Should First-generation Comprehensive Geriatric Assessment instruments be replaced by Third-generation? Comparison of the Minimal Geriatric Screening Tool (MGST) and the interRAI Acute Care (interRAI-AC) in acute clinical practice

ObjectiveComparison of the first-generation Minimum Geriatric Screening Tools (MGST) and the third-generation interRAI Acute Care (interRAI AC).DesignBased on a qualitative multiphase exchange of expert opinion, published evidence was critically analyzed and translated into a consensus.ResultsBoth methods are intended for a multi-domain geriatric assessment in acute hospital settings, but each with a different scope and goal. MGST contains a collection of single-domain, internationally validated instruments. Assessment is usually triggered by care givers' clinical impression based on geriatric expertise. A limited selection of domains is usually assessed only once, by disciplines with domain-specific expertise. Clinical use results in improvement to screen geriatric problems. InterRAI AC, tailored for acute settings, intends to screen a large number of geriatric domains. Based on systematic observational data, risk domains are triggered and clinical guidelines are suggested. Multiple observation periods outline the evolution of patients' functioning over stay in comparison to the premorbid situation. The method is appropriate for application on geriatric and non-geriatric wards, filling geriatric knowledge gaps. The interRAI Suite contains a common set of standardized items across settings, facilitating data transfer in transitional care.ConclusionThe third-generation interRAI AC has advantages compared to the first-generation MGST. A cascade system is proposed to integrate both, complementary methods in practice. The systematic interRAI AC assessment detects risk domains. Subsequently, clinical protocols suggest components of the MGST as additional assessment This cascade approach unites the strength of exhaustive assessment of the interRAI AC with domain-specific tools of the MGST.

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