Variability in vulnerability assessment of older people by individual general practitioners: a cross-sectional study.
BACKGROUND
In clinical practice, GPs appeared to have an internalized concept of "vulnerability." This study investigates the variability between general practitioners (GPs) in their vulnerability-assessment of older persons.


METHODS
Seventy-seven GPs categorized their 75-plus patients (n = 11392) into non-vulnerable, possibly vulnerable, and vulnerable patients. GPs personal and practice characteristics were collected. From a sample of 2828 patients the following domains were recorded: sociodemographic, functional [instrumental activities in daily living (IADL), basic activities in daily living (BADL)], somatic (number of diseases, polypharmacy), psychological (Mini-Mental State Examination, 15-item Geriatric Depression Scale; GDS-15) and social (De Jong-Gierveld Loneliness Scale; DJG). Variability in GPs' assessment of vulnerability was tested with mixed effects logistic regression. P-values for variability (pvar) were calculated by the log-likelihood ratio test.


RESULTS
Participating GPs assessed the vulnerability of 10,361 patients. The median percentage of vulnerable patients was 32.0% (IQR 19.5 to 40.1%). From the somatic and psychological domains, GPs uniformly took into account the patient characteristics 'total number of diseases' (OR 1.7, 90% range  = 0, p var = 1), 'polypharmacy' (OR 2.3, 90% range  = 0, p var = 1) and 'GDS-15' (OR 1.6, 90% range  = 0, p var = 1). GPs vary in the way they assessed their patients' vulnerability in the functional domain (IADL: median OR 2.8, 90% range 1.6, p var < 0.001, BADL: median OR 2.4, 90% range 2.9, p var < 0.001) and the social domain (DJG: median OR 1.2, 90% range  = 1.2, p var < 0.001).


CONCLUSIONS
GPs seem to share a medical concept of vulnerability, since they take somatic and psychological characteristics uniformly into account in the vulnerability-assessment of older persons. In the functional and social domains, however, variability was found. Vulnerability assessment by GPs might be a promising instrument to select older people for geriatric care if more uniformity could be achieved.


BACKGROUND
Netherlands Trial Register NTR1946.
Leiden University Medical Center, Department of Public Health and Primary Care, Leiden, The Netherlands.
Yvonne M
YM
Drewes
Leiden University Medical Center, Department of Public Health and Primary Care, Leiden, The Netherlands.
Jeanet W
JW
Blom
Leiden University Medical Center, Department of Public Health and Primary Care, Leiden, The Netherlands; Radboud University Nijmegen Medical Centre, Department of Primary Community Care, Nijmegen, the Netherlands.
Willem J J
WJ
Assendelft
Leiden University Medical Center, Department of Medical Statistics and Bioinformatics, Leiden, The Netherlands.
Theo
T
Stijnen
Leiden University Medical Center, Department of Public Health and Primary Care, Leiden, The Netherlands.
Wendy P J
WP
den Elzen
Leiden University Medical Center, Department of Public Health and Primary Care, Leiden, The Netherlands.
Jacobijn
J
Gussekloo
D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D058005:General Practitioners / Q000706:statistics & numerical data*; D015577:Geriatric Assessment / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male