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Evidence summaries

Comprehensive Geriatric Assessment for Older Adults Admitted to Hospital

Comprehensive geriatric assessment (CGA) appears to increase the patient's likelihood of being in their own home at up to 12 months. Level of evidence: "B"

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.

Summary

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).

Comprehensive geriatric assessment (CGA) versus admission to hospital without CGA.

Outcome (at 3 to 12 months)Relative effect(95% CI)Risk with controlRisk with CGA (95% CI)Participants (studies)
Living at homeRR 1.06(1.01 to 1.10)561 per 1000595 per 1000(567 to 617)6799(16)
MortalityRR 1.00(0.93 to 1.07)230 per 1000230 per 1000(214 to 247)10,023(21)
Admission to a nursing homeRR 0.80(0.72 to 0.89)186 per 1000151 per 1000(136 to 169)6285(14)
DependenceRR 0.97(0.89 to 1.04)291 per 1000282 per 1000(259 to 302)6551(14)
Cognitive functionNot estimableNot estimableStandardised mean difference from -0.22 to 0.353534(5)

Clinical comments

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References

  • Ellis G, Gardner M, Tsiachristas A et al. Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane Database Syst Rev 2017;9:CD006211. [PubMed]

Primary/Secondary Keywords