Can Comprehensive Geriatric Assessment Meet Frail Older People’s Needs? Results from the Randomized Controlled Study CGA-Swed

Abstract

Background: The comprehensive geriatric assessment (CGA) designed to manage frail older people requiring acute medical care, is responsible for diagnostics, assessment, treatment, and planning while addressing a person’s medical, psychological, social, and functional capabilities. The aim was to investigate if CGA had an impact on frail older people’s activities of daily living (ADL) status, self-rated health, and satisfaction with hospital care. Methods: A two-armed design with frail people aged 75 or older who required an unplanned hospital admission were randomized to either the CGA ward or to an acute medical ward. Analyses were made based on the intention-to-treat principle (ITT). The primary outcome was ADL. Data were analyzed using Chi-square and odds ratio. A subgroup analysis was performed due to non-adherence and contamination. Results: One-hundred and fifty-five people participated in the study; 78 in the intervention and 77 in the control. Participants in the intervention group had a higher odds ratio of reporting having received written information and felt that care met their needs during their hospital stay. No additional statistically significant results for the primary or secondary outcomes in the ITT analysis were achieved. Conclusion: Participants felt that the care they received with the CGA ward met their needs. The lack of additional results supporting the CGA could be due to difficulties performing pragmatic intervention trials in clinical hospital settings, and because a CGA during one hospital stay is probably not enough to have long-term effects.

Effectiveness of acute geriatric unit care on functional decline, clinical and process outcomes among hospitalised older adults with acute medical complaints: a systematic review and meta-analysis

“…The trials dated from 1985 to 2020; seven were conducted in the USA [ 27–30 , 37 , 39 , 41 ], three in Sweden [ 31 , 32 , 40 ] and one in Australia [ 38 ]. Seven were RCTs [ 29 , 32 , 37–41 ], three were quasi-RCTs [ 27 , 28 , 31 ] and one was a cluster-RCT [ 30 ]. Authors of six trials were contacted for additional information [ 29 , 32 , 38–41 ].…”

“…Seven were RCTs [ 29 , 32 , 37–41 ], three were quasi-RCTs [ 27 , 28 , 31 ] and one was a cluster-RCT [ 30 ]. Authors of six trials were contacted for additional information [ 29 , 32 , 38–41 ]. A table outlining the descriptive characteristics of included trials is presented in Supplementary Material A3 .…”

Positive effects on activities of daily living one year after receiving comprehensive geriatric assessment – results from the randomised controlled study CGA-Swed

“…The effect on ADL in the CGA-Swed study was more apparent after 12 months than after 1–6 months [ 16 ], which could be due to frail older people needing time to regain their functions in ADL. It could also be a survival effect where those who survive 1 year after the admission have the best development.…”

“…The CGA-Swed study could not show any effect on self-rated health at the 12-month follow-up, or at the 1- and 6-month follow-ups [ 16 ]. ADL is known to influence self-rated health, but it is only one of many factors that influence perceived health [ 30 ].…”

“…This is somewhat surprising since the level of dependence in ADL influences the possibility of remaining in one’s own housing [ 14 ]. The CGA-Swed study also failed to show significant effect on ADL in the short term, up to 6 months [ 16 ], but the participants were also followed up after 12 months. The primary outcome of the CGA-Swed study was the long-term change in ADL at the 12-month follow-up [ 11 ].…”