Comprehensive geriatric assessment in integrated care for older people living at home: a systematic review

Abstract

Introduction : Older people living at home may experience problems in the physical, cognitive, psychological, social and/or environmental life domains, leading to complex care needs. Integration of health and social care is widely acknowledged as an adequate way to address these complex needs. An important component of integrated care programs is a comprehensive geriatric assessment CGA which helps to identify older people’s care needs and preferences. A CGA provides the basis for a tailored care plan, consisting of specific actions to support older people in their homes. In the wide range of integrated care programs for frail older people, different CGA tools are being used. To the best of our knowledge, a comprehensive overview of the characteristics of the different CGA tools is currently lacking. The aim of our study was therefore to describe and compare different CGA tools and procedures for conducting them. Methods : A systematic literature search in the electronic databases Embase/Medline and Scopus was conducted to search for papers describing CGAs in integrated care programs for older people living at home. Our search yielded 814 potentially relevant publications. Two researchers independently assessed eligibility based on title and abstract and full text screening. In total, 26 integrated care programs were included in our review. The identified integrated care programs were reviewed as to their main characteristics: country, program objective, target group, setting and involved professionals. Data extraction for information about the CGAs included: CGA tool/instruments, comprehensiveness i.e. life domains being addressed, multidisciplinarity i.e. extent to which professionals from different disciplines are involved, person-centredness i.e. extent to which older people and informal carers are involved and procedures to conduct a CGA. Results : Included studies shows a great variety of CGAs used in integrated care programs. Most integrated care programs were implemented in the Netherlands and the United States. The majority of CGAs seemed to address comprehensiveness, multidisciplinarity and person-centredness, although the way and extent to which principles of integrated care were incorporated differed between the CGAs. Furthermore, some identified instruments are broadly used in different countries e.g. RAI-CHA, whereas others e.g. [G]OLD instrument are developed and used exclusively in one specific program. Discussion/conclusion : This study shows that integrated care programs, in different settings and for different target groups, have different ways of conducting a CGA. Due to this heterogeneity, older people’s needs and preferences are being assessed and addressed in different ways. It is still unclear what works best in conducting a CGA in the context of integrated care and whether the existing range of CGAs is adequate. Limitations/suggestions for future research : We did not include the entire range of existing CGAs in this review, as several papers did not adequately describe the CGA tool and procedures used. A more thorough description of CGAs as a component of an integrated care program is recommended to complement the current overview of CGAs. Further research is recommended to develop guidance on how older people’s problems and care needs should best be assessed and to prevent researchers and professionals from reinventing the wheel.