Comprehensive geriatric assessment for older adults admitted to ...

Comparison between admission in the acute setting to CGA wards
and in the postacute setting is not possible with existing trials.
Questions remain as to when patients should be optimally treated.
The evidence across the spectrum of the patient journey appears to
point to a benefit from CGA and some may feel that this question
is irrelevant. It would appear necessary for healthcare organisations
to justify their provision of adequate geriatric beds both in the
acute and stepdown settings. Further delineating the roles of acute
and stepdown models of CGA would be justified.
Further evaluation of these remaining questions is warranted. The
contact author would be happy to hear from trialists addressing
References to studies included in this review
Applegate 1990 {published data only}
Applegate WB, Miller ST, Graney MJ, Elam JT, Burns R,
Akins DE. A randomized, controlled trial of a geriatric
assessment unit in a community rehabilitation hospital.
New England Journal of Medicine 1990;322:1572–8.
Miller ST, Applegate WB, Elam JT, Graney MJ. Influence
of diagnostic classification on outcomes and charges in
geriatric assessment and rehabilitation. Journal of the
American Geriatrics Society 1994;42:11–5.
Asplund 2000 {published data only}
Asplund K, Gustafsen Y, Jacobsson C, Bucht G, Wahlin A,
Peterson J, et al.Geriatric-based versus general wards for
older acute medical patients: a randomised comparison
of outcomes and use of resources. Journal of the American
Geriatrics Society 2000;48:1381–8.
Cohen 2002 {published data only}
Cohen HJ, Feussner JR, Weinberger M, Carnes M, Hamdy
RC, Hseih F, et al.A controlled trial of inpatient and
outpatient geriatric evaluation and management. New
England Journal of Medicine 2002;346:905–12.
Phibbs CS, Holty JEC, Goldstein MK, Garber AM, Wang
Y, Feussner JR, et al.The effect of geriatrics evaluation and
management on nursing home use and health care costs.
Results from a randomised trial. Medical Care 2006;44(1):
91–5.
Cohen 2002 GEMC {published data only}
∗ Cohen HJ, Feussner JR, Weinberger M, Carnes M,
Hamdy RC, Hsieh F, et al.A controlled trial of inpatient
and outpatient geriatric evaluation and management. New
England Journal of Medicine 2002;346:905–12.
Cohen 2002 UCOP {published data only}
∗ Cohen HJ, Feussner JR, Weinberger M, Carnes M,
Hamdy RC, Hsieh F, et al.A controlled trial of inpatient
and outpatient geriatric evaluation and management. New
England Journal of Medicine 2002;346:905–12.
R E F E R E N C E S
Comprehensive geriatric assessment for older adults admitted to hospital (Review)
Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
these questions or further trials of in-hospital CGA.
A C K N O W L E D G E M E N T S
The authors would like to acknowledge the patient help and support
of the Cochrane Effective Practice and Organisation of Care
(EPOC) editorial group. Cochrane Effective Practice and Organisation
of Care (EPOC) editorial group. We would like to acknowledge
the peer review contribution from Pierre Durieux, Stephen
Chalcroft, Sasha Shepperd and Craig Ramsay.
Collard 1985 {published data only}
Bachman SS, Collard AF, Greenberg JN, Fountain E,
Huebner TW, Kimball B, et al.An innovative approach
to geriatric acute care delivery: the Choate-Symmes
experience. Hospital & Health Services Administration 1987;
November:509–20.
Collard AF, Bachman SS, Beatrice DF. Acute care delivery
for the geriatric patient: an innovative approach. Quarterly
Review Bulletin 1985;June:180–5.
Counsell 2000 {published data only}
Counsell SR, Holder CM, Liebenauer LL, Palmer
RM, Fortinsky RH, Kresevic DM, et al.Effects of a
multicomponent intervention on functional outcomes
and process of care in hospitalised older patients: a
randomised controlled trial of acute care for elders (ACE)
in a community hospital. Journal of the American Geriatrics
Society 2000;48:1572–81.
Fretwell 1990 {published data only}
Fretwell MD, Raymond PM, McGarvey ST, Owens N,
Traines M, Silliman RA, et al.The senior care study. A
controlled trial of a consultative / unit based geriatric
assessment program in acute care. Journal of the American
Geriatrics Society 1990;38:1073–81.
Silliman RA, McGarvey ST, Raymond PM, Fretwell MD.
Senior care study: does inpatient interdisciplinary geriatric
assessment help the family caregivers of acutely ill older
patients?. Journal of the American Geriatrics Society 1990;38
(4):461–6.
Harris 1991 {published data only}
Harris RD, Henschke PJ, Popplewell PY, Radford AJ, Bond
MJ, Turnbull RJ, et al.A randomised study of outcomes
in a defined group of acutely ill elderly patients managed
in a geriatric assessment unit or a general medical unit.
Australian and New Zealand Journal of Medicine 1991;21:
230–4.
Hogan 1987 {published data only}
Hogan DB, Fox RA, Badley BWD, Mann OE. Effect of a
geriatric consultation service on management of patients in
16