The implementation of brief geriatric assessments into primary care settings

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The growing population of older adults poses a increased challenge for primary care physicians as they look to identify older adults with unmet needs or geriatric conditions. A recent systematic review, published in BMC Geriatrics, explored the role of Brief Geriatric Assessments (BGAs) as a tool for screening older adults in primary care and community settings.

Unlike Comprehensive Geriatric Assessments (CGAs), which are both resource-intensive and time-consuming, BGAs offer a streamlined approach to geriatric screening. These brief tools can identify individuals at risk for adverse health outcomes or those who may benefit from additional CGAs. The review analyzed 25 studies conducted since the 1990s, covering a range of tools and applications in primary care, community and mixed settings.

The studies collectively examined 79,560 older adults, primarily women, with an average age of 79.7 years. Most BGAs were designed as self-reported questionnaires, often administered by trained non-health care professionals, making them feasible for wide-scale clinical implementation.

What the review found about BGA utility

The review highlighted that BGAs effectively screen for various geriatric syndromes, including psychological distress, depression, frailty, fall risk, sarcopenia and anorexia. Tools including the Rapid Geriatric Assessment (RGA), FRAIL scale and Zulfiqar Frailty Scale (ZFS) were among those included in the study.

Although physical and psychological domains were consistently included in the study, assessments of mobility, functional ability and socio-environmental factors varied. The inclusion of frailty-specific domains underscores the growing recognition of frailty as a multidimensional syndrome that warrants early intervention.

The review’s findings suggest that BGAs could serve as a practical screening tool for primary care physicians, aiding in the identification of older adults who might benefit from more comprehensive evaluations. Practices should keep the older demographic in mind when implementing BGAs into practice. Some keys for implementing BGAs into practice include:

• Prioritizing core assessments: Physical and psychological assessments should be included at a minimum. Mobility and functional abilities are also critical in identifying frailty and other conditions.
• Leveraging non-health care professionals: Training non-clinical staff to administer BGAs could ease the burden on physicians.
• Addressing cognitive assessment gaps: Although BGAs rely on self-reported memory issues, integrating objective cognitive assessments or caregiver input may enhance the validity of the assessments.
• Exploring online options: Digital platforms for BGAs offer potential scalability but require careful design to ensure accessibility and usability for older populations.

Overall, BGAs represent a feasible, resource-efficient tool for the identification of older adults with unmet needs. Although evidence of their impact on health outcomes remains limited, BGAs hold promise as a precursor to move forward with more intensive evaluations and clinical interventions. For primary care physicians, incorporating BGAs into practice offers a structured approach to addressing the complex needs of an aging population while optimizing resources and time.