Comprehensive geriatric assessment (CGA) of inpatients on nongeriatric wards may be of limited benefit when delivered via a team rather than a ward, conclude the authors of a meta-analysis.
The intervention appeared to improve medium-term mortality but did not affect any other outcomes, report Mieke Deschodt (KU Leuven, Belgium) and colleagues.
In a commentary accompanying the study in BMC Medicine, Ian Cameron and Susan Kurrle, from the University of Sydney in Australia, say that the "major unanswered question" is whether the limited effectiveness of team-delivered CGA is down to the mode of delivery or to poor adherence to the team's advice. The latter possibility needs to be investigated, they say.
Indeed, Deschodt et al found that the rate of nonadherence to GCA recommendations ranged from 23% to 33% in the 12 studies analyzed, "providing strong evidence that the intervention does not meet its full potential."
They say: "Having control over the care process is one of the key differences between the two CGA models and could be one of the main reasons why the CGA ward type is effective and the team type… is not."
The studies included 4546 patients aged 60 years and older who were hospitalized for at least 48 hours on a nongeriatric ward. The pooled results of 11 studies that reported mortality found a significant reduction in mortality at 6 and 8 months after discharge with team-based CGA versus no intervention. But there was no effect on mortality at 1 month and 1 year after discharge.
Eleven studies looked at functional status during up to 1 year of follow up. Just two of these studies reported a beneficial effect with the intervention, and there was no effect in the pooled analysis. However, the researchers note that "there was a strong ceiling effect of most of the functional measures used, which is unfortunately a frequent limitation of these types of studies and may have limited the ability to detect improvements over time."
There was also no effect on length of stay or readmission in pooled analysis of the 10 and eight trials, respectively, that reported these outcomes.
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