How to use Comprehensive Geriatric
Evaluation to Assess Older People
with Diabetes
Dr. Leocadio Rodríguez Mañas
Dr. Marta Castro Rodríguez
WHY TO DO COMPREHENSIVE GERIATRIC
ASSESSMENT?
Because CGA (Comprehensive Geriatric Assessment) has
many benefits:
•evaluating the patient’s ability to comply with treatment
recommendations and to achieve goals
•evaluating the functional, cognitive and mood impact of
vascular complications
•evaluating the need for support
Because functional status is the main predictor of adverse
events, mortality and institutionalization in older people
and DM has a great impact on it
Impact of DM on functional
status
2 years of follow
7.447 ≥ 70 a. (77± 4,6)
62,4% women
Good functional
status
DM
Intermedium
functional status
No DM
DM
No DM
Poor functional status
DM
No DM
Average ± Standard deviation
Limitation
Total
1,1 ± ,42
,96 ± ,43
3,97±,83
2,97±,82
7,82±,86
7,81±1,05
Physical
,73 ± ,26
,63 ± ,26
2,22±,38
1,83±,38
3,15±,23
3,12±,25
BADLs
,14 ± ,11
,16 ± ,11
,72 ± ,24
,46 ± ,24
1,96±,41
1,98±,49
IADLs
,35 ± ,12
,29 ± ,13
1,12±,26
,76 ± ,25
2,73±,30
2,75±,36
Blaum y cols., JAGS 2003; 51: 745-753
Accelerated Loss of Skeletal Muscle Strength in Older Adults with
Diabetes. The Health, Aging and Body Composition Study.
Health, Aging and
Body Composition
Study cohort of 1,840
patients aged 70-79y
Leg and arm muscle
mass and strength
examined at baseline
and after 3y
Compared with nondiabetes, diabetes
subjects had greater
declines in muscle
mass (p<0.5) and
strength (p<0.001),
and poorer muscle
quality (p<0.05);
upper limbs showed
no real differences
Park SW et al, Diabetes Care, 2007
Without
diabetes
With diabetes
1,535
305
Model 1
-12.4 ± 0.5
-16.5 ± 1.2
0.001
Model 2
-12.5 ± 0.5
-16.2 ± 1.1
0.001
Model 3
-12.5 ± 0.5
-15.7 ± 1.1
0.008
Model 4
-12.7 ± 0.5
-15.6 ± 1.2
0.026
Model 1
-1.22 ± 0.07
-1.57 ± 0.15
0.034
Model 2
-1.20 ± 0.06
-1.69 ± 0.14
0.001
Model 3
-1.21 ± 0.06
-1.64 ± 0.14
0.006
Model 4
-1.24 ± 0.06
-1.64 ± 0.15
0.018
n
P value
Muscle strength
(maximal torque,
Nm)
Muscle quality
(specific torque,
Nm/kg)
The Italian Longitudinal Study of Ageing (ILSA)
Maggi
S et al., Diabetologia 2004
In terms of disability, classical comorbidities only explain 38% of such adverse effects of
diabetes in women and 16% in men
Domains/Items to be assessed
MEDICAL:
•
Co-morbid conditions and disease severity
•
Medication Review
•
Nutritional status
•
Frailty
FUNCTIONAL CAPACITY:
•
Basic activities of daily living
•
Instrumental activities of daily living
•
Advanced activities of daily living
•
Gait and balance
•
Risk of falls/risk of fractures
MENTAL HEALTH:
•
Cognition
•
Mood
SOCIAL CIRCUMSTANCES AND ENVIRONMENT:
•
Informal support available from family or friends
•
Social network such a visitors or daytime activities
•
Eligibility for being offered care resources
•
Home comfort, facilities and safety
•
Use or potential use of telehealth technology etc
•
Transport facilities
•
Accessibility to local resources
Medical evaluation
Co-morbid conditions and disease severity:
•Cardiovascular Risk Assessment (Framingham/Score/UKPDS)
Only in patients with a life expectancy over 10 years.
•Charlson index
Medication Review:
•Beer criteria
Nutritional status:
•Mini Nutritional Assessment (MNA)
Frailty:
•Fried criteria
Comorbidity/Medication Review
Charlson Index
Table showing one set of drugs as
classify by the Beer´s criteria
Nutritional status
Mini-Nutritional
Assessment (MNA)
FRIED CRITERIA FOR FRAILTY OR PRE-FAIL
INDIVIDUALS
Mortality in older people with Type 2 DM according to two models of frailty
TSHA Frailty score
Fried´s model
Adjusted by age, sex, comorbidities and disability
No frail
Pre-frail
Frail
p=0,059
p=0,016
Weeks of follow-up
Weeks of follow-up
Functional capacity
o Basic activities of daily living (BADL): Barthel and Katz
indexes
o Instrumental activities of daily living (IADL): Lawton Index
o Advanced activities of daily living (AADL)
o Gait and balance: Short Physical Performance Battery (SPPB)
o Risk of falls/risk of fractures: FRAX