A comprehensive assessment for community-based, person-centered care for older adults

• Published in: BMC geriatrics 2020-06, Vol.20 (1), p.193-193, Article 193
• Main Authors: Aronoff-Spencer, Eliah, Asgari, Padideh, Finlayson, Tracy L, Gavin, Joseph, Forstey, Melinda, Norman, Gregory J, Pierce, Ian, Ochoa, Carlos, Downey, Paul, Becerra, Karen, Agha, Zia
• Format: Article
• Language: English
• Subjects: Aged; Analysis; Chewing; Comprehensive geriatric assessment; Continuity of care; Dental care; Emergency department use; Emergency medical care; Emergency Service, Hospital; Geriatric Assessment; Geriatrics; Health aspects; Health screening; Health services; Hospitalization; Humans; Integrated service delivery model; Intervention; Mental depression; Mental health; Older people; Oral health assessment; Oral hygiene; Pain; Patient-centered care; Person-centered care; Quality control; Quality of Life; Questionnaires; Regression analysis; Self Care; Social aspects; Social factors
• ISSN: 1471-2318; 1471-2318
• DOI: 10.1186/s12877-020-1502-7

Many health and social needs can be assessed and met in community settings, where lower-cost, person-centered, preventative and proactive services predominate. This study reports on the development and implementation of a person-centered care model integrating dental, social, and health services for low-income older adults at a community dental clinic co-located within a senior wellness center. A digital comprehensive geriatric assessment (CGA) and referral system linking medical, dental, and psychosocial needs by real-time CGA-derived metrics for 996 older adults (age ≥ 60) was implemented in 2016-2018 as part of a continuous quality improvement project. This study aims to describe: 1) the development and content of a new CGA; 2) CGA implementation, workflows, triage, referrals; 3) correlations between CGA domains, and adjusted regression models, assessing associations with self-reported recent hospitalizations, emergency department (ED) visits, and clinically-assessed dental urgency. The multidisciplinary team from the senior wellness and dental centers planned and implemented a CGA that included standard medical history along with validated instruments for functional status, mental health and social determinants, and added oral health. Care navigators employed the CGA with 996 older adults, and made 1139 referrals (dental = 797, care coordination = 163, social work = 90, mental health = 32). CGA dimensions correlated between oral health, medical status, depressive symptoms, isolation, and reduced quality of life (QoL). Pain, medical symptoms, isolation and depressive symptoms were associated with poorer self-reported health, while general health was most strongly correlated with lower depressive symptoms, and higher functional status and QoL. Isolation was the strongest correlate of lower QoL. Adjusted odds ratios identified social and medical factors associated with recent hospitalization and ED visits. General and oral health were associated with dental urgency. Dental urgency was most strongly associated with general health (AOR = 1.78,95%CI [1.31, 2.43]), dental symptoms (AOR = 2.39,95%CI [1.78, 3.20]), dental pain (AOR = 2.06,95%CI [1.55-2.74]), and difficulty chewing (AOR = 2.80, 95%CI [2.09-3.76]). Dental symptoms were associated with recent ED visits (AOR = 1.61, 95%CI [1.12-2.30]) or hospitalizations (AOR = 1.47, 95%CI [1.04-2.10]). Community-based inter-professional care is feasible with CGAs that include medical, dental, and social factors. A