Does CGA Improve Health Outcomes in the Community? An Umbrella Review

Rachel C Ambagtsheer; Mark Q Thompson; Graeme R Tucker; Timothy Schultz; Justin Beilby; Renuka Visvanathan

doi:10.1016/j.jamda.2023.03.018

Does CGA Improve Health Outcomes in the Community? An Umbrella Review

J Am Med Dir Assoc. 2023 Jun;24(6):782-789.e15. doi: 10.1016/j.jamda.2023.03.018. Epub 2023 Apr 20.

Authors

Rachel C Ambagtsheer¹, Mark Q Thompson², Graeme R Tucker³, Timothy Schultz⁴, Justin Beilby⁵, Renuka Visvanathan²

Affiliations

¹ National Health and Medical Research Council (NHMRC) Centre of Research Excellence: Frailty and Healthy Ageing, University of Adelaide, South Australia, Australia; Torrens University Australia, South Australia, Australia. Electronic address: rambagtsheer@torrens.edu.au.
² National Health and Medical Research Council (NHMRC) Centre of Research Excellence: Frailty and Healthy Ageing, University of Adelaide, South Australia, Australia; Adelaide Geriatrics Training & Research with Aged Care (G-TRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, South Australia, Australia.
³ National Health and Medical Research Council (NHMRC) Centre of Research Excellence: Frailty and Healthy Ageing, University of Adelaide, South Australia, Australia.
⁴ National Health and Medical Research Council (NHMRC) Centre of Research Excellence: Frailty and Healthy Ageing, University of Adelaide, South Australia, Australia; Flinders Health and Medical Research Institute, Flinders University, South Australia, Australia.
⁵ National Health and Medical Research Council (NHMRC) Centre of Research Excellence: Frailty and Healthy Ageing, University of Adelaide, South Australia, Australia; Torrens University Australia, South Australia, Australia.

PMID: 37088103
DOI: 10.1016/j.jamda.2023.03.018

Abstract

Objectives: To perform an umbrella review of systematic reviews with meta-analyses (MAs) examining the effectiveness of comprehensive geriatric assessment (CGA) delivered within community settings to general populations of community-dwelling older people against various health outcomes.

Design: Umbrella review of MAs of randomized controlled trials (RCTs).

Setting and participants: Systematic reviews with MAs examining associations between CGA conducted within the community and any health outcome, where participants were community-dwelling older people with a minimum mean age of 60 years or where at least 50% of study participants were aged ≥60 years. Studies focusing on residential care, hospitals, post-hospital care, outpatient clinics, emergency department, or patients with specific conditions were excluded.

Methods: We examined CGA effectiveness against 12 outcomes: not living at home, nursing home admission, activities of daily living (ADLs) and instrumental ADLs (IADLs), physical function, falls, self-reported health status, quality of life, frailty, mental health, hospital admission, and mortality, searching the MEDLINE/PubMed, Cochrane Library, CINAHL, Embase databases from January 1, 1999, to August 10, 2022. AMSTAR-2 was used to assess the quality of included systematic reviews, including risk of bias.

Results: We identified 10 MAs. Only not living at home (combined mortality and nursing home admission) demonstrated concordance between effect direction, significance, and magnitude. Significant effects were more typically observed in earlier rather than later studies.

Conclusion and implications: Given the widespread adoption of CGA as a component of usual care within geriatric medicine, the lack of strong evidence demonstrating the protective effects of CGA may be indicative of a cohort effect. If so, future RCTs examining CGA effectiveness are unlikely to demonstrate significant findings. Future studies of CGA in the community should focus on implementation and adherence to key components.

Trial registration: Study protocol registered in PROSPERO 2020 CRD42020169680.

Keywords: Geriatric assessment; aged; community medicine; primary prevention.

Publication types

Review
Research Support, Non-U.S. Gov't

MeSH terms

Activities of Daily Living
Aged
Geriatric Assessment* / methods
Hospitalization*
Humans
Middle Aged
Outcome Assessment, Health Care
Systematic Reviews as Topic