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Older people

Comprehensive geriatric assessment

What is it?

Comprehensive geriatric assessment (CGA) forms the basis of multidisciplinary specialist care for older people. It involves a systematic review of the older person’s health and care needs, care coordination, and follow-up. It is targeted at older people with complex health and care needs.

Does it work?

CGA has been studied extensively and appears to produce benefits on mortality, functional status, patient satisfaction, and reduced need for long term residential care. 1 2 3 4 5 6 7 It has mixed results on impact of use of acute hospital beds. Those models of CGA that have strong systems for long term follow up and case management are most likely to reduce the need for acute hospital care.

How does it work?

CGA works by targeting those older people with the most complex health and care needs, often with multiple health problems and threat to their independence and wellbeing. This group is at high risk of hospitalisation and care home placement. Specialist multidisciplinary assessment is used to identify opportunities for prevention, diagnosis and treatment, rehabilitation, environmental modification, carer needs and support to remain at home. Formal systems of review and follow up are required to respond to changing needs.

References

  1. Leung ACT, Liu CP, Chow NWS, Chi I. Cost-benefit analysis of a case management project for the community-dwelling frail elderly in Hong Kong. J Appl Gerontol 2004;23:70-85. External Link
  2. Lim WK, Lambert SF, Gray LC. Effectiveness of case management and post-acute services in older people after hospital discharge. Med J Aust 2003;178:262-66. External Link
  3. Landi F, Gambassi G, Pola R, Tabaccanti S, Cavinato T, Carbonin PU, et al. Impact of integrated home care services on hospital use. J Am Geriatr Soc 1999;47: 1430-4. External Link
  4. Caplan GA, Williams AJ, Daly B, Abraham K. A randomized controlled trial of comprehensive geriatric assessment and multidisciplinary intervention after discharge of elderly from the emergency department – the DEED II study. J Am Geriatr Soc 2004;52:1417-23. External Link
  5. Boult C, Boult L, Morishita L, Dowd B, Kane RL, Urdangarin CF. A randomized clinical trial of outpatient geriatric evaluation and management. J Am Geriatr Soc 2001;49:351-9. External Link
  6. Stuck AE, Aronow HU, Steiner A, Alessi CA, Bula CJ, Gold MN,et al.A trial of annual in-home comprehensive geriatric assessments for elderly people living in the community. N Engl J Med 1995;333:1184-9. External Link
  7. Stuck AE, Siu AL, Wierland GD, Adams J, Rubenstein LZ. Comprehensive geriatric assessment:a meta-analysis of controlled trials. Lancet 1993;342:1032-36. External Link