Date Presented 03/28/20
To address the growing number of older adults (≥ 65 years) living with multimorbidity conditions (two or more chronic diseases), OTs will need to utilize evidence-based tools to identify and manage these conditions. In addition to traditional activities of daily living, instrumental activities of daily living, and functional performance measures, the RGA has proven to be a useful assessment tool for OTs, linked to direct intervention planning and functional outcomes.
Primary Author and Speaker: Selena Washington
Additional Authors and Speakers: Julia Henderson - Kalb
BACKGROUND: the Rapid Geriatric Assessment (RGA),4 has been developed for health professionals to use in older persons to assess for common risk factors and/or multi-morbidity components such as frailty, sarcopenia, malnutrition and aging, and cognitive impairment. This assessment has been highly predictive of developing disability, falls, institutionalization, and hospitalization.4 The RGA tool is used widely among occupational therapists and other healthcare professionals working with older adults of various socioeconomic backgrounds. The RGA is a simple assessment tool that does not require any equipment and can be completed in less than 20 minutes.
DESIGN AND METHODOLOGY: This study used a retrospective design with a purposive sample from January 2016-December 2018 at one community organization within city of St. Louis, Missouri; occupational therapists and other health care professionals (nurses, physicians, physical therapists, and social workers) administered the RGA to 234 non-institutionalized adults (2016: n=145, 2017: n=73, 2018: n=16).
RESULTS: A descriptive analysis of the demographics include: age= 78.6 % ≥ 65 years, gender = 65.8% female and 31.2% male, and ethnicity= 92.3% African American and 6.8% Caucasian. The Rapid Geriatric Assessment components include: the FRAIL classification for overall functional health (non-frail = 21.4%, pre-frail= 37.6%, frail=39.7%); the nutritional assessment for risk of weight loss (34.6%); the sarcopenia and fall risk assessment (56.8%), and the rapid cognitive screen (normal cognition =28.2%, mild cognitive impairment= 28.6%, at risk for dementia = 40.2%). A correlational analysis revealed a statistical significance (p≤ .001) within the FRAIL, nutrition, and sarcopenia measures within this sample population; however the rapid cognitive screening was not correlated with any other measures within the Rapid Geriatric Assessment. A chi-square analysis was conducted for significance of falls and adverse events based on the RGA measures, age, and gender within this sample population; however this analysis did not show any significant differences.
CONCLUSION: The importance of this retrospective study and the purpose of the RGA is the comprehensive and predictive information this tool can provide to therapists in addition to traditional occupational and functional assessment and measures. Within the community setting, the client’s medical history is not always known and there may not be sufficient time to complete an entire occupational profile; the RGA has the ability to highlight the client’s most prevalent concerns and reveal existing functional issues in an efficient manner.4 There has been moderate evidence within the literature regarding comprehensive functional assessments for older adults with multi-morbidity conditions.1 A comprehensive assessment, such as the RGA, along with traditional ADL and IADL assessment are essential in outlining achievable goals for ADL and IADL tasks within older adult populations.
References
1. Ryan A, Wallace E, O’Hara P, Smith SM. Multimorbidity and functional decline in community-dwelling adults: a systematic review. Health and Quality of Life Outcomes. 2015;(1). doi:10.1186/s12955-015-0355-9.
2. U.S. Department of Health and Human Services Healthy People 2020. U.S. Department of Health and Human Services Healthy People 2020 website. https://www.healthypeople.gov/2020/topics-objectives/topic/older-adults. Accessed November 11, 2018.
3. Ward BW, Schiller JS, Goodman RA. Multiple Chronic Conditions among US Adults: A 2012 Update. Preventing Chronic Disease.2014; 11. doi:10.5888/pcd11.130389.
4. Morley JE, Little MO, Berg-Weger M. Rapid Geriatric Assessment: A Tool for Primary Care Physicians. Journal of the American Medical Directors Association. 2017;(3):195. doi:10.1016/j.jamda.2016.11.017.
