Comprehensive Geriatric Assessment Offered at Sanford Center

Health Sciences

Sanford leadership team.

Sanford Center for Aging's geriatric assessment leadership team includes from left, Peter Reed, director; Kelley Macmillan and Steve Phillips, M.D. Photo by Anne McMillin, APR.

Meeting the special needs of complex geriatric patients can often be challenging to primary care providers due to older adults' multiple chronic conditions, myriad medications, functional impairment and psychosocial issues. Due to the complexity of this population, geriatric-specific conditions can often go unrecognized.

However, a geriatric assessment can help identify and manage these conditions and prevent or delay their complications.

The Sanford Center Geriatric Specialty Clinic has developed a multidisciplinary and comprehensive geriatric assessment to evaluate an older person's physical, cognitive and mental health, along with socio-environmental circumstances. The intended outcomes for patients receiving this assessment are to:

  1. increase quality of life and well-being;
  2. reduce unnecessary hospitalizations and readmissions;
  3. delay placement in long-term care;
  4. increase positive aging in place.

The Sanford Center comprehensive geriatric assessment differs from a typical medical evaluation by addressing a patient's overall short- and long-term goals/priorities and general well-being, as opposed to specific illnesses or diagnoses. In addition, the assessment incorporates a multidisciplinary team including a geriatrician, pharmacist, social worker and support staff. Patients and their care partners move through the clinic "stations" and meet with members of the assessment team during the course of a four-hour appointment.

Based on the assessment results, the patient, care partner and clinic team all work together to develop a comprehensive picture of the patient's functional, psychological, medical and mental health status; and establish the patient's goals and priorities for his/her care. The patient will receive a comprehensive care plan, including any specific recommendations, to share with his/her primary care physician.

Steven L. Phillips, M.D., Sanford's geriatrician, emphasizes that the assessment is designed to complement treatment being provided by the patient's primary care provider.

"While the Sanford Center clinic does not provide primary care, the screening tools that we use to assess a client's risk for depression, frailty, falls and cognitive disorders can help identify opportunities for primary care intervention that may not have been previously evident," said Phillips.

"Any patient over the age of 65 with multiple chronic conditions, taking multiple medications or who has recently experienced significant health changes (weight loss, injury, hospitalization) would be appropriate to receive a comprehensive geriatric assessment," said Phillips. "The assessment can help identify possible options to slow the progression of symptoms."

Many older people are prescribed multiple medications by different providers, and when combined with over-the-counter medications, vitamins and herbal supplements, these can pose tremendous risks for drug-drug interactions and adverse drug events. The Sanford Center assessment also includes a medication therapy management review by Leslie Baker, Pharm.D., RPh. She reviews the patient's written medication list against the actual medication containers and the client's medical history, and provides one-on-one instruction and education to the patient and caregiver. She will also provide recommendations to the patient's primary care provider for any medication adjustments.

Beyond the physical aspects of a person's health, the Sanford Center comprehensive geriatric assessment also includes a review of the patient's psychosocial well-being. Kelley Macmillan, Ph.D., MSW, meets with the patient and care partner to discuss and assess support from family/friends, socialization/isolation risk, financial security, personal safety, nutrition/food security, faith and spirituality, caregiver stress and resources, and more.

"Many patients rarely have the opportunity to discuss these aspects of well-being since these topics are traditionally out of a medical provider's usual areas of expertise," Macmillan said. "This is a chance to identify other factors which may be negatively or positively influencing a patient's quality of life, and we can offer resources or referrals to help address areas of concern."

Following the complete assessment, the entire care team collaborates to develop a care plan that incorporates the patient's priorities and goals, and recommendations from each of the professional disciplines. The care plan is then shared with the patient and care partner, as well as the patient's primary care physician. The Sanford Center clinic staff provides recommendations only; no changes to medications are made, no diagnostic tests ordered, no medical treatment is provided. However, in some cases, referrals to social services agencies or patient/caregiver support resources will be made directly.

In the few weeks the Sanford Center clinic has been open, patients who have completed their comprehensive geriatric assessment have appreciated the thoroughness of the program and the recommendations that have been offered. Feedback from care partners also has been helpful in refining the assessment process.

For information about the Sanford Center Comprehensive Geriatric Assessment, including referral criteria and forms, visit the Sanford Geriatric Clinic or call (775) 784-6377.

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