Yale-Designed Protocol Results in Increased Diagnoses of Problems That Are Often Overlooked in the Elderly

Yale researchers have designed a geriatric assessment protocol to identify problems that often go undetected in elderly patients, such as depression, incontinence, vision and hearing loss and driving safety issues.

The guided care protocol provides a standard approach for evaluating 13 clinical issues that earlier studies showed are significant problems among the elderly, but that often go undiagnosed and untreated.

The lead author of the study, Sidney Bogardus, M.D., assistant professor of internal medicine and geriatrics at Yale School of Medicine and medical director of the Adler Geriatrics Assessment Center, said the protocol revealed significantly more problems and resulted in more recommendations for the patients.

“The protocol did not appear to make the clinic visit any longer,” said Bogardus, whose study was published in the February issue of the Journal of the American Geriatrics Society. “Given the growing number of older persons, the higher rates of disability among older persons, and the documented under-detection and under-treatment of many geriatric problems, strategies to improve the evaluation of these problems, such as the guided geriatric care protocol, are urgently needed.”

The 13 targeted issues covered by the quality improvement protocol included cognitive impairment, depression, behavioral issues, mobility, incontinence, nutrition, sleep, vision, hearing, caregiver issues and social support, driving safety, home safety, and health and financial planning.

The protocol was tested with 200 elderly patients examined at the Adler Center, which is based at Yale-New Haven Hospital. The first 100 patients were examined under usual standards of care. The second 100 patients were assessed using the new guided care protocol.

“The consensus of the group was that the guided care protocol was useful and feasible and did not interfere unduly either with the flow of the clinic visit or with the clinician’s ability to use their individual clinical judgment,” Bogardus said in the study. “Moreover, the clinicians reported that the guided care protocol had a noticeable impact on their clinical practice and reminded them to address key areas, but added only minimally to time spent on each new patient.”

Co-authors included Emily Richardson, Paul Maciejewski and Evelyne Gahbauer, M.D. Senior author was Sharon Inouye, M.D. The research was supported in part by a grant from the Patrick and Catherine Weldon Donaghue Medical Research Foundation and an endowment from the Gladys Brooks Foundation.