Comprehensive geriatric assessment in the outpatient setting: population characteristics and factors influencing outcome.
The chronic diseases of old age reduce the "active life expectancy" of older persons and result in significant health care expenditures. Yet, among disabled persons, the degree of disability does not explain who actually accesses long-term care (LTC) services. Comprehensive geriatric assessment (CGA) has been proposed as the technology of geriatric medicine which will reduce both excess disability and health care costs. Outpatient CGA programs may be the ideal setting in which to study older disabled persons who are at risk for increasing their use of LTC services. A prospective study of our CGA population suggests that understanding the factors which influence outcome will be critical to designing interventions and improving outcome for this population. CGA patients suffer from a limited number of functionally disabling problems, each of which has a broad array of etiologies. Use of LTC services seems most closely tied to social factors, including the feelings of burden experienced by caregivers. Caregiver burden is a better predictor of service use than any measure of the older person's mental or physical health or functional abilities. Reducing health care costs including nursing facility placement will likely require interventions which reduce caregiver burden. Further definition of the problems seen in the CGA population and delineation of the factors influencing outcome will identify interventions to achieve the desired health care outcomes.