Comprehensive geriatric assessment in older people: an umbrella review of health outcomes
Nicola Veronese, Carlo Custodero, Jacopo Demurtas, Lee Smith, Mario Barbagallo, Stefania Maggi, Alberto Cella, Nicola Vanacore, Pierangelo Lora Aprile, Luigi Ferrucci, Alberto Pilotto, The Special Interest Group in Systematic Reviews of the European Geriatric Medicine Society (EuGMS), Pilotto Alberto, Polidori Maria Cristina, Mariana Alves, Petra Benzinger, Nicolas Berg, Julie Brach, Irwin Cardoso, Alberto Cella, Ben Chefi, Annette Ciurea, Maria Cornejo Lingan Ana, Santiago Cotobal Rodeles, Alfonso J. Cruz‐Jentoft, V. Curiale, Carlo Custodero, Libuse Danielova, Franco Davies, Aafke De Groot, Cathrine De Groot, Jan De Lepeleire, Benjamin De Vries, Anne-marie Decock, Michael Denkinger, Ayşe Dikmeer, Simone Dini, A. Durand, Ami Fatin, Marilia Fernandes, Nicola Ferrara, Bahaa Francis, Laura Fratiglioni, Ellen Freiberger, Rose Galvin, Blanca Garmendia, Sophie Gillain, Javier Gómez‐Pavón, J.A. Goudzwaard, Antonio Greco, Heidi Gruner, Bernd Günther, Lisa Happe, Vered Hermush, Jan-Kees Huibregtse Bimmel, Ilaria Indiano, Julia Isaak, Javier Tamayo Jaramillo, Hanna Kerminen, Ni Laocha Aoife, Sandra Lau, Isabel Lozano, Teresa Madeira Sarmento Ana, Arduino A. Mangoni, Pedro Marques da Silva, Patricia Mars, Hana MatějovskáKubešová, Francesco Mattace‐Raso, Simone Moeskops, Andrea Molnár, Clarissa Musacchio, Kiruba Nagaratnam, Uomo Nieminen, Margaret O’Connor, Fatma Özge Kayhan Koçak, Marc Paccalin, Anil Palikhe, Tajana Pavić, Raymond Per Nordnes, Izabela Platon, Harmke Polinder, Gabriel Ioan Prada, Ragnhild Ragnheim, Lisa Ramsawak, Krzysztof Rewiuk, Carlos Rangel Rodrigues, Regina Roller‐Wirnsberger, Juhani Rossinen, Giovanni Ruotolo, Georg Ruppe, Dan Ryan, Carlo Sabbà, E. Sánchez, Sumru Savaş, Veronika Schmid, Kaisa Schroderus, Monica Siegrist, Daniel Smedberg, Orla Smit, George Soulis
Abstract
BACKGROUND: Comprehensive geriatric assessment (CGA) has been in use for the last three decades. However, some doubts remain regarding its clinical use. Therefore, we aimed to capture the breadth of outcomes reported and assess the strength of evidence of the use of comprehensive geriatric assessment (CGA) for health outcomes in older persons. METHODS: Umbrella review of systematic reviews of the use of CGA in older adults searching in Pubmed, Embase, Scopus, Cochrane library and CINHAL until 05 November 2021. All possible health outcomes were eligible. Two independent reviewers extracted key data. The grading of evidence was carried out using the GRADE for intervention studies, whilst data regarding systematic reviews were reported as narrative findings. RESULTS: Among 1,683 papers, 31 systematic reviews (19 with meta-analysis) were considered, including 279,744 subjects. Overall, 13/53 outcomes were statistically significant (P < 0.05). There was high certainty of evidence that CGA reduces nursing home admission (risk ratio [RR] = 0.86; 95% confidence interval [CI]: 0.75-0.89), risk of falls (RR = 0.51; 95%CI: 0.29-0.89), and pressure sores (RR = 0.46; 95%CI: 0.24-0.89) in hospital medical setting; decreases the risk of delirium (OR = 0.71; 95%CI: 0.54-0.92) in hip fracture; decreases the risk of physical frailty in community-dwelling older adults (RR = 0.77; 95%CI: 0.64-0.93). Systematic reviews without meta-analysis indicate that CGA improves clinical outcomes in oncology, haematology, and in emergency department. CONCLUSIONS: CGA seems to be beneficial in the hospital medical setting for multiple health outcomes, with a high certainty of evidence. The evidence of benefits is less strong for the use of CGA in other settings.