Three Decades of Comprehensive Geriatric Assessment: Evidence Coming From Different Healthcare Settings and Specific Clinical Conditions

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• 作者：Alberto Pilotto ; MD^a ; ^b ; ; Alberto Cella ; MD^a ; Andrea Pilotto ; MD^c ; Julia Daragjati ; PhD^b ; Nicola Veronese ; MD ; PhD^d ; Clarissa Musacchio ; MD^a ; Anna Maria Mello ; MD^a ; Giancarlo Logroscino ; MD ; PhD^e ; ^f ; Alessandro Padovani ; MD ; PhD^c ; Camilla Prete ; MD^a ; Francesco Panza ; MD ; PhD^e ; ^f ; ^g ; ^{geriat.dot@geriatria.uniba.it}
• 关键词：Frailty ; cancer ; cognitive impairment ; emergency medicine ; geriatrics ; orthopedics
• 刊名：Journal of the American Medical Directors Association
• 出版年：2017
• 出版时间：1 February 2017
• 年：2017
• 卷：18
• 期：2
• 页码：192.e1-192.e11
• 全文大小：361 K
• 卷排序：18

文摘

Comprehensive geriatric assessment (CGA) is a multidisciplinary diagnostic and treatment process that identifies medical, psychosocial, and functional capabilities of older adults to develop a coordinated plan to maximize overall health with aging. Specific criteria used by CGA programs to evaluate patients include age, medical comorbidities, psychosocial problems, previous or predicted high healthcare utilization, change in living situation, and specific geriatric conditions. However, no universal criteria have been agreed upon to readily identify patients who are likely to benefit from CGA. Evidence from randomized controlled trials and large systematic reviews and meta-analyses suggested that the healthcare setting may modify the effectiveness of CGA programs. Home CGA programs and CGA performed in the hospital were shown to be consistently beneficial for several health outcomes. In contrast, the data are conflicting for posthospital discharge CGA programs, outpatient CGA consultation, and CGA-based inpatient geriatric consultation services. The effectiveness of CGA programs may be modified also by particular settings or specific clinical conditions, with tailored CGA programs in older frail patients evaluated for preoperative assessment, admitted or discharged from emergency departments and orthogeriatric units or with cancer and cognitive impairment. CGA is capable of effectively exploring multiple domains in older age, being the multidimensional and multidisciplinary tool of choice to determine the clinical profile, the pathologic risk and the residual skills as well as the short- and long-term prognosis to facilitate the clinical decision making on the personalized care plan of older persons.