At-home comprehensive geriatric assessments reduced hospital admissions
Comprehensive geriatric assessments delivered by a multidisciplinary team also resulted in better functional status among community-dwelling older adults than usual care, according to the results of a systematic review and meta-analysis.
Home-based comprehensive geriatric assessments (CGAs) improved clinical and process outcomes for community dwelling, geriatric, at-risk adults, a study concluded.
Researchers conducted a systematic review and meta-analysis to compare effectiveness of home-based CGA with usual care among community-dwelling at-risk older adults, as well as to characterize the CGA that was delivered. Patients were not acutely unwell but were identified as “at risk” of poor health outcomes, including frailty or nursing home admission. The assessment was delivered by at least one clinician with gerontological expertise as part of a holistic care plan across one or more visits delivered in the participant's home or a hybrid of home and primary care settings. Results were published Feb. 18 by the Journal of the American Geriatrics Society.
Among 22 trials in 12 countries comprising 7,219 community-dwelling older adults, home-based CGA was associated with improved functional status at six to 24 months (standardized mean difference [SMD], 0.17; 95% CI, 0.09 to 0.25), at 12 months (SMD, 0.24; 95% CI, 0.02 to 0.47), and at 24 months (SMD, 0.11; 95% CI, 0.01 to 0.22); increased health-related quality of life at six to 24 and 12 months; reduced mortality at 36 months; reduced hospitalizations at six to 36 months; and improved patient satisfaction with care at six to 12 months compared to usual care. Home-based CGA resulted in little or no difference in nursing home admission, ED presentation, or adverse events.
The study authors wrote that if home-based comprehensive assessments can avert acute admissions, that could facilitate adoption of integrated care for community-dwelling older adults.
“Whilst variability in reporting was observed about how home-based CGA was coordinated, delivered, and followed up by authors, there were multiple core components that were consistent across all 22 trials: clinical leadership, a structured assessment in the home environment, specialty knowledge, experience, competence, alongside tailored treatment plans to the individual, were consistent domains across trials,” they wrote. “These features may contribute to the effectiveness of home-based CGA, as has been shown in older adults in receipt of CGA in an acute geriatric unit.”