1. DOCUMENTATION OF FIVE COMPONENTS OF THE GERIATRIC ASSESSMENT
How Thorough are Family Medicine Physicians in Assessing Geriatric Patients?
 Jesse Abesh, DO, Alison Mancuso, DO, Barry Hoffman, DO
Rowan University SOM, Department of Family Medicine, Stratford, NJ
ABSTRACT
Background and Hypothesis:
As America ages, primary care doctors will be caring for huge numbers of geriatric patients. There are almost 40 million older Americans, and this will increase. Appointments are more complex due to multiple health issues and care coordination. The objective of this study was to determine if family medicine doctors are completing a thorough evaluation of older patients based on documentation from local physicians. It was hypothesized that family doctors feel they are doing a complete multi-disciplinary geriatric assessment but lapses in documentation and care will be present.  
Methods:
In this IRB-approved retrospective chart review, data was collected from ninety patient charts which were randomly selected from patients that were treated by Rowan Family Medicine. We collected data on the presence of five parts of the geriatric assessment: medicine reconciliation, gait assessment, advance directives, and psychosocial support. The chart review examined documentation from three consecutive medical visits.
Results:
Ninety charts were analyzed from the four offices of Rowan Family Medicine with an equal distribution among the sites. Patients from ages 65 and older were selected; patients receiving home visits were excluded. Each patient was randomly selected and evaluated on whether the five components listed were included in the chart. Overall documentation showed that offices scored between 20-42%, meaning an average of 1-2 areas were addressed in each chart. Psychosocial support was most likely to be documented, (included in 71% of charts). Advance directive documentation was included in 38% of charts. Medication reconciliation was the least likely to be included, with documentation present in only 13% of charts.
Conclusion:
Study data demonstrated a lack of documentation in four out of the five areas studied. Lapses in documentation in advanced directives, medication reconciliation, gait, and ADL and IADL abilities were present in most charts. Provider education may be useful in components of a full geriatric assessment as well as promotion of Wellness Visits where each of these components is likely to be addressed more fully.
BACKGROUND
DOCUMENTATION OF FIVE COMPONENTS OF THE GERIATRIC ASSESSMENT
METHOD
Implications:
As seen in the graphic depictions, primary care providers are not documenting key aspects of the geriatric assessment. This could have wider implications such as increased hospital readmissions, adverse side effects due to medication interactions and polypharmacy, and falls due to lack of gait assessment, leading to hip fractures and increased mortality. More research will need to be conducted on the effects of not assessing these parameters in an aging population.
References
Acknowledgement
The authors want to acknowledge the Rowan IRB and the Department of Family Medicine for their support with the Research Project.
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