google Scholar 

  13. Flint K (2015) Which came first, the frailty or the heart disease? Exploring the vicious cycle. J Am Coll Cardiol 15(10):984–986

    Article  Google Scholar 

  14. Gill TM (2012) The central role of prognosis in clinical decision making. JAMA 307(2):199–200

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Benetos A, Bulpitt CJ, Petrovic M et al (2016) An expert opinion from the European Society of Hypertension-European Union Geriatric Medicine Society Working Group on the management of hypertension in very old, frail subjects. Hypertension 67(5):820–825. doi:10.1161/HYPERTENSIONAHA.115.07020

    Article  CAS  PubMed  Google Scholar 

  16. Tinetti ME, Bogardus ST Jr, Agostini JV (2004) Potential pitfalls of disease-specific guidelines for patients with multiple conditions. N Engl J Med 351:2870–2874

    Article  CAS  PubMed  Google Scholar 

  17. Guralnik JM, Simonsick EM, Ferrucci L et al (1994) A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 49:M85–M94

    Article  CAS  PubMed  Google Scholar 

  18. Di Bari M, Virgillo A, Matteuzzi D et al (2006) Predictive validity of measures of comorbidity in older community dwellers: the insufficienza cardiaca negli anziani residenti a Dicomano Study. J Am Geriatr Soc 54:210–216

    Article  PubMed  Google Scholar 

  19. Volpato S, Cavalieri M, Sioulis F et al (2011) Predictive value of the short physical performance battery following hospitalization in older patients. J Gerontol A Biol Sci Med Sci 66:89–96

    Article  PubMed  Google Scholar 

  20. Chiarantini D, Volpato S, Sioulis F et al (2010) Lower extremity performance measures predict long-term prognosis in older patients hospitalized for heart failure. J Card Fail 16:390–395

    Article  PubMed  Google Scholar 

  21. Studenski S, Perera S, Wallace D et al (2003) Physical performance measures in the clinical setting. J Am Geriatr Soc 51:314–322

    Article  PubMed  Google Scholar 

  22. Studenski S, Perera S, Patel K et al (2011) Gait speed and survival in older adults. JAMA 305:50–58

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Lilamand M, Dumonteil N, Nourhashémi F et al (2014) Gait speed and comprehensive geriatric assessment: two keys to improve the management of older persons with aortic stenosis. Int J Cardiol 173(3):580–582

    Article  CAS  PubMed  Google Scholar 

  24. Pilotto A, Ferrucci L, Franceschi M et al (2008) Development and validation of a multidimensional prognostic index for 1-year mortality from the comprehensive geriatric assessment in hospitalized older patients. Rejuvenation Res 11:151–161

    Article  PubMed  PubMed Central  Google Scholar 

  25. Pilotto A, Addante F, Franceschi M et al (2010) A multidimensional prognostic index (MPI) based on a comprehensive geriatric assessment predicts short-term mortality in older patients with heart failure. Circ Heart Fail 3:14–20

    Article  PubMed  Google Scholar 

  26. Shocken DD (2010) Prognosis of heart failure in the elderly: not an affair of the heart? Circ Heart Fail 3(1):2–3

    Article  Google Scholar 

  27. Pilotto A, Gallina P, Panza F et al (2016) Relation of statin use and mortality in community-dwelling frail older patients with coronary artery disease. Am J Cardiol 118(11):1624–1630. doi:10.1016/j.amjcard.2016.08.042

    Article  CAS  PubMed  Google Scholar 

  28. Pilotto A, Gallina P, Copetti M et al (2016) Warfarin treatment and all-cause mortality in community-dwelling older adults with atrial fibrillation: a retrospective observational study. J Am Geriatr Soc 64:1416–1424. doi:10.1111/jgs.14221

    Article  PubMed  Google Scholar 

  29. Bureau ML, Liuu E, Christiaens L, et al (2017) Using a multidimensional prognostic index (MPI) based on comprehensive geriatric assessment (CGA) to predict mortality in elderly undergoing transcatheter aortic valve implantation. Int J Cardiol 236:381–386. doi:10.1016/j.ijcard.2017.02.048

    Article  PubMed  Google Scholar 

  30. Morley JE, Vellas B, van Kan GA et al (2013) Frailty consensus: a call to action. J Am Med Dir Assoc 14:392–397. doi:10.1016/j.jamda.2013.03.022

    Article  PubMed  PubMed Central  Google Scholar 

  31. De Nicola L, Zoccali C (2016) Chronic kidney disease prevalence in the general population: heterogeneity and concerns. Nephrol Dial Transplant 31(3):331–335

    Article  PubMed  Google Scholar 

  32. Jha V, Garcia-Garcia G, Iseki K,et al (2013) Chronic kidney disease: global dimension and perspectives. Lancet 382:260–272

    Article  PubMed  Google Scholar 

  33. Weaver VM, Fadrowski JJ, Jaar BG (2015) Global dimensions of chronic kidney disease of unknown etiology (CKDu): a modern era environmental and/or occupational nephropathy? BMC Nephrol 16:145

    Article  PubMed  PubMed Central  Google Scholar 

  34. Dalrymple LS, Katz R, Rifkin DE, et al (2013) Kidney function and prevalent and incident frailty. Clin J Am Soc Nephrol 8:2091–2099

    Google Scholar 

  35. Shen Z, Ruan Q, Yu Z et al (2016) Chronic kidney disease-related physical frailty and cognitive impairment: a systemic review. Geriatr Gerontol Int 17:529–544

    Article  PubMed  Google Scholar 

  36. Feng L, Yap KB, Yeoh LY et al (2012) Kidney function and cognitive and functional decline in elderly adults: findings from the Singapore longitudinal aging study. J Am Geriatr Soc 60:1208–1214

    Article  PubMed  Google Scholar 

  37. Reese PP, Cappola AR, Shults J et al (2013) Physical performance and frailty in chronic kidney disease. Am J Nephrol 38(4):307–315

    Article  PubMed  PubMed Central  Google Scholar 

  38. Chowdhury R, Peel NM, Krosch M et al (2017) Frailty and chronic kidney disease: a systematic review. Arch Gerontol Geriatr 68:135–142

    Article  PubMed  Google Scholar 

  39. Mansur HN, Colugnati FA, Grincenkov FR et al (2014) Frailty and quality of life: A cross-sectional study of Brazilian patients with pre-dialysis chronic kidney disease. Health Qual Life Outcomes 12(1):27

    Article  PubMed  PubMed Central  Google Scholar 

  40. Bao Y, Dalrymple L, Chertow GM et al (2012) Frailty, dialysis initiation, and mortality in end-stage renal disease. Arch Intern Med 172(14):1071–1077

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Aucella F, Stoico L, Cicchella A et al (2012) Comprehensive geriatric assessment in the hemodialysis elderly population. J Nephrol 25(Suppl 19):S85–S89

    Article  PubMed  Google Scholar 

  42. Delgado C, Grimes BA, Glidden DV et al (2015) Association of frailty based on self-reported physical function with directly measured kidney function and mortality. BMC Nephrol 16:203

    Article  PubMed  PubMed Central  Google Scholar 

  43. McAdams-DeMarco MA, Tan J, Salter ML et al (2015) Frailty and cognitive function in incident hemodialysis patients. CJASN 10(12):2181–2189

    Article  PubMed  PubMed Central  Google Scholar 

  44. Bowling CB, O’Hare AM (2012) Managing older adults with CKD: individualized versus disease-based approaches. Am J Kidney Dis 59(2):293–302

    Article  PubMed  Google Scholar 

  45. Parlevliet JL, Buurman BM, Pannekeet MM et al (2012) Systematic comprehensive geriatric assessment in elderly patients on chronic dialysis: a cross-sectional comparative and feasibility study. BMC Nephrol 13:30–30. doi:10.1186/1471-2369-13-30

    Article  PubMed  PubMed Central  Google Scholar 

  46. Pilotto A, Sancarlo D, Franceschi M et al (2010) A multidimensional approach to the geriatric patient with chronic kidney disease. J Nephrol 23(S15):S5–10

    PubMed  Google Scholar 

  47. Pilotto A, Sancarlo D, Aucella F et al (2012) Addition of the multidimensional prognostic index to the estimated glomerular filtration rate improves prediction of long-term all-cause mortality in older patients with chronic kidney disease. Rejuvenation Res 15(1):82–88

    Article  PubMed  PubMed Central  Google Scholar 

  48. van Loon IN, Wouters TR, Boereboom FTJ et al (2016) The relevance of geriatric impairments in patients starting dialysis: a systematic review. Clin J Am Soc Nephrol 11(7):1245–1259

    Article  PubMed  PubMed Central  Google Scholar 

  49. Halbert RJ, Natoli JL, Gano A, Badamgarav E, Buist AS, Mannino DM (2006) Global burden of COPD: systematic review and meta-analysis. Eur Respir J 28:523–532. doi:10.1183/09031936.06.00124605

    Article  CAS  PubMed  Google Scholar 

  50. Eisner MD, Iribarren C, Blanc PD et al (2011) Development of disability in chronic obstructive pulmonary disease: beyond lung function. Thorax 66:108–114. doi:10.1136/thx.2010.137661

    Article  PubMed  Google Scholar 

  51. van Dijk WD, van den Bemt L, van den Haak-Rongen S, Bischoff E, van Weel C, Veen JC, Schermer TR (2011) Multidimensional prognostic indices for use in COPD patient care. A systematic review. Respir Res 12:151. doi:10.1186/1465-9921-12-151

    Article  PubMed  PubMed Central  Google Scholar 

  52. Incalzi AR, Pedone C (2014) Outcomes of pharmacological trials are not for the elderly respiratory patient. Am J Respir Crit Care Med 189:1286

    Google Scholar 

  53. Kon SS, Jones SE, Schofield SJ et al (2015) Gait speed and readmission following hospitalisation for acute exacerbations of COPD: a prospective study. Thorax 70:1131–1137. doi:10.1136/thoraxjnl-2015-207046

    Article  PubMed  Google Scholar 

  54. Galizia G, Cacciatore F, Testa G et al (2011) Role of clinical frailty on long-term mortality of elderly subjects with and without chronic obstructive pulmonary disease. Aging Clin Exp Res 23:118–125

    Article  PubMed  Google Scholar 

  55. de Torres JP, Casanova C, Marín JM, et al (2014) Prognostic evaluation of COPD patients: GOLD 2011 versus BODE and the COPD comorbidity index COTE. Thorax 69:799–804. doi:10.1136/thoraxjnl-2014-205770

  56. Roberts MH, Mapel DW, Bruse S, Petersen H, Nyunoya T (2013) Development of a modified BODE index as a mortality risk measure among older adults with and without chronic obstructive pulmonary disease. Am J Epidemiol 178:1150–1160. doi:10.1093/aje/kwt087

    Article  PubMed  PubMed Central  Google Scholar 

  57. Pedone C, Scarlata S, Forastiere F, Bellia V, Antonelli Incalzi R (2014) BODE index or geriatric multidimensional assessment for the prediction of very-long-term mortality in elderly patients with chronic obstructive pulmonary disease? A prospective cohort study. Age Ageing 43:553–558. doi:10.1093/ageing/aft197

    Article  PubMed  Google Scholar 

  58. Maddocks M, Kon SS, Canavan JL et al (2016) Physical frailty and pulmonary rehabilitation in COPD: a prospective cohort study. Thorax 71:988–995. doi:10.1136/thoraxjnl-2016-208460

    Article  PubMed  PubMed Central  Google Scholar 

  59. Jones SE, Maddocks M, Kon SS et al (2015) Sarcopenia in COPD: prevalence, clinical correlates and response to pulmonary rehabilitation. Thorax 70:213–218. doi:10.1136/thoraxjnl-2014-206440

    Article  PubMed  Google Scholar 

  60. McDonald VM, Simpson JL, Higgins I, Gibson PG (2011) Multidimensional assessment of older people with asthma and COPD: clinical management and health status. Age Ageing 40:42–49. doi:10.1093/ageing/afq134

    Article  PubMed  Google Scholar 

  61. Yoshikawa TT, Marrie TJ (2000) Community-acquired pneumonia in the elderly. Clin Infect Dis 31:1066–1078. doi:10.1086/318124

    Article  Google Scholar 

  62. Pilotto A, Addante F, Ferrucci L et al (2009) The multidimensional prognostic index predicts short- and long-term mortality in hospitalized geriatric patients with pneumonia. J Gerontol A Biol Sci Med Sci 64: 880–887. doi:10.1093/gerona/glp031

  63. McDonald VM, Higgins I, Wood LG, Gibson PG (2013) Multidimensional assessment and tailored interventions for COPD: respiratory utopia or common sense? Thorax 68:691–694. doi:10.1136/thoraxjnl-2012-202646

    Article  PubMed  PubMed Central  Google Scholar 

  64. Sanders DS, Carter MJ, Goodchap RJ, Cross SS, Gleeson DC, Lobo AJ (2002) Prospective validation of the Rockall risk scoring system for upper GI hemorrhage in subgroups of patients with varices and peptic ulcers. Am J Gastroenterol 97:630–635. doi:10.1111/j.1572-0241.2002.05541.x

    Article  CAS  PubMed  Google Scholar 

  65. Vreeburg EM, Terwee CB, Snel P, Rauws EA, Bartelsman JF, Meulen JH, Tytgat GN (1999) Validation of the Rockall risk scoring system in upper gastrointestinal bleeding. Gut 44:331–335

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  66. Blatchford O, Murray WR, Blatchford M (2000) A risk score to predict need for treatment for upper-gastrointestinal haemorrhage. Lancet 356:1318–1321. doi:10.1016/s0140-6736(00)02816-6

    Article  CAS  PubMed  Google Scholar 

  67. Atkinson RJ, Hurlstone DP (2008) Usefulness of prognostic indices in upper gastrointestinal bleeding. Best Pract Res Clin Gastroenterol 22:233–242. doi:10.1016/j.bpg.2007.11.004

    Article  PubMed  Google Scholar 

  68. Masaoka T, Suzuki H, Hori S, Aikawa N, Hibi T (2007) Blatchford scoring system is a useful scoring system for detecting patients with upper gastrointestinal bleeding who do not need endoscopic intervention. J Gastroenterol Hepatol 22:1404–1408. doi:10.1111/j.1440-1746.2006.04762.x

    Article  PubMed  Google Scholar 

  69. Cooper GS, Kou TD, Wong RC (2009) Outpatient management of nonvariceal upper gastrointestinal hemorrhage: unexpected mortality in medicare beneficiaries. Gastroenterology 136:108–114. doi:10.1053/j.gastro.2008.09.030

    Article  PubMed  Google Scholar 

  70. Pilotto A, Franceschi M (2017) Upper gastrointestinal disorders—chapter 93. In: Halter JB, Ouslander JG, Studenski S et al (eds) Hazzard’s Geriatric Medicine and Gerontology, 7th edition. McGraw Hill Publisher, New York

    Google Scholar 

  71. Pilotto A, Addante F, D’Onofrio G et al (2007) Usefulness of the comprehensive geriatric assessment in older patients with upper gastrointestinal bleeding: a two-year follow-up study. Dig Dis 25:124–128. doi:10.1159/000099476

    Article  PubMed  PubMed Central  Google Scholar 

  72. Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R (1973) Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 60:646–649

    Article  CAS  PubMed  Google Scholar 

  73. Malinchoc M, Kamath PS, Gordon FD, Peine CJ, Rank J, ter Borg PC (2000) A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology 31:864–871. doi:10.1053/he.2000.5852

    Article  CAS  PubMed  Google Scholar 

  74. Pilotto A, Addante F, D’Onofrio G, Sancarlo D, Ferrucci L (2009) The comprehensive geriatric assessment and the multidimensional approach. A new look at the older patient with gastroenterological disorders. Best Pract Res Clin Gastroenterol 23(6):829–837

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. National Research Council, Neuroscience Institute, Aging Branch, Via Giustiniani, 2, 35128, Padova, Italy

    Nicola Veronese

  2. Department Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, Genoa, Italy

    Nicola Veronese, Anna Maria Mello, Clarissa Musacchio & Alberto Pilotto

Authors
  1. Nicola Veronese
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anna Maria Mello
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Clarissa Musacchio
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alberto Pilotto
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nicola Veronese .

Editor information

Editors and Affiliations

  1. Geriatric Care, Orthogeriatrics and Rehab, Ospedali Galliera, Genoa, Italy

    Alberto Pilotto

  2. Dept. of Aging and Health, St. Thomas Hospital, London, United Kingdom

    Finbarr C. Martin

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this chapter

Cite this chapter

Veronese, N., Mello, A.M., Musacchio, C., Pilotto, A. (2018). Comprehensive Geriatric Assessment in Patients with Organ Failure. In: Pilotto, A., Martin, F. (eds) Comprehensive Geriatric Assessment. Practical Issues in Geriatrics. Springer, Cham. https://doi.org/10.1007/978-3-319-62503-4_12

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-62503-4_12

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-62502-7

  • Online ISBN: 978-3-319-62503-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation