Geriatrics Section, Department of Internal Medicine, University of Palermo, Palermo, Italy.
Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", Bari, Italy.
Age Ageing. 2022 May 1;51(5). doi: 10.1093/ageing/afac104.
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.
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.
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.
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.
全面老年评估（CGA）在过去三十年中得到了应用。然而，对于其临床应用仍存在一些疑问。因此，我们旨在广泛收集报道的结果，并评估全面老年评估（CGA）在老年人群健康结果中的应用的证据强度。
对 Pubmed、Embase、Scopus、Cochrane 图书馆和 CINHAL 中使用 CGA 评估老年人的系统评价进行伞式综述，检索时间截至 2021 年 11 月 5 日。所有可能的健康结果均符合条件。两名独立审查员提取关键数据。干预研究的证据分级采用 GRADE 进行，而系统评价的数据则作为叙述性结果报告。
在 1683 篇论文中，考虑了 31 篇系统评价（19 篇有荟萃分析），包括 279744 名受试者。总体而言，有 13/53 项结果具有统计学意义（P<0.05）。有高质量证据表明，CGA 可降低疗养院入院率（风险比[RR] = 0.86；95%置信区间[CI]：0.75-0.89）、跌倒风险（RR = 0.51；95%CI：0.29-0.89）和医院内压疮风险（RR = 0.46；95%CI：0.24-0.89）；降低髋部骨折患者谵妄风险（OR = 0.71；95%CI：0.54-0.92）；降低社区居住的老年人体力虚弱的风险（RR = 0.77；95%CI：0.64-0.93）。没有荟萃分析的系统评价表明，CGA 可改善肿瘤学、血液学和急诊科的临床结果。
CGA 似乎对多种健康结果在医院医疗环境中有益，具有较高的证据确定性。在其他环境中使用 CGA 的益处证据较弱。
