Comment: The quality of the evidence is downgraded by study quality (unclear allocation concealment, lack of blinding), inconsistency (heterogeneity in patients and outcomes) and upgraded by large magnitude of effect.
A Cochrane review [Abstract] 1 included 29 studies with a total of 13 766 elderly subjects in a hospital setting across 9 mostly high-income countries. Comprehensive geriatric assessment (CGA) is a multidimensional, interdisciplinary diagnostic process to determine the medical, psychological and functional capabilities of a frail elderly person in order to develop a co-ordinated and integrated plan for treatment and long-term follow up.Most trials evaluated CGA that was provided on a specialised hospital ward or across several wards by a mobile team. CGA increased the likelihood of patients to be in their own homes, decreased admittance to a nursing home and made no difference in mortality, dependence or cognitive function (table T1).
| Outcome (at 3 to 12 months) | Relative effect(95% CI) | Risk with control | Risk with CGA (95% CI) | Participants (studies) |
|---|---|---|---|---|
| Living at home | RR 1.06(1.01 to 1.10) | 561 per 1000 | 595 per 1000(567 to 617) | 6799(16) |
| Mortality | RR 1.00(0.93 to 1.07) | 230 per 1000 | 230 per 1000(214 to 247) | 10,023(21) |
| Admission to a nursing home | RR 0.80(0.72 to 0.89) | 186 per 1000 | 151 per 1000(136 to 169) | 6285(14) |
| Dependence | RR 0.97(0.89 to 1.04) | 291 per 1000 | 282 per 1000(259 to 302) | 6551(14) |
| Cognitive function | Not estimable | Not estimable | Standardised mean difference from -0.22 to 0.35 | 3534(5) |
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