Population
A Cochrane review «Ellis G, Gardner M, Tsiachristas A ym. Comprehensi...»1 included 29 randomised trials recruiting 13,766 participants across nine, mostly high-income countries. Trials that compare CGA for people at the age of 65 years and older admitted to hospital are included in the review.
Intervention
Comprehensive geriatric assessment (CGA) can be delivered on a specialist CGA ward or across several wards by a mobile team. On a CGA ward, care is provided by a specialist team that conducts a tailored assessment across a variety of domains, while possibly using standardised assessment tools to gather information. Assessment findings are discussed in a multi-disciplinary meeting, and a plan of treatment is developed. Members of the multi-disciplinary team are responsible for delivering the recommended treatment or rehabilitation plan (such as physiotherapy, occupational therapy, or medical treatment). CGA delivered by a mobile team also includes a multi-disciplinary assessment of a patient that is performed on one or more general medical wards. This is followed by a multi-disciplinary team meeting that results in a recommended plan for treatment with recommendations passed on to the ward team (medical and nursing staff). Multi-disciplinary team members may or may not be involved in delivering direct care (e.g. physiotherapy input).
Comparison
Routine medical care
Outcome
CGA increases the likelihood that patients:
– will be alive and in their own homes at 3 to 12 months' follow-up (risk ratio (RR) 1.06, 95% confidence interval (CI) 1.01 to 1.10; 16 trials, 6799 participants; high-certainty evidence)
– decreases the likelihood that patients will be admitted to a nursing home at 3 to 12 months follow-up (RR 0.80, 95% CI 0.72 to 0.89; 14 trials, 6285 participants; high-certainty evidence)
CGA may lead to a small increase in costs, and evidence for cost-effectiveness is of low-certainty. Healthcare costs per participant in the CGA group were on average GBP 234 (95% CI GBP 144 to GBP 605) higher than in the usual care group (17 trials, 5303 participants; low-certainty evidence).