Mapping the Unseen Burden: Comprehensive Geriatric Assessment of

Author

Atul Gopal Agrawal, Ankita Agrawal

Abstract

 Background: Acute hospital care in India remains largely organ-specific, and multidomain geriatric syndromes are frequently unrecognised. We quantified the burden of frailty, functional dependence, malnutrition, cognitive impairment, depressive symptoms and polypharmacy among hospitalised older adults, compared screen-detected cognitive and affective impairment with discharge documentation, and examined predictors of adverse 30-day outcomes.

Methods: In this single-centre prospective observational study (July 2023–January 2024), 450 consecutive adults aged ≥60 years admitted to General Medicine, Orthopaedics and Geriatric wards of a tertiary teaching hospital in Karimnagar, Telangana, underwent comprehensive geriatric assessment (CGA) within 24–48 h using validated Telugu-translated instruments (Katz ADL, Lawton IADL, MNA-SF, Mini-Cog, GDS-15, FRAIL). Participants were followed for 30 days after discharge. The composite outcome was emergency readmission or loss of ≥1 Katz point. Predictors were examined by multivariable logistic regression; robustness to unmeasured confounding was explored with E-values.

Results: Mean age was 68.4 ± 6.2 years; 52.2% were male and 69.3% rural residents. Polypharmacy affected 62.4% (95% CI 57.9–66.8), frailty or pre-frailty 58.7% (54.1–63.1), IADL dependence 50.7%, depressive symptoms 38.9%, ADL dependence 36.4%, cognitive impairment 34.2% (30.0–38.7), and malnutrition or nutritional risk 41.3% (16.0% malnourished). Only 6.2% and 4.1% of discharge summaries recorded cognitive symptoms and depression, respectively, a 5.5-fold and 9.5-fold shortfall relative to screening. Among 432 participants followed up (96.0%), 108 (25.0%; 95% CI 21.1–29.3) had the composite outcome. Frailty (aOR 2.84; 95% CI 1.62–4.98), cognitive impairment (2.15; 1.28–3.61), polypharmacy (1.92; 1.15–3.20) and malnutrition (1.81; 1.04–3.15) were independently associated with the outcome.

Conclusions: Multidomain geriatric vulnerabilities are common and largely undocumented in routine inpatient care in this setting, and four of them independently predict early post-discharge deterioration. Structured CGA at admission, linked to a defined action pathway, is a feasible priority for Indian teaching hospitals.

Keywords

comprehensive geriatric assessment; frailty; hospitalised older adults; unmet health needs; cognitive impairment; polypharmacy; 30-day readmission; Telangana; India

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