Comprehensive geriatric assessment for older adults admitted to hospital

Ellis G, Gardner M, Tsiachristas A, Langhorne P, Burke O, Harwood RH, Conroy SP, Kircher T, Somme D, Saltvedt I, Wald H, O'Neill D, Robinson D, Shepperd S

What is the aim of this review?

The aim of this Cochrane Review was to find out if organised and co-ordinated specialist care (known as comprehensive geriatric assessment, or CGA) can improve care provided to older people admitted to hospital. Researchers at Cochrane collected and analysed all relevant studies to answer this question and included 29 trials in the review.

Key messages

Giving older people who are admitted to hospital access to specialist co-ordinated geriatric assessment (CGA) services on admission to hospital increases the chances that they will be alive in their own homes at follow-up.

What was studied in the review?

Older people admitted to hospital may have multiple, complex, and overlapping problems. They are more prone to rapid loss of independence during an acute illness, leading to potential admission to a nursing home. Some of this decline might be avoided if care needs are identified appropriately and if treatment is co-ordinated and managed. Specialist co-ordinated care (known as comprehensive geriatric assessment, or CGA) was developed to address medical, social, mental health, and physical needs with the help of a skilled multi-disciplinary team. The aims are to maximise recovery and to return patients to previous levels of function when possible. In hospital, CGA is carried out on a geriatric ward, or on a general ward that is visited by a specialist geriatric team.

What are the main results of the review?

Review authors found 29 relevant trials from nine countries that recruited 13,766 people. These studies compared CGA with routine care for patients over 65 who were admitted to hospital. Most trials evaluated CGA that was provided on a specialised hospital ward or across several wards by a mobile team. The review shows that older people who receive CGA rather than routine medical care after admission to hospital are more likely to be living at home and are less likely to be admitted to a nursing home at up to a year after hospital admission.

We found no evidence that CGA reduces risk of death during follow-up at up to a year after admission, and we noted that CGA appeared to make little or no difference in dependence (whether patients need help for everyday activities such as feeding and walking).

We found too much variation in cognitive function and length of hospital stay to draw a conclusion. Uncertainty regarding the cost-effectiveness analysis suggests that further research is needed.

How up-to-date is this review?

Review authors searched for studies that had been published up to 5 October 2016.

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