Comprehensive geriatric assessment in elderly outpatients with dementia

Aliberti, Márlon Juliano Romero; Kikuchi, Elina Lika; Magaldi, Regina Miksian; Paschoal, Sérgio Márcio Pacheco; Jacob Filho, Wilson

doi:10.1590/S1980-57642008DN10300013

Abstract

Dementia is a common disabling disease in the elderly. In such patients, general health conditions may worsen the functional decline and loss of autonomy. The Comprehensive Geriatric Assessment (CGA) is a validated and recommended instrument for multidimensional evaluation of the aged. Nonetheless, it has yet to be assessed in demented patients. Objectives: To analyze the functional, emotional and clinical status in elderly with dementia measured by the CGA. We also compared the results obtained in the same patients stratified for severity of dementia. Methods: Transversal study with demented elderly outpatients. Subjects were evaluated by the CGA consisting of clinical data, Clinical Dementia Rating, performance-oriented mobility assessment of gait and balance (POMA), Cornell scale for depression, activities of daily living, Mini Mental Status Examination (MMSE), Mini Nutritional Assessment, Whispered and Snellen Test. Results: Fifty-two patients with mean age of 77 years were evaluated. Majority of patients had Alzheimer disease (77%). Depression was the most prevalent comorbidity. The POMA score was related to the number of falls in the previous year. Also, there was correlation between complaints of visual and hearing impairment and the results on the Snellen and Whispered Tests. Regarding severity, 56% presented mild, 33% moderate and 11% severe condition. Patients with moderate/severe dementia had less leisure activities, greater risk of falls, along with worse performance on the MMSE, POMA and activities of daily living. Conclusions: The CGA was applied in demented elderly with the help of their caregivers, and was able to better characterize patient state of health. Subjects with moderate/severe dementia obtained poor results in several assessed criteria.

Key words:
elderly; dementia; geriatric assessment.

Resumo

Demência é uma doença comum e incapacitante entre os idosos. Nesses pacientes, condições gerais de saúde podem agravar ainda mais o declínio funcional e a perda da autonomia. A Avaliação Geriátrica Global (AGG) é um instrumento validado e recomendado para uma abordagem multidimensional do idoso, porém, ainda pouco estudada em pacientes com demência. Objetivo: Analisar o estado funcional, emocional e clínico dos idosos portadores de demência através da aplicação da AGG. Nós também comparamos os resultados obtidos nos mesmos pacientes classificados de acordo com a gravidade da demência. Métodos: Estudo transversal com idosos ambulatoriais portadores de demência. Eles, acompanhados de seus cuidadores, foram submetidos à AGG que constava de dados clínicos, escore clínico de demência, escala do equilíbrio e marcha de Tinetti (EEMT), escala de Cornell para depressão, atividades de vida diária, mini exame do estado mental (MEEM), mini avaliação nutricional e Testes do Sussurro e Snellen. Resultados: Cinqüenta e dois idosos com idade média de 77 anos. A maioria possuía doença de Alzheimer (77%). A comorbidade mais prevalente foi depressão. A pontuação na EEMT relacionou-se com o número de quedas no último ano. Houve também correlação entre a queixa de déficit auditivo e visual com os resultados dos Testes do Sussurro e Snellen. Em relação à gravidade obteve-se: 56% leve, 33% moderada e 11% grave. Os pacientes com demência moderada/grave apresentaram menos atividades de lazer, maior risco para quedas, pior desempenho no MEEM, na EEMT e nas atividades de vida diária. Conclusões: A AGG foi realizada nos idosos portadores de distúrbios cognitivos com o auxílio do cuidador, e foi capaz de caracterizar melhor o estado geral de saúde desses pacientes. Indivíduos com demência moderada/grave obtiveram piores resultados em diversos critérios avaliados.

Palavras-chave:
idoso; demência; avaliação geriátrica.

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References

¹
Rubenstein LV, Calkins DR, Greenfield S, et al. Health status assessment for elderly patients. Report of the Society of General Internal Medicine Task Force on Health Assessment. J Am Geriatr Soc 1989;37:562-569.
²
Ramos LR. Epidemiologia do Envelhecimento. In: Freitas EV, Py L, Neri AL, et al., editors. Tratado de Geriatria e Gerontologia. Rio de Janeiro: Guanabara-Koogan; 2002:72-78.
³
Machado JCB. Doença de Alzheimer. In: Freitas EV, Py L, Neri AL, et al., editors. Tratado de Geriatria e Gerontologia . Rio de Janeiro: Guanabara-Koogan ; 2002:133-147.
⁴
Doraiswamy M. Prevalence and impact of medical comorbidity in Alzheimer's disease. J Gerontol A Biol Sci Med Sci 2002;57:M173-77.
⁵
Bynum JPW, Rabins PV, Weller W, Niefeld M, Anderson GF, Wu AW. The relationship between a dementia diagnosis, chronic illness, medicare expenditures, and hospital use. J Am Geriatr Soc 2004;52:187-194.
⁶
Hill JW, Futterman R, Duttagupta S, Mastey V, Lloyd JR, Fillit H. Alzheimer's disease and related dementias increase costs of comorbidities in managed Medicare. Neurology 2002; 58:62-70.
⁷
Brauner DJ, Muir JC, Sachs GA. Treating nondementia illnesses in pacientes with dementia. JAMA 2002; 283:3230-3235.
⁸
Bowen JD, Malter AD, Sheppard L, et al. Predictors of mortality in patients diagnosed with probable Alzheimer's disease. Neurology 1996;47:433-439.
⁹
Solomon D, Brown AS, Brummel-Smith K, et al. National Institutes of Health Consensus Development Conference Statement: Geriatric Assessment Methods for Clinical Decision-Making. J Am Geriatr Soc 2003;51:1490-1494.
¹⁰
Devons, CAJ. Comprehensive geriatric assessment: making the most of the aging years. Curr Opin Clin Nutr Metab Care 2002;5:19-24.
¹¹
Ellis G, Langhorne P. Comprehensive geriatric assessment for older hospital patients. Br Med Bull 2005;71:45-59.
¹²
Costa, EFA, Monego ET . Avaliação Geriátrica Ampla (AGA). Revista da UFG (online) 2003 Dez; 2(5). Available in: http://www.proec.ufg.br
» http://www.proec.ufg.br
¹³
Morris JC. The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology 1993;43:2412-2414.
¹⁴
Tinetti ME. Performance-oriented assessment of mobility problems in elderly patients. J Am Geriatr Soc 1986;34:119-126.
¹⁵
Alexopoulos GS, Abrams RC, Young RC, Shamoian CA. Cornell Scale for Depression in Dementia. Biol Psychiatry 1988;23:271-284.
¹⁶
Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged. The index of ADL. A standardized measure of biological and psychosocial function. JAMA 1963; 185:94-99.
¹⁷
Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969;9:179-186.
¹⁸
Almeida OP. Mini mental state examination and the diagnosis of dementia in Brazil. Arq Neuropsiquiatr 1998;56:605-612.
¹⁹
Guigoz Y, Vellas B, Garry PJ. Mini nutritional assessment: A Practical Assessment Tool for Grading the Nutritional State of Elderly Patients. Facts Res Gerontol?(suppl nutrition) 1994;2:15-59.
²⁰
Associação Médica Brasileira. Classificação Brasileira Hierarquizada de Procedimentos Médicos, 4ª ed. Pub. L. No. 85-89073-03-03, em setembro de 2005.
²¹
Rollason V, Vogt N. Reduction of Polypharmacy in the Elderly. Drugs Aging 2003;20:817-832.
²²
Tariot P. Medical management of advanced dementia. J Am Geriatr Soc 2003;51:S305-313.
²³
Chaves MLF. Diagnóstico diferencial das doenças demenciantes. In: Caramelli PC, Forlenza OV, editors. Neuropsiquiatria Geriátrica. São Paulo: Atheneu; 2000:81-104.
²⁴
Camarano AA. Envelhecimento da População Brasileira: Uma Contribuição Demográfica. In: Freitas EV, Py L, Neri AL, et al., editors. Tratado de Geriatria e Gerontologia . Rio de Janeiro: Guanabara-Koogan ; 2002:58-71.
²⁵
Avorn J. Polypharmacy: A New Paradigm for Quality Drug Therapy in the Elderly? Arch Intern Med 2004;164:1957-1959.
²⁶
Fu C, Chute DJ, Farag ES. Comorbidity in dementia. Arch Pathol Lab Med 2004;128:32-38.
²⁷
Gross PA, Hermogenes AW, Sacks HS, Lau J, Levandowski R. The efficacy of influenza vaccine in elderly persons: A meta-analysis and review of the literature. Ann Intern Med 1995;123:518-527.
²⁸
Ministério da Saúde/Secretaria de Vigilância em Saúde/Departamento de Vigilância Epidemiológica/Coordenação Geral do Programa Nacional de Imunizações. Informe Técnico, 2006. Campanha Nacional de Vacinação do Idoso (on line). Available in: www.sbgg.org.br/profissional/artigos/pdf/informe.pdf
» www.sbgg.org.br/profissional/artigos/pdf/informe.pdf
²⁹
van Doorn C, Gruber-Baldini AL, Zimmerman S, et al. Dementia as risk factor for falls and fall injuries among nursing home residents. J Am Geriatr Soc 2003;51:1213-1218.
³⁰
Cunha UGV, Scoralick FM, Silva AS. Depressão e Demência: Diagnóstico Diferencial. In: Freitas EV, Py L, Neri AL, et al., editors. Tratado de Geriatria e Gerontologia . Rio de Janeiro: Guanabara-Koogan ; 2002:165-167.
³¹
Forlenza OV. Transtornos depressivos na doença de Alzheimer. In: Caramelli PC, Forlenza OV, editors. Neuropsiquiatria Geriátrica . São Paulo: Atheneu ; 2000:189-200.
³²
Desai AK, Grossberg GT, Sheth DN. Activities of Daily Living in Patients with Dementia. CNS Drugs 2004;18:853-872.
³³
Morris J, Volicer L. Nutricional management of individuals with Alzheimer's disease and other progressive dementias. Nutr Clin Care 2001;4:148-155.
³⁴
Reyes-Ortega G, Guyonnet S, Ousset PJ. Weigth loss in Alzheimer's disease and resting energy expenditure (REE), a preliminary report. J Am Geriatr Soc 1997;45:1414-1415.
³⁵
Covinski KE, Yaffe K. Dementia, prognosis and the needs of patients and caregivers. Ann Intern Med 2004;140:573-575.
³⁶
Banerjee S, Smith SC, Lamping DL, Harwood RH, Foley B, Smith P. Quality of life in dementia: more than just cognition. J Neurol Neurosurg Psychiatry 2006;77:146-148.

Publication Dates

Publication in this collection
Jul-Sep 2007

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
Rubenstein LV, Calkins DR, Greenfield S, et al. Health status assessment for elderly patients. Report of the Society of General Internal Medicine Task Force on Health Assessment. J Am Geriatr Soc 1989;37:562-569.

[2] ²
Ramos LR. Epidemiologia do Envelhecimento. In: Freitas EV, Py L, Neri AL, et al., editors. Tratado de Geriatria e Gerontologia. Rio de Janeiro: Guanabara-Koogan; 2002:72-78.

[3] ³
Machado JCB. Doença de Alzheimer. In: Freitas EV, Py L, Neri AL, et al., editors. Tratado de Geriatria e Gerontologia . Rio de Janeiro: Guanabara-Koogan ; 2002:133-147.

[4] ⁴
Doraiswamy M. Prevalence and impact of medical comorbidity in Alzheimer's disease. J Gerontol A Biol Sci Med Sci 2002;57:M173-77.

[5] ⁵
Bynum JPW, Rabins PV, Weller W, Niefeld M, Anderson GF, Wu AW. The relationship between a dementia diagnosis, chronic illness, medicare expenditures, and hospital use. J Am Geriatr Soc 2004;52:187-194.

[6] ⁶
Hill JW, Futterman R, Duttagupta S, Mastey V, Lloyd JR, Fillit H. Alzheimer's disease and related dementias increase costs of comorbidities in managed Medicare. Neurology 2002; 58:62-70.

[7] ⁷
Brauner DJ, Muir JC, Sachs GA. Treating nondementia illnesses in pacientes with dementia. JAMA 2002; 283:3230-3235.

[8] ⁸
Bowen JD, Malter AD, Sheppard L, et al. Predictors of mortality in patients diagnosed with probable Alzheimer's disease. Neurology 1996;47:433-439.

[9] ⁹
Solomon D, Brown AS, Brummel-Smith K, et al. National Institutes of Health Consensus Development Conference Statement: Geriatric Assessment Methods for Clinical Decision-Making. J Am Geriatr Soc 2003;51:1490-1494.

[10] ¹⁰
Devons, CAJ. Comprehensive geriatric assessment: making the most of the aging years. Curr Opin Clin Nutr Metab Care 2002;5:19-24.

[11] ¹¹
Ellis G, Langhorne P. Comprehensive geriatric assessment for older hospital patients. Br Med Bull 2005;71:45-59.

[12] ¹²
Costa, EFA, Monego ET . Avaliação Geriátrica Ampla (AGA). Revista da UFG (online) 2003 Dez; 2(5). Available in: http://www.proec.ufg.br
» http://www.proec.ufg.br

[13] ¹³
Morris JC. The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology 1993;43:2412-2414.

[14] ¹⁴
Tinetti ME. Performance-oriented assessment of mobility problems in elderly patients. J Am Geriatr Soc 1986;34:119-126.

[15] ¹⁵
Alexopoulos GS, Abrams RC, Young RC, Shamoian CA. Cornell Scale for Depression in Dementia. Biol Psychiatry 1988;23:271-284.

[16] ¹⁶
Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged. The index of ADL. A standardized measure of biological and psychosocial function. JAMA 1963; 185:94-99.

[17] ¹⁷
Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969;9:179-186.

[18] ¹⁸
Almeida OP. Mini mental state examination and the diagnosis of dementia in Brazil. Arq Neuropsiquiatr 1998;56:605-612.

[19] ¹⁹
Guigoz Y, Vellas B, Garry PJ. Mini nutritional assessment: A Practical Assessment Tool for Grading the Nutritional State of Elderly Patients. Facts Res Gerontol?(suppl nutrition) 1994;2:15-59.

[20] ²⁰
Associação Médica Brasileira. Classificação Brasileira Hierarquizada de Procedimentos Médicos, 4ª ed. Pub. L. No. 85-89073-03-03, em setembro de 2005.

[21] ²¹
Rollason V, Vogt N. Reduction of Polypharmacy in the Elderly. Drugs Aging 2003;20:817-832.

[22] ²²
Tariot P. Medical management of advanced dementia. J Am Geriatr Soc 2003;51:S305-313.

[23] ²³
Chaves MLF. Diagnóstico diferencial das doenças demenciantes. In: Caramelli PC, Forlenza OV, editors. Neuropsiquiatria Geriátrica. São Paulo: Atheneu; 2000:81-104.

[24] ²⁴
Camarano AA. Envelhecimento da População Brasileira: Uma Contribuição Demográfica. In: Freitas EV, Py L, Neri AL, et al., editors. Tratado de Geriatria e Gerontologia . Rio de Janeiro: Guanabara-Koogan ; 2002:58-71.

[25] ²⁵
Avorn J. Polypharmacy: A New Paradigm for Quality Drug Therapy in the Elderly? Arch Intern Med 2004;164:1957-1959.

[26] ²⁶
Fu C, Chute DJ, Farag ES. Comorbidity in dementia. Arch Pathol Lab Med 2004;128:32-38.

[27] ²⁷
Gross PA, Hermogenes AW, Sacks HS, Lau J, Levandowski R. The efficacy of influenza vaccine in elderly persons: A meta-analysis and review of the literature. Ann Intern Med 1995;123:518-527.

[28] ²⁸
Ministério da Saúde/Secretaria de Vigilância em Saúde/Departamento de Vigilância Epidemiológica/Coordenação Geral do Programa Nacional de Imunizações. Informe Técnico, 2006. Campanha Nacional de Vacinação do Idoso (on line). Available in: www.sbgg.org.br/profissional/artigos/pdf/informe.pdf
» www.sbgg.org.br/profissional/artigos/pdf/informe.pdf

[29] ²⁹
van Doorn C, Gruber-Baldini AL, Zimmerman S, et al. Dementia as risk factor for falls and fall injuries among nursing home residents. J Am Geriatr Soc 2003;51:1213-1218.

[30] ³⁰
Cunha UGV, Scoralick FM, Silva AS. Depressão e Demência: Diagnóstico Diferencial. In: Freitas EV, Py L, Neri AL, et al., editors. Tratado de Geriatria e Gerontologia . Rio de Janeiro: Guanabara-Koogan ; 2002:165-167.

[31] ³¹
Forlenza OV. Transtornos depressivos na doença de Alzheimer. In: Caramelli PC, Forlenza OV, editors. Neuropsiquiatria Geriátrica . São Paulo: Atheneu ; 2000:189-200.

[32] ³²
Desai AK, Grossberg GT, Sheth DN. Activities of Daily Living in Patients with Dementia. CNS Drugs 2004;18:853-872.

[33] ³³
Morris J, Volicer L. Nutricional management of individuals with Alzheimer's disease and other progressive dementias. Nutr Clin Care 2001;4:148-155.

[34] ³⁴
Reyes-Ortega G, Guyonnet S, Ousset PJ. Weigth loss in Alzheimer's disease and resting energy expenditure (REE), a preliminary report. J Am Geriatr Soc 1997;45:1414-1415.

[35] ³⁵
Covinski KE, Yaffe K. Dementia, prognosis and the needs of patients and caregivers. Ann Intern Med 2004;140:573-575.

[36] ³⁶
Banerjee S, Smith SC, Lamping DL, Harwood RH, Foley B, Smith P. Quality of life in dementia: more than just cognition. J Neurol Neurosurg Psychiatry 2006;77:146-148.

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