G.SUM1, S.O. NICHOLAS1, Z.L. NAI1, Y.Y. DING1, W.S. TAN1
Geriatric Education and Research Institute1
Synthesising evidence on quantitative health outcomes and qualitative implementation barriers and facilitators from Comprehensive Geriatric Assessment (CGA) on community-dwelling older adults would inform practice and policy for older patients who are not in inpatient settings or with specific chronic conditions.
We systematically searched medical and social science electronic databases (Ovid Medline, Embase, Cumulative Index of Nursing and Allied Health Literature (CINAHL), PsycINFO) for primary articles published from 1 January 2000 to 31 October 2020.
We screened 14,151 titles and abstracts and 203 full texts, and selected 43 articles. Most studies had CGAs conducted at home (n=25, 58%) and in primary care (n=8, 19%), and by nurses (n=22, 51%). There was evidence of improved functional status (5 of 19 RCTs, 2 of 3 pre-post), frailty and fall outcomes (3 of 6 RCTs, 1 pre-post), mental health outcomes (3 of 6 RCTs, 2 pre-post), self-rated health (1 of 6 RCTs, 1 pre-post), and quality of life (4 of 16 RCTs, 3 pre-post). Implementation barriers involved lack of partnership alignment and feedback, poor acceptance of preventive work, and challenges in operationalising and optimising CGAs. Facilitators included wholistic assessment and education, highly skilled staff, and improvements in care coordination and convenience.
There is heterogeneity in CGA intervention implementation and findings on health outcomes. While there is perceived positive value from CGA when carried out by highly skilled staff, barriers such as bringing providers into a partnership, greater acceptance of preventive care, and operational issues could impede its implementation.