Comprehensive geriatric assessment for older adults admitted to ...

Risk of bias in included studies
The studies identified were heterogeneous in quality (Figure 3).
All employed some method of individual patient randomisation,
however reporting of key issues such as allocation concealment
varied. Outcome assessment was seldom blinded. This is less significant
for hard outcomes such as death or institutionalisation,
but becomes more important for outcomes such as activities of
daily living or cognition.
Figure 3. ’Risk of bias’ graph: review authors’ judgements about each risk of bias item presented as
percentages across all included studies.
We extracted data from published information only. We did not
contact trialists for additional data. Reporting of outcomes was
variable. Different reporting mechanisms were used for description
of some data (for example, activities of daily living, which could be
reported as a categorical or variable outcome). For this reason, we
did not combine some outcomes for meta-analysis. Data quality
was also variable with some trialists reporting data with standard
deviations, some reporting interquartile ranges and some reporting
standard errors.
We noted attrition in some trials (Collard 1985; Harris 1991) for
functional outcomes. In some cases (Collard 1985) this exceeded
25%. We felt that the possibility of attrition bias might be introduced
for outcomes that could be unduly influenced by an un-
Comprehensive geriatric assessment for older adults admitted to hospital (Review)
Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
blinded trial design. Results from this trial have been included for
the outcome of dependence, however the results must be interpreted
with some caution.
Effects of interventions
Comparison 1: Comprehensive geriatric assessment
(CGA) versus usual care
The first primary outcome summarises data from 22 trials of
10,315 participants comparing CGA with usual care (e.g. on a
general medical ward). We analysed this using the main subgrouping
of CGA wards and CGA teams versus usual care. Subgroup
8