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.
PICOs
Plain language summary
Comprehensive geriatric assessment for older adults admitted to hospital
This review investigates whether specialist, organised and co‐ordinated geriatric care (normally referred to as comprehensive geriatric assessment or CGA) is better for patient outcomes than conventional care in a hospital setting. There is a clear and significant improvement in the chances of a patient being alive and in their own home at up to a year after an emergency hospital admission if they receive co‐ordinated specialist services. This effect is consistently seen from trials of geriatric wards where patients are admitted to a dedicated ward area and receive care from a specialist multidisciplinary team. This effect was not clearly seen where patients remained in a general ward and received assessment from a visiting specialist multi‐disciplinary team.
