Gil de Gómez Barragán M J, Ramalle-Gómara E
Unidad Docente de MFyC. La Rioja. España.
Aten Primaria. 2003 Jun 30;32(2):92-100. doi: 10.1016/s0212-6567(03)70743-4.
To review and update evidence on the effectiveness of the comprehensive geriatric assessment (CGA) of the elderly in the community environment.
Systematic review.
MEDLINE (January 1997 to November 2001) and The Cochrane Library, completed with a manual search.
Randomised clinical trials (RCT) to study the effects of a CGA in people over 64 and not in an institution. Trials that assessed mortality, institutionalisation and functional status were included. Those conducted after hospital discharge or not in a community environment were excluded. 133 summaries were reviewed and 16 articles analysed.
Methodological quality assessed with adapted Jadad scale. A data archive was worked out to collect information on characteristics of the population and the intervention and on the main findings.
The quality of the trials was adequate, though they had important methodological differences. Eleven trials found no favourable effects in the result variables studied. Five of the twelve trials which assessed functional status and one of the twelve that evaluated admissions to institutions found some favourable effect. None of the nine studies with mortality data found favourable results.
Evidence for the effectiveness of the CGA for the elderly not in institutions continues to be inconsistent and insufficient. Nevertheless, given the complexity of this intervention, it seems prudent to continue to conduct CGAs of the elderly in the PC environment until such time as further studies clarify the role of these programmes.
回顾并更新关于老年人在社区环境中进行综合老年评估（CGA）有效性的证据。
系统评价。
MEDLINE（1997年1月至2001年11月）和考克兰图书馆，并辅以手工检索。
随机临床试验（RCT），以研究CGA对64岁以上非住院人群的影响。纳入评估死亡率、机构收容率和功能状态的试验。排除出院后进行的试验或非社区环境中的试验。共审查了133篇摘要，分析了16篇文章。
采用改良的雅达量表评估方法学质量。建立了一个数据档案，以收集有关人群特征、干预措施以及主要研究结果的信息。
试验质量尚可，但存在重要的方法学差异。11项试验在所研究的结果变量中未发现有益效果。在评估功能状态的12项试验中，有5项以及在评估机构收容情况的12项试验中，有1项发现了一些有益效果。在有死亡率数据的9项研究中，均未发现有益结果。
对于非住院老年人，CGA有效性的证据仍然不一致且不充分。然而，鉴于这种干预措施的复杂性，在进一步研究阐明这些项目的作用之前，在初级保健环境中继续对老年人进行CGA似乎是谨慎之举。
