David Barer, MB, DM
In elderly patients hospitalized on an emergency basis, does inpatient comprehensive geriatric assessment (CGA) increase the likelihood of living at home after discharge?
Included studies compared CGA with usual inpatient care in patients ≥ 65 years of age hospitalized on an emergency basis with medical, psychological, functional, or social problems. Studies of condition-specific organized care (e.g., stroke units) were excluded. CGA was defined as multilevel assessment and management of medical, psychiatric, functional, and social domains by a multidisciplinary team. CGA care was delivered on specialist geriatric wards or by mobile CGA teams, which assessed and made recommendations for patients in general medical wards. Primary outcome was living at home (likelihood of being alive and in one's own home). Secondary outcomes included mortality and institutionalization.
MEDLINE, EMBASE/Excerpta Medica, CINAHL, American College of Physicians, AARP Ageline, Cochrane Central Register of Controlled Trials, and Database of Abstracts of Reviews of Effects were searched to April 2010 for randomized controlled trials (RCTs). Cochrane Effective Practice and Organization of Care Group Register and database of studies awaiting assessment were reviewed. Reference lists of identified studies and conference proceedings of 2 geriatrics societies were reviewed. 22 RCTs met the selection criteria (n = 10 315, mean age range 74 to 83 y, 24% to 100% men). Median follow-up was 12 months (range 6 wk to 12 mo). Study quality varied; allocation concealment was often not reported, and outcome assessors were seldom blinded.
Meta-analysis showed that CGA improved the likelihood of living at home and reduced risk for institutionalization compared with usual care. Subgroup analysis showed that CGA in specialized wards improved the likelihood of living at home and reduced risk for institutionalization; CGA by mobile teams did not (Table). CGA did not differ from usual care for mortality.
Inpatient comprehensive geriatric assessment of elderly patients hospitalized on an emergency basis improves the likelihood of living at home after discharge.
*NS = not significant; RBR = relative benefit reduction; other abbreviations defined in Glossary. RBI, RBR, RRR, RRI, NNT, CI, and event rates calculated from data in article using a fixed-effect model.
†All CGA interventions, CGA delivered on specialist geriatric wards, and CGA delivered by mobile teams.
Barer D. Review: Inpatient comprehensive geriatric assessment improves the likelihood of living at home at 12 months. Ann Intern Med. ;155:JC6–2. doi: 10.7326/0003-4819-155-12-201112200-02002
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Published: Ann Intern Med. 2011;155(12):JC6-2.
Geriatric Medicine, Hospital Medicine.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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