An Old Challenge with New Promises: A Systematic Review on Comprehensive Geriatric Assessment in Long-Term Care Facilities

Abstract

Comprehensive geriatric assessment (CGA) is a multidimensional and multidisciplinary diagnostic process focused on determining the clinical profile, pathological risk, residual skills, short- and long-term prognosis, and personalized therapeutic and care plan of the functionally compromised and frail older subjects. Previous evidence suggested that the effectiveness of CGA programs may be influenced by settings where the CGA is performed [i.e., hospital, posthospital discharge/long-term care facilities (LTCFs), or community/home] as well as the specific clinical conditions of older frail individuals. In this scenario, CGA and quality of care in LTCFs have been a challenge for decades. In the present article, we systematically reviewed evidence from the last three decades of clinical research devoted to systematic implementation of CGA programs in LTCFs, that is, nursing homes, care homes, residential homes, and rehabilitation facilities. In the United States, all LTC residents must undergo a CGA on a regular basis on admission to a facility, prompting the development of the Resident Assessment Instrument (RAI) Minimum Data Set, a specific CGA-based assessment tool in this population. In the LTCF setting, the present reviewed evidence suggested that most complex older subjects may benefit from a CGA in terms of improved quality of care and reduced hospitalization events and that CGA must be standardized across healthcare settings to promote greater health system integration and coordination. In the LTCF setting, particularly in nursing homes, other new and promising CGA programs have also been proposed to develop rapid screening CGA-based tools to enhance in the future the ability of primary care physicians to recognize and treat geriatric syndromes in this setting. However, at present, the interRAI suite of instruments represented an integrated health information system that has the potential to provide person-centered information transcending healthcare settings.

Self-reported exhaustion, physical activity, and grip strength predict frailty transitions in older outpatients with chronic diseases

“…The CGA is a multidimensional and multidisciplinary diagnostic process that aims to determine the clinical profile, pathological risk, residual skills, short- and long-term prognosis, and personalized therapeutic and care plan of individuals who are functionally compromised or frail. [ 12 ] The study inclusion criteria were as follows [ 13 ] : functional decline (as measured by new disabilities in activities of daily living [ADL] or instrumental ADL [IADL]); a clinical diagnosis of depression or dementia; mobility impairment; ≥1 fall in the past year; weight loss of >5% per year; multiple comorbidities (≥5 diseases); polypharmacy (≥8 classes of drugs per day); multiple specialty physician visits in the past 6 months (≥3 different specialties with ≥2 visits for each specialty); hospitalization in the past year (≥1); frequent emergency room visits in the past year (≥2); and age above 80 years. Patients who were bedridden, in a nursing home, had an expected life expectancy of <6 months, or had a severe hearing or communication disorder were excluded.…”

Aging in HIV-Infected Subjects: A New Scenario and a New View

“…The needs of an aging population are emphasized in the World Health Organization definition of health: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” In older adults, the medical, physical, mental, and social aspects of health could be assessed using a comprehensive geriatric assessment (CGA) to ascertain health status and individual needs [ 87 , 88 ]. CGA is a multidimensional, interdisciplinary diagnostic process that makes it possible to determine the medical, psychological, and functional capabilities of an older person by using specific criteria including age, medical comorbidities, psychosocial problems, previous or predicted high health care utilization, change in living situation, and specific geriatric conditions.…”

“…It is mainly focused on determining the pathological risk, residual skills, short- and long-term prognosis, and the personalized therapeutic and care plan of the functionally compromised and frail older subjects. A systematic review of data coming from the last three decades about the systematic implementation of CGA programs evidences that mainly complex older subjects may benefit from a CGA, by improving quality of care and reducing hospitalization events [ 88 ].…”

Clinical-functional vulnerability in older adults and its impact on primary health care actions

“…Recommendations and worldwide evidences indicate that health policies which prioritize strategies to strengthen preventive health care in the elderly have obtained better economic results and effectiveness in controlling negative health outcomes in this population (8) . In the context of public health, epidemiological data plays an important role in the prevention of adverse events and enables early diagnosis and intervention (11) .…”

“…In the context of geriatric care, the search for instruments capable of scaling the level of vulnerability of patients and its determining factors is increasing, since this strategy is indicated for optimization of services and resources of the health system in assisting the elderly population (6)(7)(8) . Specifically in the context of primary care, for early detection of geriatric syndromes, it is necessary to use quick and simple instruments, applied by professionals from several health fields (4,9,10) .…”