Journal of the American Medical Directors Association
JAMDA OnlineReview ArticleThree Decades of Comprehensive Geriatric Assessment: Evidence Coming From Different Healthcare Settings and Specific Clinical Conditions
Section snippets
Comprehensive Geriatric Assessment: Definition
The observations of high rates of institutionalization in the frail older population and the inadequacy of provision for readily recognisable and remedial problems in this high-risk group led to the development of one of the cornerstones of modern geriatric care: comprehensive geriatric assessment (CGA).1, 2 The concept is that the early identification of individuals at greatest risk for complications and unfavorable outcomes would enable a more adequate treatment plan and a better allocation
Methods
A literature database search was performed electronically via OVID (MEDLINE and SCOPUS), combining the term “comprehensive geriatric assessment” with the following keywords: “mortality,” “death,” “outcome,” “hospital,” “nursing home,” “randomized controlled trial,” “review,” and “meta-analysis”. The search was restricted to articles published in the English language until June, 2016.
In addition, a manual check on the reference lists in the articles and reviews identified was also conducted to
The Key Components of CGA
CGA is sometimes termed geriatric evaluation and management, particularly when geriatric assessment programs combine geriatric evaluation with management.5 The key components of different models of CGA include a coordinated multidisciplinary assessment, geriatric medicine expertise, identification of medical, physical, social, and psychological problems, and the formation of a plan of care including appropriate rehabilitation.6
The core domains of CGA are functional status, mobility, gait speed,
CGA in Different Healthcare Settings
During the last 30 years, the clinical geriatric models based on CGA have evolved in different healthcare settings to meet differing needs becoming the foundation of “progressive” geriatric care, including acute hospital care, day hospitals, rehabilitation units, nursing homes, and home-care services.8 In progressive geriatric care, CGA is performed at varying levels of intensity in different settings, and its content may vary with the healthcare setting (ie, hospital, posthospital
CGA in Specific Settings or Clinical Conditions
Among innovative approaches to outpatient CGA/OAS, practice redesign approaches focus on specific geriatric conditions for assessment and management by physicians or nurse practitioners. However, a series of particular settings or specific clinical conditions were the object or recent interest for tailored CGA programs in older frail patients (Table 2).
Multidimensional Geriatric Assessment and Clinical Decision Making
A large and increasing body of evidence indicated that the prognosis of older patients was strongly related to the presence of concomitant diseases and to the degree of physical, cognitive, biological, and social impairment.74 CGA, capable of effectively exploring these multiple domains of health, is indeed the multidimensional and multidisciplinary tool of choice to determine the prognosis of the functionally compromised and frail older patient [ie, multidimensional geriatric assessment (MGA)].
Conclusions
A systematic CGA of older adults may identify a variety of treatable health problems and lead to better health outcomes. Healthcare settings or specific clinical conditions may modify the effectiveness of CGA programs. Home and hospital CGA programs were shown to be consistently beneficial for several health outcomes, including mortality, disability, and cognitive functions. Ongoing studies explore the clinical usefulness of CGA programs in older frail patients who are candidates for surgery,
References (90)
- et al.
Comprehensive geriatric assessment: A meta-analysis of controlled trials
Lancet
(1993) - et al.
The influence of outpatient comprehensive geriatric assessment on survival: A meta-analysis
Arch Gerontol Geriatr
(2004) - et al.
Validation of the Minimum Data Set in identifying hospitalization events and payment source
J Am Med Dir Assoc
(2011) - et al.
Comprehensive geriatric care for patients with hip fractures: A prospective, randomised, controlled trial
Lancet
(2015) - et al.
The orthogeriatrics model of care: Systematic review of predictors of institutionalization and mortality in post-hip fracture patients and evidence for interventions
J Am Med Dir Assoc
(2012) - et al.
Use of comprehensive geriatric assessment in older cancer patients: Recommendation from the task force on CGA of the International Society of Geriatric Oncology (SIOG)
Crit Rev Oncol Hematol
(2005) - et al.
Development and validation of a Multidimensional Prognostic Index for mortality based on a standardized multidimensional assessment schedule (MPI-SVaMA) in community-dwelling older subjects
J Am Med Dir Assoc
(2013) - et al.
Relation of statin use and mortality in community-dwelling frail older patients with coronary artery disease
Am J Cardiol
(2016) Dr. Marjory Warren and the origin of British geriatrics
J Am Geriatr Soc
(1984)- et al.
Comprehensive geriatric assessment: Evidence
Geriatric assessment: Methods for clinical decision making
JAMA
Impacts of geriatric evaluation and management programs on defined outcomes: Overview of the evidence
J Am Geriatr Soc
Improved care for patients on a new geriatric evaluation unit
J Am Geriatr Soc
The BRIGHTEN program: Implementation and evaluation of a program to bridge resources of an interdisciplinary geriatric health team via electronic networking
Gerontologist
Freeman award lecture: Comprehensive geriatric assessment: From miracle to reality
J Gerontol A Biol Sci Med Sci
A randomized, controlled trial of a geriatric assessment unit in a community rehabilitation hospital
N Engl J Med
A randomised trial of care in a hospital medical unit especially designed to improve the functional outcomes of acutely ill older patients
N Engl J Med
A randomized trial of comprehensive geriatric assessment and home intervention in the care of hospitalized patients
Age Ageing
Geriatric-based versus general wards for older acute medical patients: A randomised comparison of outcomes and use of resources
J Am Geriatr Soc
Effects of a multicomponent intervention on functional outcomes and process of care in hospitalized older patients: A randomized controlled trial of Acute Care for Elders (ACE) in a community hospital
J Am Geriatr Soc
A controlled trial of inpatient and outpatient geriatric evaluation and management
N Engl J Med
Effectiveness of acute geriatric units on functional decline, living at home, and case fatality among older patients admitted to hospital for acute medical disorders: Meta-analysis
BMJ
Inpatient rehabilitation specifically designed for geriatric patients: Systematic review and meta-analysis of randomised controlled trials
BMJ
The effectiveness of inpatient geriatric evaluation and management units: A systematic review and meta-analysis
J Am Geriatr Soc
Impact of geriatric consultation teams on clinical outcome in acute hospitals: A systematic review and meta-analysis
BMC Med
Comprehensive geriatric assessment for older adults admitted to hospital
Cochrane Database Syst Rev
Comprehensive geriatric assessment for older adults admitted to hospital: Meta-analysis of randomised controlled trials
BMJ
The geriatric floating interdisciplinary transition team
J Am Geriatr Soc
Postdischarge geriatric assessment of hospitalized frail elderly patients
Arch Intern Med
Comprehensive discharge planning and home follow-up of hospitalized elders: A randomized clinical trial
JAMA
The care span: The importance of transitional care in achieving health reform
Health Aff
Effects of preventive home visits to elderly people living in the community: Systematic review
BMJ
Effectiveness of home based support for older people: Systematic review and meta-analysis
BMJ
Multidimensional preventive home visit programs for community-dwelling older adults: A systematic review and meta-analysis of randomized controlled trials
J Gerontol A Biol Sci Med Sci
Effectiveness of a geriatric evaluation unit. A randomized clinical trial
N Engl J Med
Effects of hospital-wide interventions to improve care for frail older inpatients: A systematic review
BMJ Qual Saf
Evaluation of the Mobile Acute Care of the Elderly (MACE) service
JAMA Intern Med
Improving patient handovers from hospital to primary care: A systematic review
Ann Intern Med
Designing the national resident assessment instrument for nursing homes
Gerontologist
A commitment to change: Revision of HCFA's RAI
J Am Geriatr Soc
Post-Acute Care Indicators
The Resident Assessment Instrument-Minimum Data Set 2.0 quality indicators: A systematic review
BMC Health Serv Res
Facility versus unit level reporting of quality indicators in nursing homes when performance monitoring is the goal
BMJ Open
Targeting residents for transitions from nursing home to community
Health Serv Res
Predicting mortality of residents at admission to nursing home: A longitudinal cohort study
BMC Health Serv Res
Cited by (276)
Validation of a seven-question tool (PRISMA-7) in predicting prognosis of older adults in the emergency department: A prospective study
2023, American Journal of Emergency MedicineTelepharmacy Model of Care
2023, Clinical TherapeuticsClinical practice guidelines for frailty vary in quality but guide primary health care: a systematic review
2023, Journal of Clinical EpidemiologyResearch-Practice Partnership to Develop and Implement Routine Mental Health Symptom Tracking Tool Among Older Adults During COVID-19
2023, American Journal of Geriatric PsychiatryCitation Excerpt :Mental health screening can help identify mental health needs and facilitate appropriate referrals.9 When mental health screening is integrated into routine care in late life, it reduces the risk of mortality, acute hospitalization, and other adverse health outcomes.10–11 Development of brief and simple needs identification tools that can be administered remotely and tailored to the needs of older adults and agency staff can improve detection and treatment.
Expanding Access to CBT-I for Older Adults: Review and Expansion of Recent Recommendations
2024, Current Sleep Medicine Reports
This work was supported from the MPI_AGE European project co-funded by the Consumers, Health, Agriculture, and Food Executive Agency (CHAFEA) in the frame of the European Innovation Partnership on Active and Healthy Aging Second Health Program 2008–2013. The contents of this article are the sole responsibility of the above mentioned Authors and can under no circumstances be regarded as reflecting the position of the European Union.
The authors declare no conflicts of interest.