Newcastle University, Institute for Health and Society, Newcastle upon Tyne, Tyne and Wear, UK.
Department of Health Sciences, College of Medicine, Biological Sciences and Psychology, University of Leicester, Centre for Medicine, University Road, Leicester LE1 7RH, UK.
Age Ageing. 2018 Jan 1;47(1):149-155. doi: 10.1093/ageing/afx166.
BACKGROUND: Comprehensive Geriatric Assessment (CGA) is now the accepted gold standard for caring for frail older people in hospital. However, there is uncertainty about identifying and targeting suitable recipients and which patients benefit the most. OBJECTIVES: our objectives were to describe the key elements, principal measures of outcome and the characteristics of the main beneficiaries of inpatient CGA. METHODS: we used the Joanna Briggs Institute umbrella review method. We searched for systematic reviews and meta-analyses describing CGA services for hospital inpatients in the Cochrane Database of Systematic Reviews, Database of Reviews of Effectiveness (DARE), MEDLINE and EMBASE and a range of other sources. RESULTS: we screened 1,010 titles and evaluated 419 abstracts for eligibility, 143 full articles for relevance and included 24 in a final quality and relevance check. Thirteen reviews, reported in 15 papers, were selected for review. The most widely used definition of CGA was: 'a multidimensional, multidisciplinary process which identifies medical, social and functional needs, and the development of an integrated/co-ordinated care plan to meet those needs'. Key clinical outcomes included mortality, activities of daily living and dependency. The main beneficiaries were people ≥55 years in receipt of acute care. Frailty in CGA recipients and patient related outcomes were not usually reported. CONCLUSIONS: we confirm a widely used definition of CGA. Key outcomes are death, disability and institutionalisation. The main beneficiaries in hospital are older people with acute illness. The presence of frailty has not been widely examined as a determinant of CGA outcome.
背景:全面老年评估(CGA)现在是医院照顾虚弱老年人的公认黄金标准。然而,对于识别和确定合适的接受者以及哪些患者受益最大,仍存在不确定性。
目的:我们的目的是描述关键要素、主要结局指标以及住院 CGA 的主要受益人的特征。
方法:我们使用了 Joanna Briggs 研究所的伞式审查方法。我们在 Cochrane 系统评价数据库、疗效评价数据库(DARE)、MEDLINE 和 EMBASE 以及一系列其他来源中搜索了描述医院住院患者 CGA 服务的系统评价和荟萃分析。
结果:我们筛选了 1010 个标题,并对 419 个摘要进行了资格评估,对 143 篇全文进行了相关性评估,并对 24 篇进行了最终的质量和相关性检查。13 项综述,在 15 篇论文中报道,被选中进行综述。最广泛使用的 CGA 定义是:“一种多维、多学科的过程,可识别医疗、社会和功能需求,并制定综合/协调的护理计划以满足这些需求”。主要的临床结局包括死亡率、日常生活活动能力和依赖程度。主要受益人为≥55 岁接受急性护理的人群。CGA 接受者的脆弱性和患者相关结局通常未被报告。
结论:我们确认了广泛使用的 CGA 定义。关键结局是死亡、残疾和机构化。医院的主要受益人群是患有急性疾病的老年人。脆弱性作为 CGA 结局的决定因素尚未得到广泛研究。
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