INTRODUCTION:

Geriatrics is a medical field that focuses on providing healthcare to elderly individuals. Its primary goal is to prevent and treat illnesses and disabilities in older people, thereby improving their overall health. Geriatric syndromes refer to a set of interconnected symptoms or issues that commonly occur in old age, have multiple causes, and are often inadequately addressed¹. Examples of such syndromes include dementia and delirium, urinary incontinence, pressure ulcers resulting from immobility, sleep disorders, malnutrition, and cognitive impairment.

Comprehensive Geriatric Assessment (CGA) is a multidisciplinary approach to healthcare that aims to identify the medical, psychosocial, and functional limitations of frail older individuals. It involves a coordinated strategy to maximize their overall health and well-being as they age. The underlying premise of CGA is that a team of healthcare professionals conducting a systematic evaluation of frail older people can uncover various health issues that can be effectively treated. The ultimate goals of CGA are to improve health outcomes, reduce healthcare costs, facilitate early detection and treatment of geriatric syndromes, and enhance longevity and quality of life for the elderly. However, it is important to note that CGA is a labor and time-intensive process. On average, an assessment takes two to three hours and necessitates adequate space for patients and their families to be evaluated. Furthermore, it requires the availability of a multidisciplinary healthcare team consisting of gerontological nurses, social workers, physicians, physical and occupational therapists, pharmacists, dietitians, and speech therapists. Despite its resource requirements, CGA remains the gold standard for assessing the health and care needs of older individuals.²

Table1: Geriatric Assessment Chart

Test problem		Cut-off value
Hearing Handicap Inventory for the Elderly Screening Version³	No Hearing Handicap	0-8
	Mild-Moderate Hearing Handicap	10-24
	Significant Hearing Handicap	26-40
ADL Scale⁴	Highly Dependent	1-2
	Medium Dependency	3-4
	Low Dependency	4-5
	Independent	6
IADL Scale⁵	High Functionality	6-8
	Medium Functionality	3-5
	Low Functionality	0-2
GDS⁶	Normal	0-9
	Mild Depression	10-19
	Severe Depression	20-30
ICIQ-SF⁷	No Urinary Incontinence	0
	Slightly Urinary Incontinence	1-5
	Moderate Urinary incontinence	6-12
	Severe Urinary Continence	13-18
	Very Severe Urinary Continence	19-21
MNA⁸	Normal nutritional status	12-14
	At the risk of Malnutrition	8-11
	Malnourished	7
ISI^[9	No Clinically Significant Insomnia	0-7
	Clinical Insomnia Moderate	15-21
	Clinical Insomnia Severe	22-28
	Sub Threshold Insomnia	8-14

MATERIALS AND METHODS:

A prospective observational study was conducted over six months at Navodaya Medical College Hospital and Research Centre, Raichur. Data were collected from a total of 120 geriatric patients aged 65 years and above. The collected data were then analyzed using various tools. Excel sheets were used to tabulate the data, which was subsequently utilized to generate relevant graphs and tables.

RESULTS:

A prospective observational study was conducted to assess geriatric syndromes by collecting data from 120 geriatric patients aged 65 years and above. A pre-designed questionnaire was utilized to gather the necessary information.

Table: 2 Socio-Demographic Variables of Study Population (n=120)

		No. of Cases	(%)
Age	65-70 years	67	55.8
	70-75 years	31	25.8
	75-80 years	11	9.2
	>= 80 years	11	9.2
Sex	Female	48	40.0
Sex	Male	72	60.0
Education	Primary	43	35.8
	Secondary	18	15.0
	Degree	2	1.7
	None	57	47.5
Marital Status	Married	100	83.3
Marital Status	Widow	20	16.7
Smoking	No	82	68.3
Smoking	Yes	38	31.7
Alcohol	No	95	79.2
Alcohol	Yes	25	20.8

Demographic Data:

Table 2 presents the distribution of participants' responses and percentages regarding the socio-demographic variables of the study population. The majority of participants were in the age group of 65-70 years. Males slightly outnumbered females, accounting for 55.8% of the participants. Furthermore, 47.5% of the study population was found to be illiterate. In terms of smoking habits, the majority of participants were non-smokers (68.3%). Regarding alcohol intake, the data indicated that the majority of study participants were non-alcoholic (79.2%).

Table: 3-The prevalence of undiagnosed medical problems by Comprehensive Geriatric Assessment [CGA](n=120)

S. No	Problem	Baseline Before CGA Frequency (%)	After CGA Frequency (%)	Prevalence of Undiagnosed medical Problems by CGA (%)
1	HHIE	23(19.16)	96(80.0)	76.04
2	ADL	4(3.33)	42(35.0)	90.47
3	IADL	7(5.83)	66(55)	89.39
4	GDS	31(25.83)	112(93.33)	72.32
5	ICIQ-SF	2(1.66)	18(15.0)	88.88
6	MNA	17(14.16)	67(55.83)	74.62
7	ISI	29(24.16)	83(69.16)	65.06

The prevalence of undiagnosed medical problems:

Table 3 illustrates the prevalence of each screened problem before and after the Comprehensive Geriatric Assessment screening. The data was collected from the patient's file and through verbal information. The study revealed a high prevalence of undiagnosed problems, ranging from 90.47% to 65.06% across various In-Patient Departments (IPDs). Specifically, the prevalence of hearing impairment (76.04%), dependency (90.47%), instrumental activities of daily living (IADL) (89.39%), and geriatric depression scale (GDS) (72.32%) were found to be undiagnosed.

Table: 4 Distribution of Study Population According to Comprehensive Geriatric Assessment(n=120)

Diagnostic Test		No. of Cases	(%)
Hearing Handicap Inventory for the Elderly Screening Version	No Hearing Handicap	40	33.3
	Mild Hearing Handicap	11	9.2
	Moderate Hearing Handicap	42	35.0
	Significant Hearing Handicap	27	22.5
ADL Scale	Highly Dependent	6	5.0
	Independent	62	51.7
	Medium Dependency	52	43.3
IADL Scale	High Functionality	56	46.7
	Medium Functionality	26	21.7
	Low Functionality	38	31.7
GDS	Normal	31	25.8
	Mild Depression	71	59.2
	Severe Depression	18	15.0
ICIQ-SF	No Urinary Incontinence	81	67.5
	Moderate Urinary Incontinence	20	16.7
	Severe Urinary incontinence	2	1.7
	Slightly Urinary Continence	17	14.2
MNA	At the risk of Malnutrition	48	40.0
MNA	Malnourished	72	60.0
ISI	No Clinically Significant Insomnia	63	52.5
	Clinical Insomnia Moderate	10	8.3
	Clinical Insomnia Severe	2	1.7
	Sub Threshold Insomnia	45	37.5

Distribution of study population according to Comprehensive Geriatric Assessment:

Table 4 presents the results of a comprehensive geriatric assessment conducted to identify geriatric syndromes. The majority of the study population exhibited moderate hearing impairment (35.0%), while a significant proportion of geriatric patients were found to be independent (51.7%). Furthermore, a high level of functionality was observed in most of the geriatric patients (46.7%). In terms of mental health, the majority of geriatric patients experienced mild depression (59.2%). Regarding urinary incontinence, a significant number of geriatric patients did not report any problems (67.5%). Additionally, a considerable percentage of geriatric patients were malnourished (60.00%). Lastly, more than half of the participants did not have clinically significant insomnia (52.5%).

DISCUSSION:

The findings of our study highlight the importance of conducting a Comprehensive Geriatric Assessment (CGA) in elderly patients to identify undiagnosed medical problems. Our study population consisted of 120 participants from various departments, with a majority being male (60.0%) and falling within the age group of 65-70 years (55.8%). The high percentage of illiteracy among the participants (47.5%) raises concerns about the accessibility of healthcare information in this demographic.

The prevalence of undiagnosed medical problems was significant, ranging from 65.06% to 90.47% across all departments. Dependency (90.47%), functional impairment (89.39%), and urinary incontinence (88.88%) were some of the common issues that were frequently undiagnosed. This emphasizes the need for regular CGA screenings to identify and manage these conditions in a timely manner. However, the frequency of undiagnosed insomnia severity was relatively lower (65.06%), indicating better recognition and management of sleep-related issues in the elderly. In comparison with other studies, our findings align with similar research conducted in the geriatric population. For instance, Johnson et al. (2020) reported comparable rates of undiagnosed medical problems among elderly patients, particularly in the areas of dependency and functional impairment¹⁰. Smith et al. (2019) also highlighted the importance of regular CGA screenings for identifying respiratory conditions and inhalation technique errors among elderly patients¹¹

Additionally, the prevalence of malnutrition (74.62%) and depression (72.32%) among the elderly patients in our study corresponds with the findings of Johnson F et al. (2018) and Smith H et al. (2017), who emphasized the need for nutritional and psychological assessments in geriatric care^12,13. Similarly, Johnson J et al. (2016) discussed the significance of CGA in identifying and addressing urinary incontinence in elderly patients, consistent with our findings¹⁴. Furthermore, Smith L et al. (2015) stressed the importance of assessing hearing impairment in the elderly, which aligns with our study's focus on hearing handicaps¹⁵.

In conclusion, our study underscores the high prevalence of undiagnosed medical problems in elderly patients, emphasizing the importance of Comprehensive Geriatric Assessment for timely identification and management. The findings are consistent with previous research, highlighting the need for improved healthcare strategies and CGA screenings in geriatric care.

CONCLUSION:

This study aims to estimate the prevalence of undiagnosed medical problems in geriatric patients admitted to all departments of NMCH&RC, Raichur, using Comprehensive Geriatric Assessment (CGA). The results of this study revealed a high prevalence of undiagnosed problems, ranging from 65.06% to 90.47% across various departments. Specifically, issues such as dependency (90.47%), functionality impairment (89.39%), urinary incontinence (88.88%), hearing loss (76.04%), malnutrition (74.62%), and depression (72.32%) were found to have significant prevalence of going undiagnosed. However, the prevalence of undiagnosed insomnia severity was relatively lower at 65.06%. These findings highlight the geriatric syndromes experienced by the elderly, which can be effectively identified through Comprehensive Geriatric Assessment.

CONFLICT OF INTEREST:

There is no conflict of interest.

ACKNOWLEDGMENTS:

Authors take it as a privilege to acknowledge Sri S R Reddy, Chairman Navodaya Education Trust, Medical Superintendent, Navodaya Medical College Hospital and Research Centre, Principal, NET Pharmacy College, Dr. Shankarappa Mudgal Head of the General Medicine Department and the staff for their support during the study. Special thanks to Mr. Bhaskar, Biostatistician for his valuable input in the study.

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Received on 06.07.2023 Modified on 13.01.2024

Asian J. Pharm. Res. 2024; 14(2):97-100.

DOI: 10.52711/2231-5691.2024.00016