The ABCD of the comprehensive geriatric assessment

To the Editor: Kaur and colleagues propose the ABCD (abbreviated, brief, comprehensive, detailed) approach for older patients.1 Further to that, we propose extending the mnemonic to ABCDEF with E for efficiency and F for feasibility. This would make it more realistic.

The Australian population is ageing. Older patients are often beset by numerous comorbidities. Innovative approaches to facilitate minimisation of hospitalisation and early discharge of frail older patients are urgently needed. Comprehensive geriatric assessment is advocated as the gold standard of managing older patients’ medical needs to improve quality of life. It requires specialist geriatrician assessment in geriatric evaluation and management wards. Unfortunately, a minority of older patients end up being admitted to geriatric evaluation and management units, whereas acute medical beds are mostly occupied by older patients where access to comprehensive geriatric assessment is poor.2 Further, the cost‐effectiveness of comprehensive geriatric assessment in specialised units remains unknown and its utility in reducing length of stay and avoiding readmissions is limited.3

The ABCD concept is intriguing. However, it is unlikely to resolve the dilemma of bed occupancy and length of stay of older patients unless the approach is sufficiently efficient and feasible. These elements conveniently extend the mnemonic to ABCDEF. By “efficiency” we mean efficiency in early recognition of their acute issues, establishing a multimodal approach of therapeutic interventions and discharge planning. “Feasibility” of utilising ABCD in various hospital settings must also be considered. Hospital in the home in appropriately selected patients is an example of efficient and feasible comprehensive geriatric assessment based on the ABCD approach.4 For the ABCD to be properly executed, E (efficiency) and F (feasibility) are integral to this approach. Timely access to specialist geriatric care along with improved delivery of primary care for older people are key issues that need to be concurrently addressed.5