Background: With worldwide population aging, increasing numbers of people need hospital care. Evidence suggests comprehensive geriatric assessment (CGA) is superior to usual care.
Objective: To summarize the evidence for the effects of CGA in frail and moderately frail patients compared with usual care in acute care settings.
Data sources: CINAHL, PsycInfo, Cochrane Library, EMBASE, and PubMed were searched in October 2011, January 2013, and February 2015.
Study eligibility: Randomized controlled trials.
Participants: Older adults aged ≥ 65 years who were admitted to hospital with a complex condition, divided into frail and moderately frail groups.
Control: Usual care.
Outcomes: Change in housing, personal activities of daily living (PADL), instrumental activities of daily living (IADL), readmission, cognitive function, depression, quality-of-life care-giver burden, and mortality.
Study appraisal and synthesis: The grading of recommendations assessment development and evaluation (GRADE) system to assess the quality of evidence and PRISMA-guidelines for meta-analyses and reviews. Continuous data were presented as standardized mean differences and dichotomous data were presented as risk differences.
Results: Twenty-nine articles based on 17 unique studies (6005 patients in total). CGA was categorized as CGA-ward or CGA-consult. In the frail group, CGA-ward was superior to usual care for change in housing, PADL, and depression. CGA-consult was superior to usual care for PADL and IADL in the moderately frail group.
Conclusion: There was a stronger effect for frail older adults and CGA-ward compared with usual care. This highlights the importance of detecting frailty. However, the degree of evidence was limited.
Elsevier, 2015. Vol. 6, no 6, 523-540 p.
Comprehensive geriatric assessment, Frailty, Acute care, Systematic review, Meta-analysis