Ellis Graham, Whitehead Martin A, O'Neill Desmond, Langhorne Peter, Robinson David
Medicine for the Elderly, Monklands Hospital, Monkscourt Avenue, Airdrie, Scotland, UK, ML6 0JS.
Cochrane Database Syst Rev. 2011 Jul 6(7):CD006211. doi: 10.1002/14651858.CD006211.pub2.
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.
We sought to evaluate the effectiveness of CGA in hospital for older adults admitted as an emergency.
We searched the Cochrane Effective Practice and Organisation of Care (EPOC) Group Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), the Database of Abstracts of Reviews of Effects (DARE), MEDLINE, EMBASE, CINAHL and AARP Ageline, and handsearched high-yield journals.
We searched for randomised controlled trials comparing CGA (whether by mobile teams or in designated wards) to usual care.
Two review authors initially assessed eligibility and trial quality and extracted published data.
Twenty-two trials evaluating 10,315 participants in six countries were identified. Patients in receipt of CGA were more likely to be alive and in their own homes at up to six months (OR 1.25, 95% CI 1.11 to 1.42, P = 0.0002) and at the end of scheduled follow up (median 12 months) (OR 1.16, 95% CI 1.05 to 1.28, P = 0.003) when compared to general medical care. In addition, patients were less likely to be institutionalised (OR 0.79, 95% CI 0.69 to 0.88, P < 0.0001). They were less likely to suffer death or deterioration (OR 0.76, 95% CI 0.64 to 0.90, P = 0.001), and were more likely to experience improved cognition in the CGA group (OR 1.11, 95% CI 0.20 to 2.01, P = 0.02). Subgroup interaction in the primary outcomes suggests that the effects of CGA are primarily the result of CGA wards.
AUTHORS' CONCLUSIONS: Comprehensive geriatric assessment increases a patient's likelihood of being alive and in their own home at up to 12 months.
综合老年评估（CGA）是一个多维度、跨学科的诊断过程，旨在确定体弱老年人的医疗、心理和功能能力，以便制定协调一致的综合治疗和长期随访计划。
我们试图评估综合老年评估对急诊入院的老年人的有效性。
我们检索了Cochrane有效实践与护理组织（EPOC）小组注册库、Cochrane对照试验中心注册库（CENTRAL）（Cochrane图书馆）、疗效评价文摘数据库（DARE）、医学期刊数据库（MEDLINE）、荷兰医学文摘数据库（EMBASE）、护理学与健康领域数据库（CINAHL）和美国退休人员协会老年信息数据库（AARP Ageline），并手工检索了高影响力期刊。
我们检索了比较综合老年评估（无论是通过移动团队还是在指定病房进行）与常规护理的随机对照试验。
两位综述作者最初评估了研究的纳入资格和试验质量，并提取了已发表的数据。
共识别出22项试验，涉及6个国家的10315名参与者。与普通医疗护理相比，接受综合老年评估的患者在长达6个月时（比值比1.25，95%置信区间1.11至1.42，P = 0.0002）以及在预定随访结束时（中位数12个月）（比值比1.16，95%置信区间1.05至1.28，P = 0.003）存活且在家中的可能性更高。此外，患者被安置到机构中的可能性较小（比值比）0.79，95%置信区间0.69至0.88，P < 0.0001）。他们死亡或病情恶化的可能性较小（比值比0.76，95%置信区间0.64至0.90，P = 0.001），并且综合老年评估组患者认知改善的可能性更大（比值比1.11，95%置信区间0.20至2.01，P = 0.02）。主要结局的亚组交互分析表明，综合老年评估的效果主要是综合老年评估病房的结果。
综合老年评估可提高患者在长达12个月时存活且在家中的可能性。
