Comprehensive Geriatric Assessment

Older people represent the fastest growing sector of society and account for the largest increase in hospital admissions. They are at highest risk of acquired disability, cognitive decline, or admission to residential care, either as a consequence of illness or as an unfortunate consequence of treatment.
Older people’s needs are more complex with potentially coexistent medical, functional, psychological, and social needs. This can lead to an atypical presentation that can often be misunderstood and requires a different approach to care.

One of the cornerstones of modern geriatric care is comprehensive geriatric assessment (CGA). This is defined as a “multidimensional interdisciplinary diagnostic process focused on determining a frail older person’s medical, psychological and functional capability in order to develop a coordinated and integrated plan for treatment and long term follow up.”

Comprehensive geriatric assessment is therefore both a diagnostic and therapeutic process. It seeks to ensure that problems are identified, quantified, and managed appropriately. The likelihood of multiple overlapping problems necessitates assessment across several domains and therefore involves several disciplines. These assessments across medical, psychiatric, functional, and social domains are required to develop a broad or multifaceted therapeutic plan to enhance recovery and promote independence.

Models of Inpatient C.G.A

There are two broad models of inpatient comprehensive geriatric assessment. The first is delivered in a discrete ward with a coordinated specialist multidisciplinary team. Patients are admitted into this facility and cared for by the specialist team, who provide the assessment and rehabilitation.
There are several names for these wards, including acute care for elders (ACE units), geriatric evaluation and management units (GEMU), or rehabilitation wards. For the purposes of this review we have grouped these together as “wards.” In the second model, a mobile or peripatetic team visit appropriate patients wherever they are admitted in a general ward setting. The team will assess the patients and make recommendations to the physicians who care for the patients.

These are sometimes referred to as interdisciplinary geriatric consultation services (grouped here under the heading of “teams”). Various reviews of comprehensive geriatric assessment already exist in the literature but have shortfalls in their comprehensiveness. One of the earliest reviews included analysis of trials of stroke care as well as orthogeriatrics and has now been superseded by individual specialty reviews. Others have looked at specific subgroups of comprehensive geriatric assessment based on timing of admission, patient defined criteria, or ward title or have simply had inadequate analysis data. We determined whether inpatient comprehensive geriatric assessment for frail older adults admitted to hospital as an emergency is more effective than routine or general medical care in hospital.

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