A prospective study assessing agreement and reliability of a geriatric evaluation.

TitreA prospective study assessing agreement and reliability of a geriatric evaluation.
Publication TypeJournal Article
Year of Publication2017
AuthorsLocatelli, I, Monod, S, Cornuz, J, Büla, CJ, Senn, N
JournalBMC geriatrics
Volume17
Issue1
Pagination153
Date Published07/2017
DOI10.1186/s12877-017-0546-9
ISSN1471-2318
Mots-clésAccidental Falls/prevention & control, Aged, Agreement, Female, Geriatric Assessment/methods, Geriatric consultation, Geriatrics/methods, Geriatrics/standards, Humans, Intraclass correlation coefficient, Kappa index, Male, Prospective Studies, Referral and Consultation/standards, Reliability, Reproducibility of Results, Switzerland/epidemiology
Abstract

BACKGROUND: The present study takes place within a geriatric program, aiming at improving the diagnosis and management of geriatric syndromes in primary care. Within this program it was of prime importance to be able to rely on a robust and reproducible geriatric consultation to use as a gold standard for evaluating a primary care brief assessment tool. The specific objective of the present study was thus assessing the agreement and reliability of a comprehensive geriatric consultation.

METHOD: The study was conducted at the outpatient clinic of the Service of Geriatric Medicine, University of Lausanne, Switzerland. All community-dwelling older persons aged 70 years and above were eligible. Patients were excluded if they hadn't a primary care physician, they were unable to speak French, or they were already assessed by a geriatrician within the last 12 months. A set of 9 geriatricians evaluated 20 patients. Each patient was assessed twice within a 2-month delay. Geriatric consultations were based on a structured evaluation process, leading to rating the following geriatric conditions: functional, cognitive, visual, and hearing impairment, mood disorders, risk of fall, osteoporosis, malnutrition, and urinary incontinence. Reliability and agreement estimates on each of these items were obtained using a three-way Intraclass Correlation and a three-way Observed Disagreement index. The latter allowed a decomposition of overall disagreement into disagreements due to each source of error variability (visit, rater and random).

RESULTS: Agreement ranged between 0.62 and 0.85. For most domains, geriatrician-related error variability explained an important proportion of disagreement. Reliability ranged between 0 and 0.8. It was poor/moderate for visual impairment, malnutrition and risk of fall, and good/excellent for functional/cognitive/hearing impairment, osteoporosis, incontinence and mood disorders.

CONCLUSIONS: Six out of nine items of the geriatric consultation described in this study (functional/cognitive/hearing impairment, osteoporosis, incontinence and mood disorders) present a good to excellent reliability and can safely be used as a reference (gold standard) to evaluate the diagnostic performance of a primary care brief assessment tool. More objective/significant measures are needed to improve reliability of malnutrition, visual impairment, and risk of fall assessment before they can serve as a safe gold standard of a primary care tool.

Alternate URL

http://www.ncbi.nlm.nih.gov/pubmed/28724392?dopt=Abstract

WOS ID (UT)

000405863900003

Alternate JournalBMC Geriatr
Citation Key / SERVAL ID8072
Peer reviewRefereed
PubMed ID28724392

                         

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