What is community geriatrics?

What is Community Geriatrics

Community geriatrics is the practice of delivering comprehensive, multidimensional geriatric assessment and coordinated care management to older adults living in their homes and community settings, rather than in hospitals or institutions, with the goal of maximizing functional independence and quality of life. 1, 2

Core Components

Community geriatrics fundamentally involves:

• Comprehensive geriatric assessment (CGA) performed in non-institutional settings including patients' homes, primary care clinics, and community rehabilitation units 3, 2, 4
• Multidimensional evaluation across medical, psychological, functional, and social domains of health 1
• Care coordination that matches complex community-based services (delivered meals, respite care, adult day care) to the complex needs of older adults 1
• Interprofessional team approach typically led by geriatricians, nurses, or nurse practitioners, working with social workers, pharmacists, and other healthcare professionals 1, 5, 4

The Geriatric 5Ms Framework

The American Geriatrics Society recommends implementing the "Geriatric 5Ms" framework as the operational structure for community geriatrics 6:

• Mind: Assessment of cognitive and psychological health, including screening for dementia, delirium, and depression 1, 6
• Mobility: Evaluation of falls risk, gait, balance, and functional movement 6
• Medications: Systematic review and reconciliation to identify potentially inappropriate medications and deprescribing opportunities 6
• What Matters Most: Identification of each patient's meaningful health outcome goals and care preferences 6
• Multicomplexity: Addressing the intersection of multiple chronic conditions with social determinants of health 6, 7

Where Community Geriatrics Occurs

Community geriatrics is delivered in:

• Home-based settings (most common location, 58% of studies) where assessments and management occur in patients' residences 3, 2
• Primary care practices where CGA is integrated into routine outpatient visits 4
• Community rehabilitation units for older adults transitioning from hospital or requiring functional restoration 8
• Outpatient geriatric clinics that serve as community access points 3

Clinical Outcomes

Home-based comprehensive geriatric assessment in community settings demonstrates:

• Improved functional status at 6-24 months (standardized mean difference 0.17) 2
• Enhanced health-related quality of life at 6-24 months 2
• Reduced mortality at 36 months 2
• Decreased hospitalizations at 6-36 months 2
• Improved patient satisfaction with care at 6-12 months 2
• Reduced primary healthcare utilization including fewer GP consultations 8

Who Delivers Community Geriatrics

Community geriatric care is provided by:

• Nurses (most common providers, 51% of studies) who conduct assessments and coordinate care 3
• Geriatricians who perform comprehensive evaluations and lead multidisciplinary teams 8, 4
• Nurse practitioners who can independently manage community-based CGA 4
• Interprofessional teams including social workers, pharmacists, physical therapists, and home care aides 1, 5

Target Population

Community geriatrics specifically addresses:

• Community-dwelling older adults (typically ≥75 years) with complex healthcare needs 3
• At-risk, frail older adults living independently who are vulnerable to functional decline 2
• Patients with multiple chronic conditions requiring coordinated management across multiple providers 1, 7
• Older adults with geriatric syndromes including frailty, falls, cognitive impairment, and polypharmacy 7

Critical Distinction from Hospital-Based Geriatrics

Community geriatrics differs fundamentally by:

• Preventing institutionalization rather than managing acute illness in hospitals 2
• Emphasizing functional independence and quality of life over disease cure 7
• Addressing social determinants including living conditions, caregiver presence, and financial status that directly impact treatment feasibility 7
• Providing care in familiar environments which improves patient convenience and allows assessment of actual home safety and function 3

Implementation Challenges

The American Geriatrics Society notes critical workforce limitations with only 8.6 geriatricians per 100,000 people in the US, requiring primary care providers to develop geriatric competencies 6. Additional barriers include lack of partnership alignment between providers, poor acceptance of preventive work, challenges in operationalizing CGAs, and fragmented payment structures 3, 5.

Essential Care Management Process

Community geriatrics follows a systematic process 1:

• Screening and case finding to identify older adults who would benefit
• Comprehensive assessment across all relevant domains
• Care plan development that is individualized and addresses identified needs
• Implementation coordinating services across multiple providers and settings
• Ongoing monitoring with dynamic adjustment as needs change