Comprehensive geriatric assessments in integrated care programs for older people living at home: A scoping review

Abstract

In many integrated care programs, a comprehensive geriatric assessment (CGA) is conducted to identify older people's problems and care needs. Different ways for conducting a CGA are in place. However, it is still unclear which CGA instruments and procedures for conducting them are used in integrated care programs, and what distinguishes them from each other. Furthermore, it is yet unknown how and to what extent CGAs, as a component of integrated care programs, actually reflect the main principles of integrated care, being comprehensiveness, multidisciplinarity and person‐centredness. Therefore, the objectives of this study were to: (a) describe and compare different CGA instruments and procedures conducted within integrated care programs for older people living at home, and (b) describe how the principles of integrated care were applied in these CGAs. A scoping review of the scientific literature on CGAs in the context of integrated care was conducted for the period 2006–2018. Data were extracted on main characteristics of the identified CGA instruments and procedures, and on how principles of integrated care were applied in these CGAs. Twenty‐seven integrated care programs were included in this study, of which most were implemented in the Netherlands and the United States. Twenty‐one different CGAs were identified, of which the EASYcare instrument, RAI‐HC/RAI‐CHA and GRACE tool were used in multiple programs. The majority of CGAs seemed to reflect comprehensiveness, multidisciplinarity and person‐centredness, although the way and extent to which principles of integrated care were incorporated differed between the CGAs. This study highlights the high variability of CGA instruments and procedures used in integrated care programs. This overview of available CGAs and their characteristics may promote (inter‐)national exchange of CGAs, which could enable researchers and professionals in choosing from the wide range of existing CGAs, thereby preventing them from unnecessarily reinventing the wheel.

The World Health Organization (WHO) approach to healthy ageing

“…As people age, physical, sensory and cognitive impairments are more prevalent and disorders such as urinary incontinence, frailty and an increased risk of falling can lead to the loss of functional ability [33]. The training and adequate tools are needed to properly asses the medical, psychological and functional capabilities of an elderly person in order to develop a coordinated and integrated plan for treatment and long-term care [34,35].…”

A Contextual Analysis and Logic Model for Integrated Care for Frail Older Adults Living at Home: The INSPIRE Project

“…The core intervention features a CGA at the center, which is considered either beneficial or a gold standard in caring for frail older adults in certain settings [ 66 77 78 79 ]. In a recent scoping review of 27 integrated care programs for older people, the authors found that the 21 different CGA instruments used incorporated three of the dominant principles of integrated care, i.e., comprehensive, multidisciplinary and person-centred care [ 80 ]. However, they proposed that stronger involvement of both social care professionals and older adults could strengthen the CGA process, which will be key in the INSPIRE model [ 12 ].…”

Geriatric care in European countries where geriatric medicine is still emerging

“…Prevalence varies from 20 to 44% and is affected by family care norms [11]. This diversity exists not only in the available supportive solutions but in other fields of geriatric medicine as in the case of integrated care programs for older where many different CGA instruments are used and this is proposedly driven by the need to have context or population-specific procedures that suit best screening, assessment and management purposes of each specific program [12]. We can easily distinguish the variety, the accessibility and the particularities of the available services that can be used to provide care designated for older people across countries.…”