Multidimensional geriatric assessment in primary care: a scoping review

A scoping review using the Joanna Briggs Institute methodology was carried out on the databases Web of Science, Scopus, Medical Literature Analysis and Retrieval System Online (MEDLINE) and Literatura Latino Americana e do Caribe em Ciencias da Saude (LILACS). The studies addressed the population of older people aged ≥60 years, the concept of multidimensional assessment and the primary care setting.

Results

a total sample of 19 publications was included for qualitative analysis. The studies selected were of different designs (predominantly cross-sectional) and most were in English. The evaluation comprised three dimensions; instruments developed applicable to primary care; two types of information technologies used to support the evaluation; and the relevant findings about the practice.

Conclusion

this review identified tools that were based on several existing instruments. Strategies should be tailored for assessing older individuals in a quick feasible manner. Specific domains were commonly present in the instruments, considered important for providing a comprehensive assessment tailored for the older population.

Keywords
Aged; Geriatric Assessment; Primary Care

Database

Web of Science (English)

(multidimensional assessment) AND (aged) AND (primary health care); (multidimensional assessment) AND (aged) AND (primary care); (multidimensional assessment) AND (elderly) AND (primary health care); (multidimensional assessment) AND (elderly) AND (primary care); (multidimensional assessment) AND (older) AND (primary health care); (multidimensional assessment) AND (older) AND (primary care); (multidimensional assessment) AND ((geriatric)) OR ((gerontology)) AND (primary health care); (multidimensional evaluate) AND ((geriatric)) OR ((gerontology)) AND (primary health care); (multidimensional evaluate) AND (aged) AND (primary health care); (multidimensional evaluate) AND (aged) AND (primary care); (multidimensional evaluate) AND (elderly) AND (primary health care); (multidimensional evaluate) AND (elderly) AND (primary care); (multidimensional evaluate) AND (older) AND (primary health care); (multidimensional evaluate) AND (older) AND (primary care).

Identifier*	Study title	Journal name	Country	Study design	Year	Quality of evidence**
A1 (¹⁰10 Garrard JW, Cox NJ, Dodds RM, Roberts HC, Sayer AA. Comprehensive geriatric assessment in primary care: a systematic review. Aging Clin Exp Res [Internet]. 2020 [cited 2022 apr 05]; 32(2):197-205. Disponível em: https://pubmed.ncbi.nlm.nih.gov/30968287/.)	Comprehensive geriatric assessment in primary care: a systematic review	Aging Clinical and Experimental Research	United Kingdom	Systematic review	2020	Level 1
A2 (¹¹11 Pavón IL, Bartrolí MR, Pérez BI, Gil LG, Molinet PR, Parrón MF. Aplicación de un protocolo de valoración geriátrica en atención primaria: comparación con los datos de la historia clínica. Aten Primaria [Internet]. 2000 [cited 2022 apr 04];25(9):630-633. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7681494/.)	Aplicación de un protocolo de valoración geriátrica en atención primaria: comparación con los datos de la historia clínica	Atención Primaria	Spain	Cross-sectional study	2000	Level 4
A3 (¹²12 Moraes EN, Pereira AMVB, Azevedo RS, Moraes FL. Avaliação multidimensional do idoso [Internet]. Curitiba: Secretaria de Estado da Saúde do Paraná; 2018 [cited on 2022 apr 05]. Disponível em: https://www.saude.pr.gov.br/sites/default/arquivos_restritos/files/documento/2020-04/avaliacaomultiddoidoso_2018_atualiz.pdf.)	Avaliação Multidimensional do Idoso	State Secretariat for Health of Paraná	Brazil	Brazilian government document	2018	Level 5
A4 (¹³13 Lino VTS, Portela MC, Camacho LAB, Rodrigues NCP, Andrade MKN, O’Dwyer G. Rastreamento de problemas de idosos na atenção primária e proposta de roteiro de triagem com uma abordagem multidimensional. Cadernos de Saúde Pública [Internet]. 2016 [cited 2022 apr 05];32(7):1-12. Disponível em: https://www.scielo.br/j/csp/a/RbMjMrPjTwRzHjC984PCYxj/abstract/?lang=pt.)	Rastreamento de problemas de idosos na atenção primária e proposta de roteiro de triagem com uma abordagem multidimensional	Cadernos de Saúde Pública	Brazil	Cross-sectional study	2016	Level 4
A5 (¹⁴14 Dios-Quiroga F, Soliño-Lourindo S, Pallas-Queijo C, González-Formoso C, Constenla-Castro A, Conde-Freire S, Clavería A. Multidimensional geriatric assessment with MAGIC questionnaire and quality of life in elderly primary care patients. Int J Environ Res Public Health [Internet]. 2020 [cited 2022 apr 05];17(19):7089. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32998200/.)	Multidimensional Geriatric Assessment with MAGIC Questionnaire and Quality of Life in Elderly Primary Care Patients	International Journal of Environmental Research and Public Health	Spain	Cross-sectional study	2020	Level 4
A6 (¹⁵15 Saraiva MD, Venys AL, Abdalla FLP, Fernandes MS, Pisoli PH, Sousa DMRV et al. AMPI-AB validity and reliability: a multidimensional tool in resource-limited primary care settings. BMC Geriatr [Internet]. 2020 [cited 2022 apr 05]; 20 (124). Disponível em: https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-020-01508-9.)	AMPI-AB validity and reliability: a multidimensional tool in resource-limited primary care settings	BMC Geriatrics	Brazil	Longitudinal study	2020	Level 4
A7 (¹⁶16 Prefeitura da cidade de São Paulo. Manual avaliação multidimensional da pessoa idosa na atenção básica - AMPI-AB. São Paulo: Secretaria Municipal de Saúde [Internet]. 2021 [cited 2021 apr 05]. Disponível em: https://www.prefeitura.sp.gov.br/cidade/secretarias/upload/saude/MANUAL_AMPI_AB_AT. UALIZAO_2021.pdf.)	Avaliação Multidimensional da Pessoa Idosa na Atenção Básica AMPI-AB	Municipal Secretariat for Health of São Paulo	Brazil	Brazilian Government Document	2021	Level 5
A8 (¹⁷17 Munoz Silva CA, Rojas Orellana PA, Marzuca-Nassr GN. Criterios de valoración geriátrica integral en adultos mayores con dependencia moderada y severa en Centros de Atención Primaria en Chile. Rev. méd. Chile [Internet]. 2015 [cited 2022 apr 05];143(5): 612-618. Disponível em: http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000500009&lng=es&nrm=iso.)	Criterios de valoración geriátrica integral en adultos mayores con dependencia moderada y severa en Centros de Atención Primaria en Chile	Revista Médica de Chile	Chile	Review	2015	Level 5
A9 (¹⁸18 Brotons C, Monteserín R, Martínez M, Sellarès J, Baulies A, Fornasini M. Evaluación de la efectividad de un instrumento para identificar problemas sociales y sanitarios en la población anciana adscrita a un centro de atención primaria. Aten Primaria [Internet]. 2005 [cited 2022 apr 05];36(6):317-23. Disponível em: https://www.elsevier.es/pt-revista-atencion-primaria-27-articulo-evaluacion-efectividad-un-instrumento-identificar-13079866.)	Evaluación de la efectividad de un instrumento para identificar problemas sociales y sanitarios en la población anciana adscrita a un centro de atención primaria	Atención Primaria	Spain	Cross-sectional study	2005	Level 4
A10 (¹⁹19 Tran, HPT, Leonard, SD. Geriatric assessment for primary care providers. Prim Care [Internet]. 2017 [cited 2022 apr 05];44(3):399-411. Disponível em: https://pubmed.ncbi.nlm.nih.gov/28797368/.)	Geriatric Assessment for Primary Care Providers	Primary Care	United States	Review	2017	Level 5
A11 (²⁰20 Piolanti, A, Gostoli, S, Gervasi, J, Sonino, N, & Guidi, J. A Trial Integrating Different Methods to Assess Psychosocial Problems in Primary Care. Psychotherapy and Psychosomatics [Internet]. 2019 [cited 2022 sep 06 ]; 88(1): 30–36. Disponível em: https://doi.org/10.1159/000496477. https://doi.org/10.1159/000496477... )	A Trial Integrating Different Methods to Assess Psychosocial Problems in Primary Care	Psychotherapy and Psychosomatics	Italy	Cross-sectional study	2019	Level 4
A12 (²¹21 Račić, M, Petković, N, Bogićević, K, Marić, I, Matović, J, Pejović, V, et al. Comprehensive geriatric assessment: comparison of elderly hemodialysis patients and primary care patients. Renal failure [Internet]. 2015 [cited 2022 sep 06]; 37(7): 1126–1131. Disponível em: https://doi.org/10.3109/0886022X.2015.1057459. https://doi.org/10.3109/0886022X.2015.10... )	Comprehensive geriatric assessment: comparison of elderly hemodialysis patients and primary care patients	Renal Failure	Bosnia and Herzegovina and Serbia	Cross-sectional study	2015	Level 3
A13 (²²22 Fletcher AE, Price GM, Ng ES, Stirling SL, Bulpitt CJ, Breeze E, et al. Population-based multidimensional assessment of older people in UK general practice: a cluster-randomised factorial trial. Lancet (London, England) [Internet]. 2004 [cited 2022 sep 06];364(9446): 1667–1677. Disponível em: https://doi.org/10.1016/S0140-6736(04)17353-4. https://doi.org/10.1016/S0140-6736(... )	Population-based multidimensional assessment of older people in UK general practice: a cluster-randomised factorial trial	Lancet	United Kingdom	Clinical trial	2004	Level 2
A14 (²³23 van Hout HP, Nijpels G, van Marwijk, HW, Jansen, AP, Van't Veer, PJ, Tybout W, Stalman, WA. Design and pilot results of a single blind randomized controlled trial of systematic demand-led home visits by nurses to frail elderly persons in primary care. BMC geriatrics [Internet]. 2005 [cited 2022 sep 06];5, 11. Disponível em: https://doi.org/10.1186/1471-2318-5-11. https://doi.org/10.1186/1471-2318-5-11... )	Design and pilot results of a single blind randomized controlled trial of systematic demand-led home visits by nurses to frail elderly persons in primary care	BMC Geriatrics	Holland	Clinical trial	2005	Level 2
A15 (²⁴24 Chen, CY, Gan P, How CH. Approach to frailty in the elderly in primary care and the community. Singapore medical jornal [Internet]. 2018 [cited 2022 sep 06]; 59(5): 240–245. Disponível em: https://doi.org/10.11622/smedj.2018052. https://doi.org/10.11622/smedj.2018052... )	Approach to frailty in the elderly in primary care and the community	Singapore Medical Journal	Singapore	Continued Medical Education Article	2018	Level 6
A16 (²⁵25 Tai CJ, Yang YH, Huang CY, Pan SC, Hsiao YH, Tseng TG, Lee MC. Development of the Brief Geriatric Assessment for the General Practitioner. The journal of nutrition, health & aging [Internet]. 2021 [cited 2022 sep 06]; 25(1): 134–140. Disponível em: https://doi.org/10.1007/s12603-020-1456-7. https://doi.org/10.1007/s12603-020-1456-... )	Development of the Brief Geriatric Assessment for the General Practitioner	The Journal of Nutrition, Health & Aging	Taiwan	Cross-sectional study	2020	Level 4
A17(²⁶26 Adja K, Lenzi J, Sezgin D, O'Caoimh R, Morini M, Damiani G, Buja A, Fantini MP. The Importance of Taking a Patient-Centered, Community-Based Approach to Preventing and Managing Frailty: A Public Health Perspective. Frontiers in public health [Internet]. 2020 [cited 2022 sep 06]; 8, 599170. Disponível em: https://doi.org/10.3389/fpubh.2020.599170. https://doi.org/10.3389/fpubh.2020.59917... )	The Importance of Taking a Patient-Centered, Community-Based Approach to Preventing and Managing Frailty: A Public Health Perspective	Frontiers in Public Health	Italy/Ireland	Review article	2020	Level 5
A18(²⁷27 Calvani DL, Douris KR. Functional assessment: a holistic approach to rehabilitation of the geriatric client. Rehabilitation nursing : the official journal of the Association of Rehabilitation Nurses [Internet]. 1991 [cited 2022 sep 06]; 16(6): 330–335. Disponível em: https://doi.org/10.1002/j.2048-7940.1991.tb01243.x. https://doi.org/10.1002/j.2048-7940.1991... )	Functional Assessment: A Holistic Approach to Rehabilitation of the Geriatric Client	Rehabilitation Nursing Journal	United States	Case report	1991	Level 5
A19(²⁸28 Hébert R, Robichaud L, Roy PM, Bravo G, Voyer L. Efficacy of a nurse-led multidimensional preventive programme for older people at risk of functional decline. A randomized controlled trial. Age and ageing [Internet]. 2001 [cited 2022 sep 06]; 30(2): 147–153. Disponível em: https://doi.org/10.1093/ageing/30.2.147. https://doi.org/10.1093/ageing/30.2.147... )	Efficacy of a nurse-led multidimensional preventive programme for older people at risk of functional decline. A randomized controlled trial.	BMJ Open	Canada	Clinical trial	2001	Level 2

Dimensions of CGA	1. Clinical Dimension 2. Psychosocial Dimension 3. Functional Dimension (A3, A5, A7, A10)
Instruments developed for CGA applicable to primary care by dimension	Clinical Dimension Anamnesis – questionnaire on: - Hearing deficits (A2, A4, A5, A7, A12); - Vision deficits (A2, A5, A7, A12, A19); - Urinary or fecal incontinence (A3, A5, A7, A10); - Sleep (A3, A10); - Medications/polypharmacy (A3, A7, A10, A12, A19); - Tobacco use (A3, A10, A16); - Alcohol use (A3, A10, A16); - Sexuality (A3, A10); - Physical activity (A3, A10, A16); - Vehicle steering (A3); - Immunization (A3, A5); - Use of orthoses or prostheses (A3); - Domestic violence (A3, A10); - Self-rated health (A4, A7); - History of Falls (A4, A5, A7, A12); - Age (A7, A11); - Chronic conditions/comorbidities (A7, A12, A16); - History of hospitalization (A7); - Oral health assessment (A3, A7); - Family relationships (A10, A12); - Education (A12); - Living arrangements (A12, A16); - Income (A12, A16); - Gender (A12); - Pain (A12); - Constipation (A12); - Marital status (A16); - Quality of life – Short-Form Health Survey (SF-12) (A11).
	Psychosocial DimensionMOOD - Yesavage Geriatric Depression Scale (A2, A3, A10, A16, A19); - Patient Health Questionnaire-9 (PHQ-9) (A10); - Cornell Scale (A10); - Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (A11); - Diagnostic Criteria for Psychosomatic Research (DCPR) –(A11); - Psychosocial Index (PSI) (A11); - Patient Health Questionnaire-2 (PHQ-2) (A4, A10); - Illness Attitude Scales (IAS) (A11).
Instruments developed for CGA applicable to primary care by dimension	COGNITION - Mini-Mental State Exam (MMSE) (A2, A3); - Short Portable Mental Status Questionnaire (SPMSQ) (A2, A16); - Brief Mini-mental (A8); - Mini-Cog (A10, A11); - Point Cognitive Screener (10-cs) (A7); - Montreal Cognitive Assessment (MoCA) (A10); - Clock Drawing Test (A3, A5); - Verbal Fluency (A3); - Figure naming (A3); - Word List from CERAD (A3); - Saint Louis University Mental Status (SLUMS) test (A10).
	SOCIAL - Social support scale (Self-complete Scale by California Department of Mental Health) (A2); - Social support (A7); - Social data - social vulnerability questionnaire (A7); - Zarit Caregiver burden scale (A8); - Assessment of caregiver (A3); - Medical Outcomes Study (MOS) (A4);
	Functional DimensionACTIVITIES - Instrumental Activities of Daily Living – IADL (Lawton-Brody scale) (A2, A3, A4, A6, A7, A10, A12, A16, A18); - Activities of daily living - ADL (Katz Index) (A3, A4, A5, A6, A7, A10, A12, A18); - Pfeffer´s Functional Activities Questionnaire (FAQ) (A3); - Barthel Index(A8, A18); - Clinical Frailty Scale (CFS) (A15);
	MOBILITY - Timed Up-and-Go Test (A3, A12); - Romberg Test (A3); - Nudge Test (A3); - Single Leg Stance Test (A3); - 6-minute Walk Test (A3); - Get Up-and-Go Test (A2, A3, A10); - 400 m Walk (A7); - Grasp, handgrip and pinch (A3, A4, A7, A16); - 6-meter walk test (6MWT) (A16); - Tinetti test (A19); - Daily micturition test (A3);
	COMMUNICATION - Snellen test (A3, A7, A10, A16); - Whisper Test (A3, A7, A10); - Finger friction (A10); - Newspaper or magazine reading at 25 cm (A3); - Assessment of voice, speech and swallowing (A3); - Hearing Handicap Inventory for the Elderly (A19);
Instruments developed for CGA applicable to primary care by dimension	NUTRITION - Mini-assessment of Nutrition (MAN) (A3); - Body Mass Index (BMI) (A4, A10, A12, A16); - Nutritional Health Checklist (A12);
	FALLS - Environmental fall risk assessment (A3); SLEEP - Sleep diary (A10).
Multidimensional instruments developed for CGA applicable to primary care	- Vulnerable Elders Survey (VES-13) (A3); - Clinical-Functional Vulnerability Index-20 (IVCF-20) (A3); - Frailty Visual-Analogue Scale (A3); - “Avaliação Multidimensional do Idoso Hierarquizada”-Hierarchical Multidimensional Geriatric Assessment (A3); - Moore & Siu (A4); - Avaliação Rápida Multidimensional da Pessoa Idosa (ARMI) Rapid Multidimensional Geriatric Assessment (A4); - RAPIDO (Rastreamento de Problemas de Idosos) Geriatric Problem Screening (A4); - MAGIC Questionnaire (A5, A16); - EQ-5D-5L Questionnaire (A5); - Avaliação Multidimensional de Pessoas Idosas (AMPI-AB) – Multidimensional Assessment of Older People (A6, A7); - Examen de medicina preventiva del adulto mayor (EMPAM) – (A8); - Self-administered Questionnaire (A9); - Self-assessment Questionnaires (A10); - FRAIL (frailty screening) (A15); - Brief Geriatric Assessment (BGA) (A16); - The Functional Autonomy Measurement System (SMAF) (A19).
Information Technology used to implement CGA	- Postal-based screening (A9, A19, A14); - Telephone-based approaches (A6, A10).
Relevant findings on practice of CGA in primary care	- Not all older people should undergo comprehensive evaluation using CGA. The assessment should be given to those at higher risk of disability (A3, A4); - Rapid screening and assessment instruments and strategies should be used (A13, A15); tests should be simple and suitable for use in routine practice (A5) - There are difficulties incorporating CGA into the routine of primary care professionals (A10, A12, A16); - Tools and scales can support, but not replace, clinical judgment (A18) - For cognitively impaired older people attending consultations alone, family members or caregivers can take part in some of the interview via telephone conference call (A10).

Universidade do Estado do Rio Janeiro Rua São Francisco Xavier, 524 - Bloco F, 20559-900 Rio de Janeiro - RJ Brasil, Tel.: (55 21) 2334-0168 - Rio de Janeiro - RJ - Brazil
E-mail: revistabgg@gmail.com

Acompanhe os números deste periódico no seu leitor de RSS

[1] Correspondence Ricardo Bezerra Cavalcante ricardo.cavalcante@ufjf.br