Comprehensive geriatric assessment for older adults admitted to ...

Authors’ conclusions
Comprehensive geriatric assessment increases a patient’s likelihood of being alive and in their own home at up to 12 months.
P L A I N L A N G U A G E S U M M A R Y
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.
B A C K G R O U N D
Hospital admissions for emergencies have continued to increase
year on year. The largest increases have occurred in the over 65
age group (DOH 2006; OECD 2004; Wood 2001), leading some
epidemiologists to conclude that the future of inpatient emergency
medical care is the care of the older adult (Wood 2001).
Observing high rates of institutionalisation in the frail elderly population,
Warren and colleagues identified the lack of a comprehensive
assessment of the medical, social, functional or psychological
needs of this high-risk group (Mathews 1984). They also
observed the inadequacy of provision for readily recognisable and
remedial problems. This observation led to the development of
one of the cornerstones of modern geriatric care: the comprehensive
geriatric assessment (CGA). Comprehensive geriatric assessment
is defined as a “multidimensional interdisciplinary diagnostic
process focused on determining a frail elderly person’s medical,
psychological and functional capability in order to develop a coordinated
and integrated plan for treatment and long term follow
up” (Rubenstein 1991).
Models of CGA have evolved in different healthcare settings and to
meet differing needs. Common to these interventions are several
key features that have been attributed with their effectiveness. The
key components include:
• co-ordinated multidisciplinary assessment;
• geriatric medicine expertise;
• identification of medical, physical, social and psychological
problems; and
• the formation of a plan of care including appropriate
rehabilitation.
Comprehensive geriatric assessment for older adults admitted to hospital (Review)
Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
In addition, several key components have been associated with
improved CGA outcomes (Stuck 1993). These were highlighted
in a systematic review as:
• the ability to directly implement treatment
recommendations made by the multidisciplinary team; and
• long-term follow up.
In 1993, Andreas Stuck and colleagues conducted a meta-analysis
of different service-based interventions for older people (Stuck
1993). This meta-analysis provided a framework for the definition
of inpatient and outpatient models of CGA. Inpatient CGA was
divided into two types. The first was delivered by a team in a discrete
ward, with control over the delivery of the multi-disciplinary
team recommendations (these are sometimes known as a Geriatric
Evaluation and Management Units (GEMU) or alternatively
Acute Care for Elders Units (ACE)). The second was a multidisciplinary
team assessing patients and delivering recommendations
to the physicians caring for older patients (known as the Inpatient
Geriatric Consultation Service (IGCS)). Results of this metaanalysis
showed a benefit on short-term mortality, reduced institutionalisation
and readmission, improved cognitive functioning
and, for some models, improved physical functioning. Since this
meta-analysis, a number of studies have reported trials of CGA
(Asplund 2000; Cohen 2002; Counsell 2000; Landefeld 1995;
Nikolaus 1999; Reuben 1995; Saltvedt 2002). In addition there
have been a number of systematic reviews and meta-analyses of
various subgroups of CGA. One meta-analysis looked specifically
at ACE units (Baztan 2009) and included case-control studies.
One evaluated a subgroup of postacute geriatric wards in combination
with orthogeriatric rehabilitation units (Bachmann 2010).
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