52 Should Physiotherapists and Occupational Therapists be Part of the Comprehensive Geriatric Assessment Clinics within the Outpatient Setting?

The British Geriatric Society (2015) recommends a multidisciplinary team (MDT) Comprehensive Geriatric Assessment (CGA) framework as the Gold standard of care for frail older adults with complex needs. There are currently five Consultant and Nurse-led outpatient CGA clinics in the Older Persons’ Assessment Unit (OPAU), which refer into Physiotherapy (PT) and Occupational Therapy (OT) following their assessments. The aim was to improve the care of patients across the CGA pathway by auditing to establish whether therapists should be involved in the initial assessment of patients in these clinics. Of all new CGA patients in a six month period, only 8% and 2% were referred to PT and OT respectively, warranting further investigation due to the known complexity of this population. Methods Set criteria were established, incorporating the core domains of CGA, designed to highlight patients needing therapy assessment, and were screened using patient questionnaires and medical notes review over a three week period. Results 53 patients were screened against the CGA domains. Rate of completion amongst CGA domains was highly variable: polypharmacy (89%); social (66%); falls (43%); nutrition (43%); continence (25%); mood (23%); cognition (21%); vision (13%); and timed up and go (9%). During the audit, consultants referred four patients to PT and none to OT, compared with screening against the established criteria, which highlighted 28 patients to PT and 22 to OT. Overall, 86% of those screened required therapy intervention. Discussion This project identified a substantial number of patients are failing to receive full, effective CGA including onward therapy intervention, which is key in identifying and managing frailty and improved patient outcomes. Conclusions This audit highlights the value and need for a multi-disciplinary approach, including PT and OT assessment, within CGA outpatient clinics, to ensure a holistic review of and intervention in the complex needs of older adults.