Geriatric Education and Research Institute, Singapore, Singapore.
Department of Geriatric Medicine, Institute of Geriatrics and Active Aging, Tan Tock Seng Hospital, Singapore, Singapore.
BMC Geriatr. 2022 Apr 29;22(1):379. doi: 10.1186/s12877-022-03024-4.
Comprehensive geriatric assessment (CGA) addresses the bio-psycho-social needs of older adults through multidimensional assessments and management. Synthesising evidence on quantitative health outcomes and implementation barriers and facilitators would inform practice and policy on CGA for community-dwelling older adults.
We systematically searched four medical and social sciences electronic databases for quantitative, qualitative, and mixed methods studies published from 1 January 2000 to 31 October 2020. Due to heterogeneity of articles, we narratively reviewed the synthesis of evidence on health outcomes and implementation barriers and facilitators.
We screened 14,151 titles and abstracts and 203 full text articles, and included 43 selected articles. Study designs included controlled intervention studies (n = 31), pre-post studies without controls (n = 4), case-control (n = 1), qualitative methods (n = 3), and mixed methods (n = 4). A majority of articles studied populations aged ≥75 years (n = 18, 42%). CGAs were most frequently conducted in the home (n = 25, 58%) and primary care settings (n = 8, 19%). CGAs were conducted by nurses in most studies (n = 22, 51%). There was evidence of improved functional status (5 of 19 RCTs, 2 of 3 pre-post), frailty and fall outcomes (3 of 6 RCTs, 1 of 1 pre-post), mental health outcomes (3 of 6 RCTs, 2 of 2 pre-post), self-rated health (1 of 6 RCTs, 1 of 1 pre-post), and quality of life (4 of 17 RCTs, 3 of 3 pre-post). Barriers to implementation of CGAs involved a lack of partnership alignment and feedback, poor acceptance of preventive work, and challenges faced by providers in operationalising and optimising CGAs. The perceived benefits of CGA that served to facilitate its implementation included the use of highly skilled staff to provide holistic assessments and patient education, and the resultant improvements in care coordination and convenience to the patients, particularly where home-based assessments and management were performed.
There is mixed evidence on the quantitative health outcomes of CGA on community-dwelling older adults. While there is perceived positive value from CGA when carried out by highly skilled staff, barriers such as bringing providers into a partnership, greater acceptance of preventive care, and operational issues could impede its implementation.
全面老年评估（CGA）通过多维评估和管理来满足老年人的生物心理社会需求。综合定量健康结果以及实施障碍和促进因素的证据，将为社区居住的老年人的 CGA 实践和政策提供信息。
我们系统地检索了四个医学和社会科学电子数据库，以获取 2000 年 1 月 1 日至 2020 年 10 月 31 日发表的定量、定性和混合方法研究。由于文章存在异质性，我们对健康结果和实施障碍及促进因素的证据进行了叙述性综述。
我们筛选了 14151 篇标题和摘要以及 203 篇全文文章，并纳入了 43 篇选定的文章。研究设计包括对照干预研究（n=31）、无对照的前后研究（n=4）、病例对照研究（n=1）、定性方法（n=3）和混合方法（n=4）。大多数文章研究的是≥75 岁的人群（n=18，42%）。CGA 最常在家中（n=25，58%）和初级保健环境中进行（n=8，19%）。在大多数研究中，CGA 由护士进行（n=22，51%）。有证据表明，CGA 可改善功能状态（19 项 RCT 中的 5 项，3 项前后研究中的 2 项）、衰弱和跌倒结局（6 项 RCT 中的 3 项，1 项前后研究中的 1 项）、心理健康结局（6 项 RCT 中的 3 项，2 项前后研究中的 2 项）、自我报告的健康状况（6 项 RCT 中的 1 项，1 项前后研究中的 1 项）和生活质量（17 项 RCT 中的 4 项，3 项前后研究中的 3 项）。CGA 实施的障碍涉及合作伙伴关系和反馈缺乏一致性、预防性工作接受度低，以及提供者在实施和优化 CGA 方面面临挑战。CGA 的实施之所以能够得到促进，是因为它具有高度专业技能的员工进行全面评估和患者教育，以及由此带来的护理协调和患者便利性的改善，特别是在开展家庭为基础的评估和管理时。
关于 CGA 对社区居住的老年人的定量健康结果的证据存在差异。虽然 CGA 由高技能的员工实施时具有感知到的积极价值，但合作伙伴关系的建立、预防性护理的更大接受度以及操作性问题等障碍可能会阻碍其实施。
