A Cochrane review included 22 studies with a total of 10 315 elderly subjects in a hospital setting. Comprehensive geriatric assessment (CGA) is a multidimensional, interdisciplinary diagnostic process to determine the medical, psychological and functional capabilities of a frail elderly person in order to develop a co-ordinated and integrated plan for treatment and long-term follow up. Patients receiving CGA were more likely to be alive and in their own homes at up to 6 months (OR 1.25, 95% CI 1.11 to 1.42; 14 studies, n=5117) and at the end of scheduled follow up (median 12 months) (OR 1.16, 95% CI 1.05 to 1.28; 18 studies, n=7062) when compared to general medical care. In addition, patients were less likely to be institutionalised (OR 0.78, 95% CI 0.69 to 0.88; 19 studies, n=7137). There is a difference between the benefits of CGA wards (OR 0.73, 95% CI 0.64 to 0.84; 14 studies, n=6252) and CGA teams (OR 1.16, 95% CI 0.83 to 1.63; 5 studies, n=485). This suggests that the overall benefit results from trials of CGA wards. They were less likely to suffer death or deterioration (OR 0.76, 95% CI 0.64 to 0.90; 5 studies, n=2622), and were more likely to experience improved cognition in the CGA group (OR 1.11, 95% CI 0.20 to 2.01).
Comment: The quality of the evidence is downgraded by study quality (unclear allocation concealment, lack of blinding), inconsistency (heterogeneity in patients and outcomes) and upgraded by large magnitude of effect.
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