COMPREHENSIVE GERIATRIC ASSESSMENT FOR OLDER ADULTS ADMITTED TO HOSPITAL

Background: Comprehensive geriatric assessment (CGA) is a multidimensional, multidisciplinary diagnostic and therapeutic process to determine the medical, mental and functional problems of older people with frailty in order to develop a co-ordinated and integrated plan for treatment and follow-up. This is an update of a previously published Cochrane review. Methods: We searched CENTRAL, MEDLINE, Embase, three other databases and two trials registers. We included randomised controlled trials that compared inpatient CGA (geriatric wards or mobile teams), to usual care on a general medical ward for older people admitted to hospital as an emergency. For this update, we requested individual patient data (IPD) from trialists, and conducted a survey of trialists to obtain details of the delivery of CGA. We estimated cost-effectiveness comparing inpatient CGA with hospital admission without CGA in terms of cost per quality adjusted life year (QALY) gained, cost per life year (LY) gained, and cost per life year living at home (LYLAH) gained. Results: Twenty-nine trials recruiting 13,766 participants across nine countries were included. CGA increases the likelihood of patients being alive and in their own homes at 3 to 12 month follow-up (RR 1.06, 95% CI 1.01 to 1.10, 16 trials), results in little or no difference in mortality at 3 to 12 month follow-up (RR 1.00, 95% CI 0.93 to 1.07, 22 trials), decreases the likelihood of patients being admitted to a nursing home at 3 to 12 months (RR 0.80, 95% CI 0.72 to 0.89, 14 trials), results in little or no difference in dependence (RR 0.97, 95% CI 0.89 to 1.04, 14 trials) and may make little or no difference to cognitive function (SMD -0.22 to 0.35, 5 trials). The probability of CGA to be cost-effective at a £20,000 ceiling ratio for a QALY, LY and LYLAH was 0.50, 0.89, and 0.47 respectively. Conclusions: Older patients are more likely to be alive and in their own homes at follow-up if they received CGA on admission to hospital. Further research is required on cost effectiveness.