Diagnosis of frailty after a Comprehensive Geriatric Assessment: differences between family physicians and geriatricians.
BACKGROUND
To compare the outcomes of Comprehensive Geriatric Assessments by family physicians and geriatricians.


METHODS
An explorative observational study was conducted in six family practices (12 ambulatory family practitioners) and 1 geriatric department (4 hospital-based geriatricians) from a university medical center in Nijmegen (the Netherlands). As participants, we included 587 patients aged 70 years and older and registered in the six family practices. The main outcome measures were the judgment on the following: 1) absence or presence of frailty and 2) the state (good-fair-poor) on 8 underlying domains (physical, medication, cognition, sensory, instrumental activities of daily living scale, mobility, mental, and social) according to family practitioners and geriatricians based on a Comprehensive Geriatric Assessment.


RESULTS
Family physicians and geriatricians agreed on frailty absence/presence in 76% of cases. Geriatricians considered elderly more often frail than family physicians did (n = 294, 50% vs n = 213, 36%). Disagreement on frailty status was notably found in the patients who had less distinct, either poor or good, health states. Discordant frailty judgments, in which the geriatrician rated a person as frail and the family physicians did not, were related to geriatricians more often rating physical health as impaired. Further, geriatricians' judgments of frailty were more strongly related to impaired scores on the domains cognition, sensory, mobility, and mental compared with family physicians judgments: odds ratios 79.3 versus 9.3, 7.6 versus 2.0, 25.0 versus 3.0, and 18.0 versus 2.2, respectively. Impaired physical health and problematic medication use had equally strong associations with frailty in geriatricians and family physicians: odds ratios of 11.5 versus 10.4 and 2.4 versus 2.5, respectively.


CONCLUSIONS
Geriatricians more often judge patients as frail compared with family physicians and seem to evaluate the available information differently. With increasing collaboration between primary and secondary care, understanding these differences becomes increasingly relevant.
From the Department of Geriatric Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands (JALK, RJFM, MP, GMOR); Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands (HJS).
Janneke A L
JA
van Kempen
From the Department of Geriatric Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands (JALK, RJFM, MP, GMOR); Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands (HJS). rene.melis@radboudumc.nl.
René J F
RJ
Melis
From the Department of Geriatric Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands (JALK, RJFM, MP, GMOR); Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands (HJS).
M
M
Perry
From the Department of Geriatric Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands (JALK, RJFM, MP, GMOR); Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands (HJS).
Henk J
HJ
Schers
From the Department of Geriatric Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands (JALK, RJFM, MP, GMOR); Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands (HJS).
Marcel G M Olde
MG
Rikkert
D000368:Aged; D000369:Aged, 80 and over; D005194:Family Practice; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D015577:Geriatric Assessment / Q000379:methods*; D005853:Geriatrics; D006801:Humans; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D016017:Odds Ratio; D010821:Physicians, Family / Q000592:standards*; D000078329:Workforce
Decision-Making; Family; Frail Elderly; Geriatrics; Physicians