Formal Geriatric Assessment Instruments and the Care of Older General Medical Outpatients

To improve identification of cognitive, affective, gait, and nutritional problems in older medical outpatients, non-physician clinic personnel administered formal geriatric assessment tools to 183 medical outpatients age 70 years and older. Definite impairments were demonstrated in 7% to 23% of patients (depending on the function being assessed), and borderline abnormal results were common as well. Overall, 56% of patients had at least one meaningful impairment identified. Few of these problems had been recognized before the survey. Assessment required 10 to 15 minutes of interviewer time per patient (approximately 22 minutes for each problem newly uncovered). A simple education and information intervention led to physicians addressing the newly identified problem in 30% to 55% of cases. These results suggest that formal geriatric assessment instruments provide an efficient mechanism for case finding in older medical outpatients. Further studies are necessary to determine whether such interventions will lead to improved outcomes in older medical outpatients.