Atención Geriátrica Integrada Comunitaria (GERiCOM Next Generation Project)

Comprehensive geriatric assessment (CGA) is the cornerstone of modern geriatric medicine and the framework around which conventional and new models of care for older people are developed. Whilst there are a substantial number of reviews synthesising the evidence on patient and service outcomes from CGA, as an intervention it remains poorly described. There is a lack of detail on how a CGA plan is coordinated, delivered and followed up, especially outside of acute care. This commentary reflects on the authors’ experience of extracting data from 57 published studies on CGA.

The CGA knowledge-do gap persists with a need to draw from complex system theory and implementation science frameworks to better describe the intervention and understand the influence of the organisation and health service within which CGA is operationalised. Equally, the voice of older people, families and staff is critical in the conduct and evaluation of CGA, and how it evolves as a model to meet the growing needs of ageing populations.

Comprehensive Geriatric Assessment (CGA) is a multidimensional interdisciplinary diagnostic process focused on determining an older person's medical, psychological and functional capability in order to develop a co‐ordinated and integrated care plan. CGA is not limited simply to assessment, but also directs a holistic management plan for older people, which leads to tangible interventions.

While there is established evidence that CGA reduces the likelihood of death and disability in acutely unwell older people, the effectiveness of CGA for community‐dwelling, frail, older people at risk of poor health outcomes is less clear.

CGA had no impact on death or nursing home admission.

There is low‐certainty evidence that community‐dwelling, frail, older people who undergo CGA may have a reduced risk of unplanned hospital admission.

Further studies examining the effect of CGA on emergency department visits and change in function and quality of life using standardised assessments are required.

To describe the evolution of a Hospital at Home (HAH) based on comprehensive geriatric assessment (CGA), including its adaptability to changing case-mixes and pathways during
the COVID-19 pandemic.

This systematic review and meta-analysis suggest that FI-Labs, made of diverse deficits, predict mortality and other adverse health outcomes in a variety of populations. FI-Lab scores did not show a consistent difference between sexes. This does not align with what is found with clinical FIs, which typically find females to be frailer [56].

Future research utilising an FI-Lab may benefit from investigating the relationship between frailty in younger populations and the subsequent health status changes. Additionally, there is emerging evidence that a more granular approach to health variable categorisation (i.e. a non-binary quantile approach) using an FI-Lab improves the model’s accuracy [46] relative to dichotomizing variables. Both avenues deserve further attention.

SDEC NHS

STOPPFrail comprises 27 criteria relating to medications that are potentially inappropriate in frail older patients with limited life expectancy. STOPPFrail may assist physicians in deprescribing medications in these patients.

Chia JQ et al. examined the construct validity of 2 self-reported frailty questionnaires, the Frailty Phenotype Questionnaire (FPQ) and FRAIL, against the Cardiovascular Health Study frailty phenotype (CHS-FP).

The 4M Framework could be a cornerstone of quality metrics for the HaH population. Potential patient- reported measures include a return to prior function, receiving enough support to perform self-care during the HaH stay, and effective transitional care education, over- sight, and handoffs. Adding to this pragmatically collected patient-centered measures such as deprescribing and simplifying medication regimens, documentation of an advance care planning or serious illness communication discussion, and emergent transfers could provide a multi- layered PCC quality and safety approach all the while minimizing regulatory burdens and expense.