American College of Physicians: Internal Medicine — Doctors for Adults ®

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Working in geriatrics

Look beyond chronic conditions

From the May 1997 ACP Observer, copyright 1997 by the American College of Physicians.

By Jennifer Fisher Wilson

When it comes to caring for elderly patients, internists need to go beyond looking for chronic medical conditions and use screening tools to focus on geriatric patients' overall health and function.

At a course on evaluating and managing geriatric patients, Patricia P. Barry, FACP, a geriatrician at Boston University, said that while most people over 65 have two or more chronic medical conditions, internists should not forget to examine elderly patients' overall health and functional status. By using comprehensive geriatric assessment (CGA), she said, physicians can collect information on topics like activities of daily living, mental health and socioeconomic resources.

According to Dr. Barry, patients most likely to benefit from CGA are those who are frail, but not terminally ill; those who are at a critical transition point in their lives, such as moving into a nursing home; and those who are declining either in function or health.

Using CGA in the office setting, however, can be problematic. Dr. Barry said that besides facing time constraints, most offices don't have a multidisciplinary team to help with CGA administration and evaluation. In addition, she noted that Medicare reimbursement for such assessments is low, because physicians can bill only for an extended visit.

To overcome these constraints, Dr. Barry suggested doing the assessment incrementally over a number of office visits.

In addition, she said, physicians should try to collect as much data before the visit by talking with family or by sending patients a previsit questionnaire asking about, for example, what medications the patient is taking and what home services the patient uses.

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