Comprehensive geriatric assessment for older adults admitted to hospital

Abstract

Background Comprehensive geriatric assessment (CGA) is a multidimensional, interdisciplinary diagnostic process to determine the medical, psychological and functional capabilities of a frail elderly person in order to develop a co-ordinated and integrated plan for treatment and long-term follow up. Objectives We sought to evaluate the effectiveness of CGA in hospital for older adults admitted as an emergency. Search methods We searched the Cochrane Effective Practice and Organisation of Care (EPOC) Group Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), the Database of Abstracts of Reviews of Effects (DARE), MEDLINE, EMBASE, CINAHL and AARP Ageline, and handsearched high-yield journals. Selection criteria We searched for randomised controlled trials comparing CGA (whether by mobile teams or in designated wards) to usual care. Data collection and analysis Two review authors initially assessed eligibility and trial quality and extracted published data. Main results Twenty-two trials evaluating 10,315 participants in six countries were identified. Patients in receipt of CGA were more likely to be alive and in their own homes at up to six months (OR 1.25, 95% CI 1.11 to 1.42, P = 0.0002) and at the end of scheduled follow up (median 12 months) (OR 1.16, 95% CI 1.05 to 1.28, P = 0.003) when compared to general medical care. In addition, patients were less likely to be institutionalised (OR 0.79, 95% CI 0.69 to 0.88, P < 0.0001). They were less likely to suffer death or deterioration (OR 0.76, 95% CI 0.64 to 0.90, P = 0.001), and were more likely to experience improved cognition in the CGA group (OR 1.11, 95% CI 0.20 to 2.01, P = 0.02). Subgroup interaction in the primary outcomes suggests that the effects of CGA are primarily the result of CGA wards. Authors’ conclusions Comprehensive geriatric assessment increases a patient’s likelihood of being alive and in their own home at up to 12 months.

Comorbidity and dementia: a mixed-method study on improving health care for people with dementia (CoDem)

“…176,177 A Cochrane review of CGA concluded that older people were more likely to be alive and in their own home after CGA. 178 The authors suggested that wards designed for CGA seem to be more effective than mobile teams. A UK study of CGA for older people considered to be at high risk of future health problems failed to show an effect on patient outcomes or subsequent use of secondary care, but the authors concluded that this was because their intervention did not deliver truly comprehensive CGA.…”

Feeding Support Team for Frail, Disabled, or Elderly People during the Early Phase of a Disaster

“…We considered that this preventive care should be multidisciplinary including feeding support and primary care. Feeding support and primary care for evacuated frail, disabled, or elderly people might need the same effect as consecutive intervention for the elderly people based on comprehensive geriatric assessment in the clinical settings (Ellis et al 2011), which becomes increasingly common.…”

What is the case for care home medicine? The geriatrician’s perspective

“…30 CGA has been shown in large meta-analyses to improve outcomes for older people including improved physical and cognitive function, reduced mortality and re-admissions to hospital. 31 Its evidence-base has predominantly derived from acute hospital settings, but it also improves outcomes in community settings. 32 CGA has been described for the non-specialist reader in other publications 33 but is, in brief, a model of care driven by comprehensive assessment taking account of medical, psychological, functional, social and environmental issues.…”