The Development of Geriatric Assessment and Intervention Guidelines for an Online Geriatric Assessment Tool: A Canadian Modified Delphi Panel Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Expert Panel
2.3. Data Analysis
2.4. Ethics
3. Results
3.1. Round One
3.2. Round Two
3.3. Round Three
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
Geriatric Domain | Tool Names and Recommendations Included | Round 1 Results % IMPortant/FEASible | Round 2 Results % IMPortant/FEASible | Round 3 Results % IMPortant/FEASible |
---|---|---|---|---|
Functional status assessment tools | Lawton IADL | IMP 74.2 FEAS 50.0 | FEAS 48.4 | FEAS 63.3 |
OARS IADL new item based on feedback | - | IMP 64.5 FEAS 51.6 | Excluded * | |
Katz ADL | IMP 70.0 FEAS 54.8 | IMP 67.7 FEAS 48.8 | Excluded * | |
Karnofsky Performance status | IMP 40.6 FEAS 50.0 | Excluded * | ||
Functional status management recommendations | Referral to a physiotherapist or other exercise professional for strength and balance training and/or general conditioning with positive screening for poor functional status | IMP 62.5 FEAS 6.3 | Excluded * | |
Referral to an occupational therapist for assistive device evaluation when positive screening for poor functional status | IMP 71.9 FEAS 12.5 | Excluded * | ||
Referral to an occupational therapist for home safety evaluation with screening for poor functional status | IMP 71.9 FEAS 18.8 | Excluded * | ||
Referral to a multidisciplinary program (i.e., geriatric exercise program, falls prevention program, cancer rehab and survivorship) with positive screening for poor functional status | IMP 62.5 FEAS 6.3 | Excluded * | ||
Referral to a social worker with positive screening for poor functional status | IMP 50.0 FEAS 28.1 | Excluded * | ||
Referral to PT/OT/SW for IADL impairments (depending the specific impairment), reworded item based on feedback | - | IMP 67.7 FEAS 29.0 | IMP 86.4 FEAS 68.2 | |
Referral to PT/OT/SW for ADL impairment (depending on the specific impairment), reworded item based on feedback | - | IMP 86.7 FEAS 40.0 | Excluded as KATZ ADL was excluded | |
Comorbidities assessment | Self-report version of the Charlson Comorbidity Index | IMP 50.0 FEAS 18.8 | IMP 43.8 FEAS 34.4 | IMP 9.1 FEAS 0.0 |
Comorbidities management recommendation | Referral for a comprehensive medication review to optimize medications in the context of multiple comorbidities | IMP 90.6 FEAS 18.8 | FEAS 34.4 | FEAS 23.8 |
Referral of patient with high number of comorbidities (cut-off to be defined) to family physician, internal medicine specialist/geriatrician for assessment and optimization. New item based on feedback | - | IMP 51.6 FEAS 15.6 | Excluded | |
Mobility/ falls assessment | Number of falls in the last 12 months | IMP 59.4 FEAS 81.3 | Excluded * | |
Number of falls in the last 6 months | IMP 66.7 FEAS 84.4 | IMP 75.0 | ||
Use of mobility devices | IMP 81.3 FEAS 87.5 | |||
Mobility/ falls management Recommendations | Recommend measuring postural vitals if ≥1 falls, in round 2/3 recommended for ≥2 falls | IMP 68.8 FEAS 50.0 | IMP 65.6 FEAS 40.6 | IMP 91.3 FEAS 87.0 |
Referral for more comprehensive fall assessment if ≥1 falls, in round 2/3 recommended for ≥2 falls | IMP 62.5 FEAS 15.6 | IMP 71.9 FEAS 9.4 | FEAS 73.9 | |
Referral to physiotherapist for mobility and balance if ≥1 falls or poor mobility, in round 2 referral to PT/OT for assessment and management of ≥2 falls | IMP 62.5 FEAS 21.9 | IMP 68.8 FEAS 31.3 | IMP 81.2 FEAS 68.2 | |
Referral to occupational therapist for mobility assist devices if ≥1 falls or poor mobility | IMP 60.0 FEAS 21.9 | Excluded * | ||
Referral for multidisciplinary falls prevention program for >1 falls or poor mobility | IMP 53.1 FEAS 9.4 | Excluded * | ||
Referral for home safety evaluation for ≥1 falls or poor mobility | IMP 53.1 FEAS 12.5 | Excluded * | ||
Referral to a home exercise program for ≥1 falls or poor mobility | IMP 50.0 FEAS 15.6 | Excluded * | ||
Check and supplement if vitamin D level <50 nmol/L for ≥1 falls or poor mobility. | IMP 31.3 FEAS 56.3 | IMP 28.1 FEAS 37.5 | Excluded | |
Review of medications ≥1 falls or poor mobility | IMP 78.1 FEAS 37.5 | FEAS 31.3 | FEAS 61.9 | |
Cognitive impairment assessment | Screen every patient for cognitive impairment with a short validated screening tool (e.g., Mini-Cog) | IMP 78.1 FEAS 35.5 | FEAS 40.6 | FEAS 73.9 |
Screen patients with cognitive complaints with screening tool such as Mini-Cog | IMP43.8 FEAS 32.2 | IMP 60.9 FEAS 36.4 | Excluded * | |
Which cognitive function tool should be used:
|
| All excluded except Mini-Cog * | ||
Cognitive impairment management recommendations | Assess decision making capacity if CI is detected | IMP 68.8 FEAS 21.9 | Excluded * | |
Recommendation to involve proxy in treatment decision-making if CI is detected | IMP 59.4 FEAS 21.9 | Excluded * | ||
Review all medications if CI is detected | IMP 81.3 FEAS 46.9 | - FEAS 43.8 | - FEAS 82.6 | |
Recommend Delirium risk counselling if CI is detected | IMP 59.4 FEAS 31.3 | Excluded * | ||
Referral to social work if CI is detected | IMP 40.6 FEAS 31.3 | Excluded * | ||
Referral for more detailed neuropsychological testing including a geriatric clinic or memory clinic if CI is detected | IMP 75.0 FEAS 16.1 | FEAS 18.8 | - FEAS 56.5 | |
Referral for cognitive rehabilitation if CI is detected | IMP 28.1 FEAS 3.1 | Excluded | ||
Nutritional status assessment | 5% weight loss in past 6 months | IMP 56,3 FEAS 62.5 | IMP 34.4 FEAS 34.4 | |
2–5% weight loss or BMI < 20 or reduced muscle mass | IMP 31.3 FEAS 25.8 | Excluded * | ||
Loss of 10% of body weight past 6 months | IMP 68.8 FEAS 71.9 | IMP 75.0 | ||
Self-report height and weight to calculate BMI and identify those with BMI < 21 | IMP 45.2 FEAS 33.3 | IMP 28.1 FEAS 21.9 | ||
Mini-nutritional assessment | IMP 40.6 FEAS 18.8 | IMP 18.8 FEAS 9.4 | ||
Nutritional status management recommendations | Referral to dietician for those with poor nutritional status | IMP 80.7 FEAS 37.5 | FEAS 37.5 | - FEAS 82.6 |
Referral meal delivery program for those with poor nutritional status | IMP 43.8 FEAS 12.5 | IMP 28.1 FEAS 25.8 | ||
Recommendations for nutritional supplements for those with poor nutritional status | IMP 62.5 FEAS 50.0 | IMP 59.4 FEAS 45.2 | IMP 54.6 FEAS 78.3 | |
Referral to social worker for those with poor nutritional status | IMP 15.6 FEAS 12.5 | Excluded | ||
Referral to physiotherapist for those with poor nutritional status | IMP 3.2 FEAS 6.3 | Excluded | ||
Referral to occupational therapist for those with poor nutritional status | IMP 9.4 FEAS 6.3 | Excluded | ||
Referral cancer rehabilitation program for those with poor nutritional status | IMP 25.8 FEAS 0.0 | Excluded | ||
Medication review assessment | Patients list the names and dosage of prescribed and over the counter medication for medication review, in round 2 changed to patients to list names of all prescribed medications, over the counter and supplements | IMP 78.1 FEAS 23.3 | - FEAS 18.8 | Excluded * |
Should patients list the dosage of all prescribed and over the counter medications and supplements? Reworded item based on feedback | IMP 56.3 FEAS 9.4 | Excluded * | ||
Do you receive help taking your medication? | IMP 78.1 FEAS 68.8 | - FEAS 81.3 | ||
Do you use a blister pack/dosette? | IMP 71.9 FEAS 71.9 | |||
In the past month, have you forgotten to take your medication as prescribed? | IMP 53.1 FEAS 53.1 | IMP 50.0 FEAS 59.4 | Excluded * | |
Patient to list names and address of the pharmacy/ies they use | IMP 68.8 FEAS 43.8 | IMP 68.8 FEAS 34.4 | IMP 72.7 FEAS 68.2 | |
Patient to list number of different medications they take on a regular basis | IMP 37.5 FEAS 28.1 | Excluded * | ||
Medication review management recommendations | Flag potential problematic medications with the Beers list | IMP 84.4 FEAS 37.5 | Excluded * | |
Recommend use of blister pack/dosette if patient indicates they sometimes forget their medication | IMP 84.4 FEAS 48.4 | - FEAS 50.0 | - FEAS 42.9 | |
Recommend blister pack/dosette if patient is on a complex regimen (e.g., 5+ daily medications) | IMP 68.8 FEAS 46.9 | IMP 56.3 FEAS 58.1 | - FEAS 50.0 | |
Recommend consultation with a pharmacist when the patient uses a certain number of medications (i.e., 10+) | IMP 75.0 FEAS 43.8 | - FEAS 37.5 | - FEAS 68.8 | |
Social support/ circumstances assessment | Should the MOS Social Support Scale 8-items be used to assess social support? In round 2, MOS-4 item was used. | IMP 53.1 FEAS 21.9 | IMP 40.6 FEAS 21.9 | IMP 33.3 FEAS 38.1 |
Do you feel safe at home? | IMP 37.5 FEAS 60.0 | IMP 40.6 FEAS 58.1 | Excluded * | |
Do you have the financial ability to pay all bills? | IMP 56.3 FEAS 59.4 | IMP 43.8 FEAS 37.5 | Excluded * | |
Should marital status be asked to assess social support? | IMP 59.4 FEAS 78.1 | Excluded * | ||
Should patients be asked about their living situation to assess social supports? | IMP 87.5 FEAS 84.4 | |||
Should the patient be asked the type and amount of current home services | IMP 75.0 FEAS 65.6 | - FEAS 65.6 | - FEAS 80.0 | |
Social support management recommendations | Referral to social worker to help identify community resources | IMP 90.6 FEAS 43.8 | - FEAS 50.0 | - FEAS 76.2 |
Referral to peer support program | IMP 50.0 FEAS 21.9 | Excluded * | ||
Referral to community-based cancer support program | IMP 50.0 FEAS 25.0 | Excluded * | ||
Referral for transportation support based on MOS-8 score of needing instrumental support | IMP 71.0 FEAS 29.0 | - FEAS 18.8 | Excluded * | |
Referral to home care based on MOS-8 score of needing instrumental ADL support | IMP 78.1 FEAS 37.5 | - FEAS 40.6 | - FEAS 87.5 | |
Depression assessment | Use PHQ-2 and if positive use PHQ-9 | IMP 56.3 FEAS 31.3 | IMP 48.4 FEAS 22.5 | IMP 85.7 FEAS 81.0 |
Distress thermometer | IMP 34.4 FEAS 25.0 | Excluded | ||
GDS-15 | IMP 50.0 FEAS 34.4 | IMP 32.3 FEAS 12.9 | ||
Depression recommendations | Referral to psychosocial oncology for counseling and/or medication if patient has depressive symptoms | IMP 87.1 FEAS 38.7 | - FEAS 28.1 | - FEAS 81.0 |
Referral to peer support program if patient has depressive symptoms | IMP 43.8 FEAS 25.0 | Excluded * | ||
Referral to community-based cancer support program if patient has depressive symptoms | IMP 50.0 FEAS 21.9 | Excluded * | ||
Counsel patient on benefits of exercise, music, peer support, mindfulness, and sleeping patterns when the patient has depressive symptoms | IMP 71.9 FEAS 25.0 | - FEAS 22.6 | - FEAS 81.0 | |
Risk prediction | Include VES-13 for risk prediction | IMP 46.7 FEAS 36.7 | Excluded * | |
Include G8 for risk prediction | IMP 40.0 FEAS 36.7 | Excluded * | ||
Substance use disorder assessment | The Short Michigan Alcohol Screen Test-Geriatric (SMAST-G) | IMP 18.8 FEAS 15.6 | Excluded | |
The Senior Alcohol Misuse Indicator (SAMI) | IMP 12.5 FEAS 6.3 | Excluded | ||
CAGE-AID screening tool | IMP 31.3 FEAS 25.0 | IMP 28.1 FEAS 28.1 | Excluded | |
Alcohol Use Disorders Identification Test (AUDIT) | IMP 6.3 FEAS 6.3 | Excluded | ||
Should the patient be asked how many alcoholic drinks per week they consume? New item based on feedback | IMP 68.8 FEAS 62.5 | IMP 81.0 FEAS 81.0 | ||
Miscellaneous | Should patients be asked about their current smoking status? | IMP 81.3 FEAS 80.0 | ||
Include 1-item self-reported hearing difficulty | IMP 71.9 FEAS 71.9 | |||
Include 1-item self-reported vision difficulty | IMP 71.9 FEAS 62.5 | - FEAS 54.8 | - FEAS 75.0 | |
Should a patient be asked how much cannabis they consume? New item included by Delphi panel experts | IMP 69.2 FEAS 76.9 |
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Characteristic | Round 1 and 2 (Same Experts) | Round 3 (Same Experts but Smaller Panel) | ||
---|---|---|---|---|
N | % | N | % | |
Gender | ||||
Female | 19 | 59.4 | 14 | 60.9 |
Male | 13 | 40.6 | 9 | 39.1 |
Age | ||||
≤45 years | 16 | 50.0 | 12 | 52.2 |
46–55 years | 9 | 28.1 | 6 | 26.1 |
>55 years | 7 | 21.9 | 5 | 21.7 |
Medical Designation | ||||
Medical Doctor | 24 | 75 | 16 | 69.6 |
Registered Nurse | 7 | 21.9 | 6 | 26.1 |
Other | 1 | 3.1 | 1 | 4.3 |
Discipline | ||||
Medical Oncology | 10 | 31.3 | 5 | 21.7 |
Radiation Oncology | 4 | 12.5 | 2 | 8.7 |
Surgical Oncology | 3 | 9.4 | 3 | 13.0 |
Geriatric Medicine | 7 | 21.9 | 6 | 26.1 |
Other | 8 | 25 | 7 | 30.4 |
% Patients 70+ | ||||
<25% | 1 | 3.2 | 1 | 4.6 |
26–50% | 6 | 19.4 | 6 | 27.3 |
51–75% | 13 | 41.9 | 6 | 27.3 |
76–100% | 11 | 35.5 | 9 | 40.9 |
Missing | 1 | 1 | ||
% of Patients Considered Frail in Their Practice | ||||
<10% | 4 | 12.9 | 3 | 13.6 |
10–25% | 6 | 19.4 | 4 | 18.2 |
26–50% | 13 | 41.9 | 8 | 36.4 |
>50% | 8 | 25.8 | 7 | 31.8 |
Missing | 1 | 1 | ||
Use Geriatric Screening Tools | ||||
At least half the time | 7 | 21.2 | 6 | 27.3 |
Some of the time or rarely | 24 | 72.7 | 16 | 72.7 |
Missing | 1 | 1 | ||
Clinical Experience with Older Adults | ||||
0–5 years | 6 | 19.4 | 4 | 18.2 |
6–10 years | 9 | 29.0 | 8 | 36.4 |
11–20 years | 10 | 30.3 | 7 | 31.8 |
>20 years | 6 | 18.1 | 3 | 13.0 |
Missing | 1 | 1 | ||
Initial Health Professional Training | ||||
Yes | 16 | 53.3 | 13 | 61.9 |
No | 14 | 46.7 | 8 | 38.1 |
Missing | 2 | 2 | ||
Graduate Training (e.g., PhD, MSc, NP) | ||||
Yes | 5 | 18.2 | 5 | 25 |
No | 22 | 81.5 | 15 | 75 |
Missing | 5 | 3 | ||
Post-Grad Training | ||||
Yes | 11 | 36.7 | 8 | 36.4 |
No | 19 | 63.3 | 14 | 63.6 |
Missing | 2 | 1 |
Geriatric Assessment Domain | Indicators Accepted for Importance and Feasibility |
---|---|
Functional status assessment tool | None |
Functional status management recommendation | None |
Comorbidity assessment tool | None |
Comorbidity management recommendation | None |
Mobility/Falls assessment | Do you use any mobility devices? |
How many falls have you had in the last 6 months? | |
Mobility/Falls management recommendation | Recommend measurement of postural vitals for someone screens positive for 2 or more falls in the last 6 months (especially if accompanied by dizziness or use of blood pressure lowering drugs) |
Consider a referral for a more detailed falls risk assessment for someone with positive screening for 2 or more falls in the last 6 months | |
Cognitive function assessment | Screen all older patients for cognitive impairment with the Mini-Cog |
Cognitive function management recommendation | Recommend review of medications if cognitive impairment is detected (to reduce medication regime complexity and/or minimize medications that can adversely impact cognition) |
Nutrition assessment | Have you lost 10% of your body weight (about 10–15 pounds) or more during the last 6 months? |
Nutrition management recommendation | Referral to a dietician (hospital-based or community-based) if a patient demonstrates nutrition risk (as defined by a weight loss of 10% or more in the last 6 months) |
Medication review assessment | Do you receive help taking your medication? |
Do you use a blister pack/dosette? | |
Medication review management recommendation | None |
Social support assessments | Patients should be asked their current living situation to assess social support |
Patients should be asked the type and amount of current home services being utilized | |
Social support management recommendation | Referral for home care be recommended if a patient identifies as needing instrumental ADL support (from the MOS-4 item scale)? |
Referral to social work to help identify community resources and supports if a patient has limited social support | |
Depression assessment | The PHQ-2 should be used for all older adults and if positive the PHQ-9 be completed |
Depression management recommendation | A referral to the family physician for further assessment or a referral to psychosocial oncology (social worker, psychology, psychiatry) for counselling or medication if a patient has depressive symptoms |
Substance use disorders and Miscellaneous | How many alcoholic drinks per week do you consume? |
Patients should be asked about their current smoking status | |
1-item self-reported hearing difficulty assessment | |
1-item self-reported vision difficulty assessment |
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Puts, M.; Papadopoulos, E.; Brennenstuhl, S.; Durbano, S.; Hossain, N.; Santos, B.; Cleverley, K.; Alibhai, S.M.H. The Development of Geriatric Assessment and Intervention Guidelines for an Online Geriatric Assessment Tool: A Canadian Modified Delphi Panel Study. Curr. Oncol. 2022, 29, 853-868. https://doi.org/10.3390/curroncol29020073
Puts M, Papadopoulos E, Brennenstuhl S, Durbano S, Hossain N, Santos B, Cleverley K, Alibhai SMH. The Development of Geriatric Assessment and Intervention Guidelines for an Online Geriatric Assessment Tool: A Canadian Modified Delphi Panel Study. Current Oncology. 2022; 29(2):853-868. https://doi.org/10.3390/curroncol29020073
Chicago/Turabian StylePuts, Martine, Efthymios Papadopoulos, Sarah Brennenstuhl, Sara Durbano, Nazia Hossain, Brenda Santos, Kristin Cleverley, and Shabbir M. H. Alibhai. 2022. "The Development of Geriatric Assessment and Intervention Guidelines for an Online Geriatric Assessment Tool: A Canadian Modified Delphi Panel Study" Current Oncology 29, no. 2: 853-868. https://doi.org/10.3390/curroncol29020073
APA StylePuts, M., Papadopoulos, E., Brennenstuhl, S., Durbano, S., Hossain, N., Santos, B., Cleverley, K., & Alibhai, S. M. H. (2022). The Development of Geriatric Assessment and Intervention Guidelines for an Online Geriatric Assessment Tool: A Canadian Modified Delphi Panel Study. Current Oncology, 29(2), 853-868. https://doi.org/10.3390/curroncol29020073