The effectiveness of comprehensive geriatric assessment intervention for older people in outpatient setting: a systematic review / meta-analysis

Abstract

Introduction

Comprehensive geriatric assessment (CGA) is a multidisciplinary diagnostic and treatment process that identifies a frail older person’s medical, psychosocial, and functional limitations. The effectiveness of CGA in patients admitted to hospitals is well known, but it is still unclear whether those benefits translate to the outpatient setting. Therefore, this study aims to assess the effectiveness of CGA in the hospital outpatient setting.

Methods

We collected randomized clinical trials comparing CGA and usual care in the outpatient setting for older patients (aged 60 years and above). We used a combination of the keywords and their synonyms in several databases: PubMed, EMBASE Proquest, and the clinical trial registry. Risk of bias (RoB) assessment was done using RoB 2 from Cochrane. GRADE assessment for outcome mortality and hospitalization was also done.

Result

We found seven articles with a total of 3,254 subjects undergoing CGA in the outpatient clinic. The implementation of CGA is highly varied from center to center. Low-quality evidence demonstrated that CGA did not significantly affect all-cause mortality, patient satisfaction, hospitalization, functional status of basic and instrumental activities of daily living, cognitive, and cost. Very low-quality evidence showed favorable quality of life in CGA group at 3 and 12 months, as reported by individual studies. No difference was found in all studies relating to the risk of hospitalization.

Conclusion

CGA is a complex intervention and is highly dependent on context. Therefore, a robust conclusion is challenging to make due to the different practices and measurement tools used in the studies. Further research using a guideline for hospital outpatient CGA may be beneficial.