Effectiveness of comprehensive geriatric assessment in frail older inpatients

Abstract

Background: Evidence regarding the effects of comprehensive geriatric assessment (CGA) on frail older inpatients is inconclusive. Moreover, various prior studies lacked proper patient selection using frailty assessment tools. Our review aimed to assess whether objectively identifying frail patients in clinical settings using a frailty tool and intervening with CGA provides clinical benefits in frail older inpatients.

Methods: A systematic review and meta-analysis were conducted by searching PubMed, Embase, and Web of Science (January 1998-October 2022). Keywords included frailty, hospitalization, and CGA. Eligible studies were randomized controlled trials involving patients aged ≥65 years, with frailty defined by specific tools. The primary outcome was mortality; secondary outcomes included activities of daily living, quality of life, pain, patient satisfaction, polypharmacy, antidepressant use, post-discharge disposition, rehospitalization, and cost-effectiveness.

Results: Of 2587 articles, 18 met inclusion criteria (2724 participants). Meta-analysis of five studies showed no significant differences in overall mortality for frail inpatients receiving CGA. However, CGA reduced mortality during follow-ups of ≤6 months. CGA also improved health-related quality of life, patient satisfaction, and activities of daily living, while reducing polypharmacy and modifying antidepressant use.

Conclusions: CGA did not significantly reduce overall mortality in frail older inpatients compared to usual care but lowered mortality rates at the 6-month follow-up. CGA also improved quality of life, daily functioning, and medication management, underscoring its value for managing frail older inpatients.

Keywords: Comprehensive geriatric assessment; Frailty; Hospitalization outcomes; Mortality reduction; Older inpatients.