Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-11-25T22:14:34.812Z Has data issue: false hasContentIssue false

Chapter 19 - Comprehensive Geriatric Assessment in Clinical Practice

Published online by Cambridge University Press:  04 April 2024

By
Khalid Ali
Edited by
George Tadros  and
George Crowther
George Tadros
Affiliation:
Aston University, Birmingham
George Crowther
Affiliation:
Leeds and York Partnership NHS Foundation Trust, Leeds
Get access

Summary

Comprehensive geriatric assessment (CGA) has been one of the cornerstones of geriatric medicine since its introduction by Marjory Warren in 1936. This kind of assessment is defined as a multidimensional and multidisciplinary process related to identifying medical, social, and functional needs and developing an integrated care plan designed to meet the patien’st needs.The practice and applications of CGA have been used to various degrees in mainstream care for older people in the UK and internationally.

Some limitations still exist around the wider implementation of CGA, as its practice relies on members of the multidisciplinary team (MDT) and on an effective communication between them, the patients, and their families. This kind of assessment has been criticised for not adequately acknowledging frailty and for not using patient-reported outcome measures to test its efficacy.

Randomised controlled studies, systematic reviews, and meta-analyses provided considerable evidence for the clinical and financial effectiveness of CGA in various hospital specialties. However, there are still concerns about the generalisability of CGA in community settings. Further research to identify target populations for CGA-led interventions and a consensus on outcome measures are required to realise CGA benefits.

In this chapter we describe required skills and practical tips to deliver CGA across a variety of settings.

Keywords

olderpeoplecomprehensivegeriatricassessmentmultidisciplinaryteamintegratedcareeffectiveness
Type
Chapter
Information
Handbook of Old Age Liaison Psychiatry , pp. 283 - 291
Publisher: Cambridge University Press
Print publication year: 2024

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Parker, S.G, McCue, P., Phelps, K. et al. What is comprehensive geriatric assessment (CGA)? An umbrella review. Age and Ageing 2018, 47: 149–55.Google ScholarPubMed
Stuck, A.E., Siu, A.L., Wieland, G.D., Adams, J. et al. Comprehensive geriatric assessment: A meta-analysis of controlled trials. Lancet 1993, 342(8878): 1032–6.CrossRefGoogle ScholarPubMed
Conroy, S.P., Bardsley, M., Smith, P. et al. Comprehensive Geriatric Assessment for Frail Older People in Acute Hospitals: The How-CGA Mixed-Methods Study. Southampton (UK): NIHR Journals Library, 2019.Google ScholarPubMed
Gladman, J.R.F., Conroy, S.P., Ranhoff, A.H. et al. New horizons in the implementation and research of comprehensive geriatric assessment: Knowing, doing and the ‘know-do’ gap. Age and Ageing 2016, 45: 194–200.CrossRefGoogle ScholarPubMed
Darby, J., Williamson, T., Logan, P. et al. Comprehensive geriatric assessment on an acute medical unit: A qualitative study of older people’s and informal carer’s perspectives of the care and treatment received. Clinical Rehabilitation 2017, 3: 126–34.Google Scholar
Harari, D., Hopper, A., Dhesi, J. et al. Proactive care of older people undergoing surgery (POPS): Designing, embedding, evaluating, and funding a comprehensive geriatrics assessment service for older elective surgical patients. Age and Ageing 2007, 36: 190–6.CrossRefGoogle Scholar
Harari, D, Martin, F.C., Buttery, A. et al. The older persons’ assessment and liaison team ‘OPAL’: Evaluation of comprehensive geriatric assessment in acute medical inpatients. Age and Ageing 2007, 36: 670–5.CrossRefGoogle ScholarPubMed
Jay, S., Whittaker, P., Mcintosh, J. et al. Can consultant geriatrician led comprehensive geriatric assessment in the emergency department reduce hospital admission rates? A systematic review. Age and Ageing 2017, 46: 366–72.Google ScholarPubMed
Deschodt, M., Flamaing, J., Haentjens, P. et al. Impact of geriatric consultation teams on clinical outcome in acute hospitals: A systematic review and meta-analysis. BMC Medicine 2013, 11: 48.CrossRefGoogle ScholarPubMed
Shields, L., Henderson, V., and Caslake, R. Comprehensive geriatric assessment for prevention of delirium after hip fracture: A systematic review of randomized controlled trials. JAGS 2017, 65: 1559–65.CrossRefGoogle ScholarPubMed
Kim, S.H., and Park, S. A meta-analysis of the correlates of successful aging in older adults. Res Aging. 2017, 39(5): 657–77.CrossRefGoogle ScholarPubMed
Ballham, S., Buxton, S., Camacho, R. et al. 36 Frailty Flying Squad: An emergency department focussed acute care of the elderly service: Dr Genevieve Robson, Royal United Hospital NHS Foundation Trust. Emerg Med J 2017, 34: A885–A886.CrossRefGoogle Scholar
Baronner, A., and MacKenzie, A. Using geriatric assessment strategies to lead end-of-life care discussions. Curr Oncol Rep 2017, 19: 75–80.CrossRefGoogle ScholarPubMed
Ellis, G., Whitehead, M., O’Neill, D. et al. Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane Database Syst Rev 2011. doi: 10.1002/14651858.CD006211.pub2.CrossRefGoogle Scholar
Conroy, S.P., Stevens, T., Parker, S.G. et al. A systematic review of comprehensive geriatric assessment to improve outcomes for frail older people being rapidly discharged from acute hospitals: Interface geriatrics. Age and Ageing 2011, 40: 436–43.CrossRefGoogle ScholarPubMed
Hermans, K., Mello, J.D.A., Spruytte, N. et al. A comparative analysis of comprehensive geriatric assessments for nursing home residents receiving palliative care: A systematic review. JAMDA 2014, 15: 467–76.Google ScholarPubMed
Feng, M.A., McMillan, D.T., Crowell, K. et al. Geriatric assessment in surgical oncology: A systematic review. Journal of Surgical Research 2015, 193: 265–72.CrossRefGoogle ScholarPubMed
Eamer, G., Saravana-Bawan, B., Westhuizen, B.V.D. et al. Economic evaluations of comprehensive geriatric assessment in surgical patients: A systematic review. Journal of Surgical Research 2017, 218: 9–17.CrossRefGoogle ScholarPubMed
Parekh, N., Ali, K., Stevenson, J.M. et al. Incidence and cost of medication harm in older adults following hospital discharge: A multicentre prospective study in the UK. Br J Clin Pharmacol 2018, 84(8): 1789–97.Google ScholarPubMed
Parekh, N., Ali, K., Page, A.J. et al. Incidence of medication-related harm in older adults after hospital discharge: A systematic review. Am Geriatr Soc 2018, 66(9): 1812–22.CrossRefGoogle ScholarPubMed
Gallagher, P., Ryan, C., Byrne, S. et al. STOPP (Screening Tool of Older Persons’ Prescriptions) and START (Screening Tool to Alert Doctors to Right Treatment): Consensus validation. Int J Clin Pharmacol Ther 2008, 46(2): 72–83.CrossRefGoogle ScholarPubMed
Parekh, N., Ali, K., Davies, G.J. et al. Medication-related harm in older adults following hospital discharge: Development and validation of a prediction tool. BMJ Qual Saf 2020, 29(2): 142–53.CrossRefGoogle ScholarPubMed
Fisher, J.M., Masud, T., Holm, E.A. et al. New horizons in geriatric medicine education and training: The need for pan-European education and training standards. European Geriatric Medicine 2017, 8: 467–73.CrossRefGoogle Scholar
Roberts, H.C.H. J. Dension, H.J., Martin, H.J. et al. A review of the measurement of grip strength in clinical and epidemiological studies: Towards a standardised approach. Age and Ageing 2011, 40: 423–9.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×