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 «Comprehensive geriatric assessment for older adults admitted to hospital»1 «Ellis G, Gardner M, Tsiachristas A et al. Comprehe...»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 «Comprehensive geriatric assessment (CGA) versus admission to hospital without CGA....»1).
| 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) |