Comprehensive geriatric assessment in older people: an umbrella review of health outcomes

• Published in: Age and ageing Vol. 51; no. 5
• Main Authors: Veronese, Nicola, Custodero, Carlo, Demurtas, Jacopo, Smith, Lee, Barbagallo, Mario, Maggi, Stefania, Cella, Alberto, Vanacore, Nicola, Aprile, Pierangelo Lora, Ferrucci, Luigi, Pilotto, Alberto
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.05.2022; Oxford Publishing Limited (England); Oxford University Press (OUP)
• Subjects: Aged; Aged, 80 and over; Clinical outcomes; Delirium; Emergency medical care; Emergency services; Evaluation; Fractured hips; Frailty; Geriatric Assessment; Geriatrics; Health status; Hematology; Home health care; Hospitalization; Humans; Independent Living; Life Sciences; Meta-analysis; Nursing homes; Older people; Oncology; Outcome Assessment, Health Care; Patient admissions; Pressure ulcers; Reviews; Statistical analysis; Systematic review; Systematic Reviews as Topic; comprehensive geriatric assessment; older people; umbrella review; systematic review
• ISSN: 0002-0729; 1468-2834; 1468-2834
• DOI: 10.1093/ageing/afac104

Abstract Background Comprehensive geriatric assessment (CGA) has been in use for the last three decades. However, some doubts remain regarding its clinical use. Therefore, we aimed to capture the breadth of outcomes reported and assess the strength of evidence of the use of comprehensive geriatric assessment (CGA) for health outcomes in older persons. Methods Umbrella review of systematic reviews of the use of CGA in older adults searching in Pubmed, Embase, Scopus, Cochrane library and CINHAL until 05 November 2021. All possible health outcomes were eligible. Two independent reviewers extracted key data. The grading of evidence was carried out using the GRADE for intervention studies, whilst data regarding systematic reviews were reported as narrative findings. Results Among 1,683 papers, 31 systematic reviews (19 with meta-analysis) were considered, including 279,744 subjects. Overall, 13/53 outcomes were statistically significant (P < 0.05). There was high certainty of evidence that CGA reduces nursing home admission (risk ratio [RR] = 0.86; 95% confidence interval [CI]: 0.75–0.89), risk of falls (RR = 0.51; 95%CI: 0.29–0.89), and pressure sores (RR = 0.46; 95%CI: 0.24–0.89) in hospital medical setting; decreases the risk of delirium (OR = 0.71; 95%CI: 0.54–0.92) in hip fracture; decreases the risk of physical frailty in community-dwelling older adults (RR = 0.77; 95%CI: 0.64–0.93). Systematic reviews without meta-analysis indicate that CGA improves clinical outcomes in oncology, haematology, and in emergency department. Conclusions CGA seems to be beneficial in the hospital medical setting for multiple health outcomes, with a high certainty of evidence. The evidence of benefits is less strong for the use of CGA in other settings.