Comprehensive geriatric assessment in primary care: a systematic review

Abstract

Background Comprehensive geriatric assessment (CGA) involves the multidimensional assessment and management of an older person. It is well described in hospital and home-based settings. A novel approach could be to perform CGA within primary healthcare, the initial community located healthcare setting for patients, improving accessibility to a co-located multidisciplinary team. Aim To appraise the evidence on CGA implemented within the primary care practice. Methods The review followed PRISMA recommendations. Eligible studies reported CGA on persons aged ≥ 65 in a primary care practice. Studies focusing on a single condition were excluded. Searches were run in five databases; reference lists and publications were screened. Two researchers independently screened for eligibility and assessed study quality. All study outcomes were reviewed. Results The authors screened 9003 titles, 145 abstracts and 97 full texts. Four studies were included. Limited study bias was observed. Studies were heterogeneous in design and reported outcomes. CGAs were led by a geriatrician (n = 3) or nurse practitioner (n = 1), with varied length and extent of follow-up (12-48 months). Post-intervention hospital admission rates showed mixed results, with improved adherence to medication modifications. No improvement in survival or functional outcomes was observed. Interventions were widely accepted and potentially cost-effective. Discussion The four studies demonstrated that CGA was acceptable and provided variable outcome benefit. Further research is needed to identify the most effective strategy for implementing CGA in primary care. Particular questions include identification of patients suitable for CGA within primary care CGA, a consensus list of outcome measures, and the role of different healthcare professionals in delivering CGA.

AMPI-AB validity and reliability: a multidimensional tool in resource-limited primary care settings

“…The discriminative ability of several screening instruments to identify older persons at increased risk of functional decline and mortality ranges from 0.60 to 0.80 in the literature, which are very similar to those demonstrated by our study [4,[15][16][17][18][19][20]. However, none of these instruments have been evaluated in the context of resource-limited primary care settings.…”

“…However, the evidence concerning the benefits of applying the broad principles of CGAs in primary care are controversial [3]. In a recent systematic review, CGAs based on primary care practice were acceptable to the individuals involved but had an inconsistent impact on mortality, functional status and hospital admission rates [4]. Moreover, there is a need for new models that address the complexity of care of older adults living with multimorbidity or frailty in primary care, as these models can lead to quality of care improvements without increases in costs [3][4][5][6][7].…”

“…To assess reliability, we included 52 participants, 63.5% female and 69% white, with a median age of 72 years (85-64) and a median schooling duration of 11 (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15) years. The median AMPI-AB score was 5 (3)(4)(5)(6)(7)(8). The mean time taken to complete the AMPI-AB was 05:44 ± 02:42 min.…”

Identification and management of frailty in English primary care: a qualitative study of national policy

“…36 A recent systematic review of comprehensive geriatric assessments in primary care also reported only limited benefits for patients. 37 NHS England have recommended further research based on the potential benefits for some critical outcomes, 38 but we are currently far from having a clear insight into approaches that work and for whom.…”

Cognitive, functional, physical, and nutritional status of the oldest old encountered in primary care: a systematic review

“…The assessment of older patients is carried out in some geriatric day hospitals, especially for complex cases. New organizations for a geriatric assessment are proposed, to allow its realization in primary care [80,81]. The geriatric assessment could be realized for example by a trained nurse in the patient's home or in multi-professional primary care health centers with good results [82].…”