Current Development in Elderly Comprehensive

8/16/2019 Current Development in Elderly Comprehensive

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Review ArticleCurrent Development in Elderly Comprehensive Assessmentand Research Methods

Shantong Jiang 1 and Pingping Li2

Key Laboratory of Carcinogenesis and ranslational Research, Ministry of Education, Department of Integration of Chineseand Western Medicine, Peking University Cancer Hospital & Institute, Beijing , China

Key Laboratory of Carcinogenesis and ranslational Research, Ministry of Education, Department of Integrative Medicineand Geriatric Oncology, Peking University Cancer Hospital & Institute, Beijing , China

Correspondence should be addressed to Pingping Li; [email protected]

Received August ; Accepted January

Academic Editor: Enoch Y. L. Lai

Copyright © S. Jiang and P. Li. Tis is an open access article distributed under the Creative Commons Attribution License,which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Comprehensive geriatric assessment (CGA) is a core and an essential part o the comprehensive care o the aging population.CGA uses specic tools to summarize elderly status in several domains that may inuence the general health and outcomeso diseases o elderly patients, including assessment o medical, physical, psychological, mental, nutritional, cognitive, social,economic, and environmental status. Here, in this paper, we review different assessment tools used in elderly patients with chronicdiseases. Te development o comprehensive assessment tools and single assessment tools specially used in a dimension o CGA

was discussed. CGA provides substantial insight into the comprehensive management o elderly patients. Developing concise andeffective assessment instruments is helpul to carry out CGA widely to create a higher clinical value.

1. Introduction

Since the st century, the aging o the population beganto accelerate. Although the aging o the population is stillconcentrated in developed countries, many developing coun-tries have entered the era o an aging population. Te UnitedNations predict that population aging will occur mainly indeveloping countries in the next years []. Te WorldHealth Organization (WHO) categorized –-year-olds as

the younger elderly, –-year-olds as the elderly, and ≥-year-olds as elderly elderly or macrobian elderly, while theNational Comprehensive Cancer Network (NCCN) denedthe –-year-olds as the younger elderly, –-year-oldsas the elderly, and >-year-olds as the macrobian elderly [].

According to the assessment in , the balance o theglobal burden o disease is gradually tilted to chronic diseaseswhich will be the rst burden o the global elderly. Te mostcommon chronic illnesses include cardiovascular disease,heart disease, cancer, chronic respiratory diseases, muscu-loskeletal disorders, pulmonary disease, diabetes, cognitiveimpairment, and depression, among which cardiovasculardisease is a major killer o elderly health, especially ischemic

heart disease. As Beard and Bloom [, ] make clear intheir viewpoint, increased disease burden will be mainly concentrated in those age-related diseases. For example, dueto the aging o population, Alzheimer’s disease will urtherincrease the burden on the elderly in the next or years.Te latest estimates show that the number o patients withdementia is expected to increase rom the current millionto million by . Tereore, under the new situationo the elderly increasing demand or health services, it is

an inevitable requirement and a challenge to develop somenew models and innovative elderly disease control to achievehealthy aging.

Comprehensive Geriatric Assessment (CGA) was pro-posed by Warren in the late s. Te National Instituteso Health (NIH) organized experts in relevant disciplines todevelop the standard o CGA in [, ]. CGA providesdetailed inormation on clinical, unctional, and cognitivedomains o older patients; it concerns the general healtho the elderly and multidimensional and comprehensivescientic assessment o health status. CGA is an importantway to implement the comprehensive management o agingpopulations. It integrates physical health, mental health,

Hindawi Publishing CorporationBioMed Research InternationalVolume 2016, Article ID 3528248, 10 pageshttp://dx.doi.org/10.1155/2016/3528248


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BioMed Research International

unctional status, social adaptability, and environment condi-tions and quanties the elderly overall health objectively. Notonly is CGA an assessment, but also it ormulates and makestreatment plans that protect the health and unctional statuso the elderly to maximize their quality o lie (QoL). CGAhas become an important means o the management o the

elderly [–].

2. The Contents of CGA and the AssessmentTools Used in Each Domain

.. Te Overall Functional Status, including Physical Health, Activitiesof Daily Living, and Fall Risk Assessment. Te WorldOrganization o National Colleges, Academies and Aca-demic Association o General Practitioners/Family Physician(WONCA) considers that separate evaluation could notreect the actual unction o a whole person or his/heractivities o daily living, though modern medicine has itsowncriteria or evaluating the unction o each organ system.

Te basis o CGA is comprehensive unctional assess-ment, which should include lots o elements, such as the sit-uation o disease o the elderly, hearing, vision, and sufferingrom urinary incontinence. Frailty is a state o vulnerability topoor resolution o homoeostasis afer a stressor event and isa consequence o cumulative decline in many physiologicalsystems during a lietime. Frailty is an important geriatricsyndrome linked to increased mortality, morbidity, and allsrisk. A longitudinalassessment ora period o twoyearsby Nget al. [] assessed Singaporean elderly with Frailty Risk Index (FRI). Weakness, slowness, low physical activity, weightloss, and exhaustion are included in FRI, and evaluation israted on seven levels (very healthy, healthy, in good health,surace weakness, mild weakness, moderate weakness, andsevere weakness) []. Te results o their study demonstratedthat FRI with a certain degree o reliability and validity as atool is applied in predicting railty symptoms o the elderly and decline in unctional status. A systematic review on thereliability and validity o FRI also proved it [].

Currently, unctional status was measured by activitieso daily living (ADL) and instrumental activities o daily living (IADL) []. Barthel’s Index Rating Scale is the mostcommonly used or ADL with the total score o points,with assessment based on scoring criteria. Te Katz Indexo Independence in Activities o Daily Living, commonly reerred to as the Katz ADL, summarizes overall perormance

in bathing, dressing, going to toilet, transerring, continence,and eeding. Clients scored yes/no or independence ineach o the six unctions; grading is based on A∼G sevenunctional levels, where higher level indicateslowerADL [–]. Function Activity Questionnaire (FAQ) is the preerredrating scale o IADL; the higher the score, the more severethe disorders, with score o more than considered asabnormal. Rapid Disability Rating Scale (RDRs) is also anassessment tool or IADL, which is used or hospitalizedand community-dwelling patients, particularly appropriateor elderly patients, but rarely used in clinical practice. Tedegree o help needs o daily lie, degree o disability, andthe degree o special issues are taken into account with the

highest score o , where higher score indicates more severedisability.

In addition, alling racture always occurs in the patientswith balance and gait disorder, with all rates as high as %under the age o more than years, o which more than hal o the elderly alls had occurred several times []. Fall was

the third cause o chronic disability in the elderly which canlead to ractures, sof tissue damage, brain damage, and death[].

Tere are many methods and scales or balance and allrisk assessment, summarized in able . Berg Balance Scale(BBS) is the world’s balance scale or patients with stroke andshowed great reliability, validity, and sensitivity in differentrecovery stages o stroke [, ]. BBS assessed balance andall risk with standing, turning around, standing on one leg,and a total o other actions, with scores ranging rom to with the cutoff point as , where lower score indicateshigher all risk. According to Pereira’s study [], BBS wasbetter than the posturographic Balance Stability System (BSS)in elderly all risk assessment. imed Up andGo est(UG)[] and inetti Gait and Balance est [] are widely usedto measure the unctional activity o the elderly balanceand physical tness, while the latter can also be used topredict the all risk by testing the patient’s gait and balanceunction. Te Fall Risk Assessment Scale or the Elderly (FRASE) is correlated with St. Tomas’s Risk Assessmentool (SRAIFY) []; both o them have the disadvantageo containing only internal all actors, but SRAIFY ismore detailed. Te Fall Risk Index (FRI) [] is suitable orpatients with stroke, and elderly patients with physical andcognitive impairment alls risk assessment usually use theFall

Assessment ool (FA), which includes assessment o all-related environment actors. Tereore, FA is also suitableor elderly patients newly admitted to assess the all risk actors due to environmental changes.

Erik Stone reported a low-cost, continuous, environ-mentally mounted monitoring system, average in-home gaitspeed (AIGS) [], compared to a set o traditional physicalperormance instruments. Te results indicate that AIGSis able to predict how an individual would score on alltraditional instruments and that the observed and smoothed

values o AIGS show better agreement than those o any o thetraditional instruments []. However, Gilles [] assessedall risk o elderly; the results o that study indicated that

multiple modes o gait evaluation provide a more compre-hensive mobility assessment than one assessment alone andbetter identiy incident alls in the elderly.

.. Cognitive Function. Dementia is a common cause o disability in the elderly; %–% o dementia cases areAlzheimer’s disease (AD). Mild cognitive impairment (MCI)is a known precursor to Alzheimer’s disease. However, MCI

is ofen overlooked and attributed to aging rather than being

investigated []. Not only will it affect the tolerance to

treatment, but also it would undermine gains o treatment in

the presence o cognitive impairment in elderly patients.


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: S c r e e n i n g i n s t r u m e n t s u s e d i n c o m p r e h e n s i v e g e r i a t r i c a s s e s s m e n t a b o

u t e l d e r l y p a t i e n t s .

D i m e n s i o n

C o n t e n t s

C o m m o n s i n g l e m e a s u r e m e n t t o o l

C o m m o n c o m p r e h e n s i v e t o o l

O v e r a l l f u n c t i o n a l s t a t u s

P h y s i c a l h e a l t h

R e s e r v e s a n d e n d u r a n c e

F R I ( F r a i l t y R i s k I n d e x ) [ ] ;

O A R S ( o l d e r A m e r i c a n r e s o u r c e s a n d

s e r v i c e s ) [ ]

C A R E ( C o m p r e h e n

s i v e A s s e s s m e n t a n d

R e f e r r a l E v a l u a t i o n ) [ ]

P G C M A I ( P h i l a d e l p h i a G e r i a t r i c

C e n t r e M u l t i l e v e l A

s s e s s m e n t

I n s t r u m e n t ) [ ]

L E I P A D [ ]

W H O Q O L B R E F ( t h e W o r l d H e a l t h

O r g a n i z a t i o n Q u a l i t y o f L i f e - B R E F )

F r i e d f r a i l t y i n s t r u m e n t [ ] ;

G i l l f r a i l t y i n s t r u m e n t [ ]

S i t u a t i o n o f d i s e a s e

G e n e r a l q u e s t i o n n a i r e

C o m o r b i d i t i e s a n d t h e s e v e r i t y

C I R S - G ( C u m u l a t i v e I l l n e s s R a t i n g S c a l e f o r G e r i a t r i c s ) ;

C C I ( C o m m o d i t y C h a n n e l I n d e x )

A c t i v i t i e s o f d a i l y l i v i n g

P h y s i c a l l i v i n g a c t i v i t y s t a t u s


P h y s i o l o g i c a l a c t i v i t i e s o f d a i l y l i v i n g ( A D L )

A D L I n d e x :

B a r t h e l ’ s I n d e x R a t i n g S c a l e , K a t z A D L [

– ] ;

P U L S E S ; r e v i s e d K e n n y S c o r e

I n

s t r u m e n t a l a c t i v i t i e s o f d a i l y l i v i n g ( I A D L ) I A D L I n d e x :

F A Q ( F u n c t i o n A c t i v i t y Q u e s t i o n n a i r e ) ;

R D R S ( R a p i d D i s a b i l i t y R a t i n g S c a l e )

B a l a n c e a n d f a l l r i s k

B B S ( B e r g B a l a n c e S c a l e ) [ , ] ;

U G ( i m e d U p a n d G o e s t ) [ ] ;

i n e t t i G a i t a n d B a l a n c e e s t [ ] ;

F R A S E ( F a l l R i s k A s s e s s m e n t S c a l e f o r t h e E l d e r l y ) [ ] ;

S R A I F Y ( S t . T o m a s ’ s R i s k A s s e s s m e n t o o l ) [ ] ;

F R I ( F a l l R i s k I n d e x ) [ ] ; F A ( F a l l A s s

e s s m e n t o o l ) [ ] ;

M F S ( M o r s e F a l l S c a l e ) [ ] ; H e n d r i c h I I F a l l R i s k M o d e l [ ]

O t h e r t o o l s : O n e - L e g B a l a n c e e s t , P h y s

i c a l P e r f o r m a n c e

e s t , a n d M u l t i d i r e c t i o n a l R e a c h e s t


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: C o n t i n u e d .

D i m e n s i o n

C o n t e n t s

C o m m o n s i n g l e m e a s u r e m e n t t o o l

C o m m o n c o m p r e h e n s i v e t o o l

M e n t a l a n d p s y c h o l o g i c a l

c o n d i t i o n

C o g n i t i v e f u n c t i o n

M M S E ( M i n i - M e n t a l S t a t e E x a m i n a t i o n

) [ ] ;

M o C A ( M o n t r e a l C o g n i t i v e A s s e s s m e n t ) [ – ] ;

I Q C O D E ( I n f o r m a n t Q u e s t i o n n a i r e o n C o g n i t i v e D e c l i n e i n

t h e E l d e r l y ) [ ] ; C D ( s i m p l e c l o c k d r a

w i n g t e s t )

D e p r e s s i o n

G D S ( G e r i a t r i c D e p r e s s i o n S c a l e ) [ , ] ;

G D S - ( s h o r t v e r s i o n - i t e m G D S ) [ ] ;

C E S - D ( C e n t e r f o r E p i d e m i o l o g i c S t u d i e s D e p r e s s i o n S c a l e )

[ ] ;

H R S D ( H a m i l t o n R a t i n g S c a l e f o r D e p r e s s i o n ) [ ]

A n x i e t y

G A I ( G e r i a t r i c A n x i e t y I n v e n t o r y ) [ ] ;

G A S ( G e r i a t r i c A n x i e t y S c a l e ) [ ] ;

G A I - S F ( s h o r t f o r m o f G A I ) [ ] ;

D S M - ( D i a g n o s t i c a n d S t a t i s t i c a l M a n u

a l o f M e n t a l

D i s o r d e r s ) [ ]

N u t r i t i o n a l s t a t u s

E v

a l u a t i o n o f m a l n u t r i t i o n

S G A ( S u b j e c t i v e G l o b a l A s s e s s m e n t ) [

] ;

M N A ( M i n i - N u t r i t i o n a l A s s e s s m e n t ) [ , ] ;

M N A - S F ( s h o r t - f o r m M i n i - N u t r i t i o n a l A s s e s s m e n t ) [ ] ;

G N R I ( G e r i a t r i c N u t r i t i o n a l R i s k I n d e x ) [ ] ;

N R S - ( N u t r i t i o n R i s k S c r e e n i n g ) [ ]

S o c i a l h e a l t h

D e m a n d o f s o c i a l s u p p o r t


E c o n o m i c a n d e n v i r o n m e n t a l

c o n d i t i o n c o n d i t i o n s

E c o n o m i c c o n d i t i o n s a n d m e d i c a l r e s o u r c e s

; G e n e r a l q u e s t i o n n a i r e

h o

m e s e c u r i t y

t r a n s p o r t a n d c o m m u n i c a t i o n s


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Mini-Mental State Examination (MMSE) [] and Mon-treal Cognitive Assessment (MoCA) are two common toolsused in cognitive unction assessment. MMSE is admin-istered in – minutes and unctions including registra-tion, attention, calculation, recall, language, ability to ollow simple commands, and orientation are examined. Lower

score indicates more severe impairment. But MMSE hasthe disadvantage o being inuenced by patient’s education,economic status, and other actors and difficulty recogniz-ing MCI []. MoCA assesses several cognitive domains,including visuospatial abilities, multiple aspects o executiveunctions, attention, concentration, working memory, andlanguage. Te test is available in versions, each o whichhas its own evaluation standard [–]. Te test and admin-istration instructions are reely accessible or clinicians athttp://www.mocatest.org/. Studies [, ] have shown that,compared to MMSE, MoCA covered more cognitive domainsand had a higher efficiency to assess MCI. In addition, thereare the Inormant Questionnaire on Cognitive Decline in the

Elderly (IQCODE) []and simpleclock drawing test (CD).

.. Emotional and Psychological Conditions. Series o com-plex emotional psychological problems that greatly affectthe occurrence, development, and treatment o diseases willoccur to the elderly as a result o dysunction or suddenchanges o living environment. And o them, depression hasbeen known to be associated with unctional limitations inelderly populations, while anxiety is ofen overlooked by theocus on dementia and depression, receiving little attentioneven though it has occurred in the elderly []. It is extremely necessary to identiy and conrm depression and anxiety asearly as possible.

Te Geriatric Depression Scale (GDS) is a -item sel-report assessment specially used to identiy depression inthe elderly developed in by Yesavage et al. [, ].A simple version o GDS, GDS- (short version -itemGeriatric Depression Scale), has been reerred []. TeGDS questions are answered “yes” or “no” or depression,reduced activity, irritability, withdrawal, painul thoughts,and negative evaluation o the past, present, and uture.Te grid sets a range o – as “severely depressed,” – as “mildly depressed,” and – as “normal.” Te Centeror Epidemiologic Studies Depression Scale (CES-D) [] isa short sel-report questionnaire with items that reectdepression severity in depressed mood, eelings o guilt and

worthlessness, eelings o helplessness and hopelessness, psy-chomotor retardation, loss o appetite, and sleep disorders,scoring the requency o occurrence o specic symptomsduring the previous week on a our-point scale at total scoreso and scoring ≥ as CES-D depression. Higher scoresindicate more seriousness. CES-D is not suitable or assessingthe changes in the severity o depression in the course o treatment.

Te Hamilton Rating Scale or Depression (HRSD) [],also named HDRS or HAMD, is a multiple item questionnaireused to provide an indication o depression designed by Hamilton in , which is the most classic and widely usedscale to rate the severity and changes o adults’ depression by

probing mood, eelings o guilt, suicide ideation, insomnia,agitation or retardation, anxiety, weight loss, and somaticsymptoms. A score o – is considered to be normal. Scoreso or higher indicate moderate, severe, or very severedepression and are usually required or entry into a clinicaltrial. Currently, another our versions were developed to

include up to items (, , , and items) except or theoriginal -item version [].

Te GAI (Geriatric Anxiety Inventory) [] and the GAS(Geriatric Anxiety Scale) [] are specially developed or theelderly to assess anxiety symptoms over the past week. Eacho the GAI’s items is rated “agree” or “disagree.” Higherscores indicate greater anxiety symptoms. However, as Gouldet al. [] described, the actor which strongly associatedwith anxiety is depressed status o elderly patients ratherthan age when assessed by GAI and GAS, which suggeststhat GAI and GAS are also suitable or the assessment o thenonelderly. Te -item GAS measures anxiety severity insomatic, cognitive, and anxiety symptoms. Te team o GAI

developed a short orm o the Geriatric Anxiety Inventory (GAI-SF) in [], which was conrmed to have the same

validity and reliability as GAI []. In addition, the Diagnosticand Statistical Manual o Mental Disorders (DSM), publishedby the American Psychiatric Association (APA), can also beused to assess anxiety. Te newest DAM- was published in [].

.. Nutrition Status. Malnutrition, a major problem associ-ated with the elderly, especially elderly hospitalized patients,affects the immune and organ unction and has an extensiveimpact on mortality and morbidity [, ].

Many nutrition screening tools are available or mal-nutrition identication. Te Subjective Global Assessment(SGA) [] is a tool to assess nutrition status developed by Detsky et al. in , recommended by ASPEN (AmericanSociety or Parenteral and Enteral Nutrition), perormedbased on patients’ medical history and physical examina-tion. It asked participations to record changes in weight,dietary intake, unctional capacity, gastrointestinal symp-toms, metabolic stress, loss o subcutaneous at, musclewasting, and ankle/sacral edema, instead o anthropometricand biochemical tests. Assessment according to the numbero the levels (A, B, and C) above projects ( o which belongto B or C, resp.) indicates moderate or severe malnutrition.

It has advantage o simple operation, repetitiveness, and noneed or any biological molecule, whereas it may be notaccurate because the assessment is based on the subjectiveimpression [].

Te Mini-Nutritional Assessment (MNA) [, ] is anelder-special tool and is extensively validated in nutritionalrisk screening and nutritional status assessment. It includes questions in our domains: nutritional assessment, subjectiveassessment, anthropometric assessment, and general assess-ment. With a total score o , scoring ≥ indicates goodnourishment, scoring – indicates risk o malnutrition,and scoring


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: Instrument domains.

Domain OARS CARE PGCMAI LEIPAD WHOQOLBREE

Physical unction × × × × ×

Activities o daily living × ×

Cognitive unctioning × × × ×

Psychological well-being × × × × ×

Nutritional status ×

Social well-being × × × × ×

Financial × ×

Environmental × × ×

Sexual unction ×

Personal construct∗ ×

Lie satisaction ×∗Personal construct psychology (PCP) is a theory o personality and cognition developed by Kelly in the s which stated that each individual’s task inunderstanding their personal psychology is to put in order the acts o his or her own experience.

clinical six-month outcome, and the results show that it wasstill a useul predictor o poor six-month outcome, althoughwith low accuracy. A simpler version o the MNA, theshort-orm Mini-Nutritional Assessment (MNA-SF) devel-oped by Rubenstein in , to be urther revised by Kaiser etal. in [], has great correlation with MNA and is widely used to screen nutritional status o the population. Currently,two versions o MNA-SF are available: MNA-SF-BMI (body mass index) and MNA-SF-CC (cal circumerence).

Te Geriatric Nutritional Risk Index (GNRI) has beendeveloped as a screening tool afer Nutritional Risk Index(NRI) on the basis o improving the deect that it is difficultto determine the past weight o the elderly to assess the

nutritional risk. It calculates weight according to the Lorentzormula (WLo): men = − 100 − [( − 150)/4]; women =−100−[(−150)/2.5]; men: (cm) = [2.02× KH (cm)] −[0.04× age (y )] + .; women: (cm) = [1.83× KH (cm)] −[0.24 × age (y )] × 84.88 (: height, KH: knee height). Andthen we can obtain segments o GNRI according tothe ormula GNRI = (. × albumin (g/L)) + (. ×(weight/WLo)): severe risk (scores < ); moderate risk (≤ GNRI ≤ ); low risk ( ≤ GNRI ≤ ); and no risk (scores> ). Research has shown that GNRI can also be a useulpredictor o poor six-month outcome besides mortality [].

3. The Research of ComprehensiveGeriatric Assessment Tools

Comprehensive assessment tools can be used directly inspecic implementation in CGA []. Currently, a largenumber o comprehensive assessment tools have been estab-lished or the elderly (including healthy elderly and elderly patients), several o which are suitable or a comprehensiveassessment o the general level o health (e.g., OARS, olderAmerican resources and services; CARE, ComprehensiveAssessment and Reerral Evaluation) in elderly patients oror the quality o lie (QoL) in elderly patients (e.g., GeriatricQoL Questionnaire (GQLQ), Quality o Lie Cards (QLC));

common comprehensive assessment tools were summarizedin ables and .

Te OARS is the rst comprehensive tool to assessgeneralhealth o the elderly developed by Duke University Centeror the study o aging and human development in .Te OARS is the most widely used tool, which has beenused or the longest time, and covers a pool o domains,whose reliability and validity have been extensively validated[, ]. Te OARS multidimensional unctional assessmentquestionnaire (OMFAQ) was included in the OARS, which isused to carry out assessment in domains: physical health,activities o daily living, mental health, social resources, andeconomic resources o the elderly. Scoring o each item

as points and assessing the comprehensive health statuso the elderly according to the score [] are carried out.About the instructions o the OARS, the Duke Center evenoffers specialized training. Te Comprehensive Assessmentand Reerral Evaluation (CARD) is a -item assessmenttool established by Gurland and Kuriansky in [, ].It summarized medical, mental, nutritional, economic, andsocial health to record, classiy, and grade the general healthand social health o the elderly.

Te Philadelphia Geriatric Centre Multilevel AssessmentInstrument (PGCMAI) was primarily developed in []. And with the ounder modication continually, themobility was integrated into the questionnaire. Until ,

the nal complete version o the PGCMAI systematically assesses behavioral competence in the domains o physicalhealth, cognition, activities o daily living, time use, mobility,social interaction, and environmental conditions. Tis modeldivides the content o each eld by rank rom simple tocomplex. Physical health, or example, will be assessed inaccordance with the cell, tissue, and organ on all levels.Depending on the number o questions included, there are versions o PGCMAI (Q, Q, and Q, where Q meansquestions).

Te LEIPAD is a questionnaire to assess QoL in theelderly which was developed by De Leo et al. in conjunctionwith the European office o the World Health Organization


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[]. Te latest version o the questionnaire is composed o sel-assessment items including the domains o physical unc-tion, personal construction, depression and anxiety, cognitiveunctioning, sexual unctioning, and lie satisaction. De Leoet al. established reliability and validity o the tool in severallanguagesand evaluatedit orcultural competencyduring the

development and testing o the instrument.Te WHOQOL-BREF (World Health OrganizationQuality o Lie-BREF) is a -item short model rom the-item WHOQOL or assessing the QoL in the elderly.Domains included in this tool are physical and mental healthand social and environmentaldomain. Te WHOQOL-BREFis a generic tool used either in the elderly or in a populationo a specic disease as a QoL screening assessment. It is beingused in populations o chronic liver and pulmonary diseaseto collect data on health and QoL throughout the UnitedStates and in other industrial nations [].

An English version o concise screening tool named “Dr.SUPERMAN” or CGA was reported by Iwamoto et al. in

[]. Included in the questionnaire are physical domain,nutritional domain, psychological domain, and activities o daily living. Participants were asked to select the appropriaterecords related to their situations. As described in the article,“Dr. SUPERMAN” is simple to operate, but the completiontime depends on the communication and understanding o patients, overall about – minutes. “Dr. SUPERMAN” wasoriginally designed by scholars rom Japan. Iwamoto et al.established reliability and validity o the scale in a pop-ulation o chronic diseases, including Alzheimer’s disease,osteoarthritis, cerebrovascular disease, depression or anxiety,and cardiopulmonary disease. No research has been reportedon reliability and validity o the English version.

Te contents o comprehensive assessment tools used inCGA are all too complicated, and even the most compre-hensive OARS scale also ailed to cover all the domains andinormation about the health unction o the elderly. Besides,CGA with time-consuming consultation led to difficulty inclinical practice. As a result, some single assessment toolsmentioned above combine to comprehensive use in CGA,and that was the means in a study by Avelino-Silva etal. [] to predict the mortality and adverse outcomes inelderly patients and obtain reliable results, which also ully demonstrated the signicance o the application o CGA.

4. Conclusion

Comprehensive geriatric assessment is a core and an essentialpart o the comprehensive management o the elderly. Withits increasing value, applications o CGA are increasingly widespread, including prediction o adverse outcomes o chronic diseases [], applications in elderly cancer patients[, ], and being recommended in the preoperative eval-uation []. All the evidence suggests that they will benetrom CGA both in the healthy individuals and in thosewith signicant impairments and multiple comorbidities.CGA can be carried out throughout the entire process o elderly patients with chronic diseases, which especially helpsidentiy some potential comorbidities that may affect clinical

decision-making, treatment outcomes, and QoL in elderly patients.

Te development o CGA is o great signicance, but itis more important to evaluate the validity and reliability o the assessment tool, which is the premise o the effectiveimplementation o CGA. As described in this text, there

are a lot o tools used in CGA, including the comprehen-sive assessment scales and single assessment tool ocusingon a special domain o aging populations with differentcharacteristics. Even though the comprehensive use o thesubscale has a good effect, there are still some differencesbetween the implementers in choices o scales. In additionto the effectiveness, reliability, and other basic elements, agood scale should be more concise but it should involveenough comprehensive core assessment domains, be easierto operate and understand, be less time-consuming, and bemore economic with advances in technology. Meanwhile,a special-developed scale or every single elderly commonchronic disease, such as chronic ischemic heart disease anddementia, will contribute to more efficient management o elderly patients, and this is the challenge and the directiono our uture efforts.

Conflict of Interests

Te authors declare that there is no conict o interestsregarding the publication o this paper.

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