Article type
Abstract
Background:
Comprehensive Geriatric Assessment (CGA) is a commonly used intervention for addressing the health needs of an increasing older adult population across the world. Traditionally applied in hospitals, there is inconclusive evidence on its effectiveness in other settings. This overview aims to provide a synthesis of the current evidence on CGA models in primary care facilities, outpatient care, community-based programs, institutional care settings and home-based care.
Methods:
The overview of reviews followed standard guidance, was prospectively registered, and adhered to PRIOR checklist for reporting. Systematic reviews reporting on older adults (≥50 years) undergoing CGA in non-hospitalized settings were included and reviews focusing on narrow high-risk groups or specific disease conditions were excluded. Searches spanned 5 medical databases up to August 2023.
Results:
Of 2574 identified articles, 22 systematic reviews met the inclusion criteria. Majority of reviews focused on community and home settings, with participants mostly aged 65 or older. Quality assessment using AMSTAR indicated moderate to good review quality. The reviews identified diverse CGA models, frequently involving nurses and multidisciplinary teams. Mortality, institutionalization, hospitalization, readmission, functional status, frailty, and quality of life were assessed as outcomes. Results showed no evidence of benefit regarding CGA on mortality, institutionalization, hospitalization, and quality of life. Functional status outcomes varied, with some evidence suggesting benefits. The evidence exclusively stems from high-income countries and among older people who would be considered ‘low-risk’.
Conclusion: There is little to no evidence of the benefit or effectiveness of CGA in community/home/primary care settings on most clinical or patient-reported outcomes. The models of CGA are highly heterogeneous across domains, delivery, dosage, and frequency. Complex interventions that could first identify suitable candidates for CGA from the community could lead to better outcomes. Future research on building and testing such interventions should be additionally planned in LMICs.
Comprehensive Geriatric Assessment (CGA) is a commonly used intervention for addressing the health needs of an increasing older adult population across the world. Traditionally applied in hospitals, there is inconclusive evidence on its effectiveness in other settings. This overview aims to provide a synthesis of the current evidence on CGA models in primary care facilities, outpatient care, community-based programs, institutional care settings and home-based care.
Methods:
The overview of reviews followed standard guidance, was prospectively registered, and adhered to PRIOR checklist for reporting. Systematic reviews reporting on older adults (≥50 years) undergoing CGA in non-hospitalized settings were included and reviews focusing on narrow high-risk groups or specific disease conditions were excluded. Searches spanned 5 medical databases up to August 2023.
Results:
Of 2574 identified articles, 22 systematic reviews met the inclusion criteria. Majority of reviews focused on community and home settings, with participants mostly aged 65 or older. Quality assessment using AMSTAR indicated moderate to good review quality. The reviews identified diverse CGA models, frequently involving nurses and multidisciplinary teams. Mortality, institutionalization, hospitalization, readmission, functional status, frailty, and quality of life were assessed as outcomes. Results showed no evidence of benefit regarding CGA on mortality, institutionalization, hospitalization, and quality of life. Functional status outcomes varied, with some evidence suggesting benefits. The evidence exclusively stems from high-income countries and among older people who would be considered ‘low-risk’.
Conclusion: There is little to no evidence of the benefit or effectiveness of CGA in community/home/primary care settings on most clinical or patient-reported outcomes. The models of CGA are highly heterogeneous across domains, delivery, dosage, and frequency. Complex interventions that could first identify suitable candidates for CGA from the community could lead to better outcomes. Future research on building and testing such interventions should be additionally planned in LMICs.