Does comprehensive geriatric assessment (CGA) in an outpatient care setting affect the causes of death and the quality of palliative care? A subanalysis of the age-FIT study

Jenny Dahlqvist,Anne Ekdahl,Maria Friedrichsen

doi:10.1007/s41999-019-00198-w

Abstract

Key summary pointsAimDoes comprehensive geriatric assessment (CGA) affect the causes of death and the quality of palliative care when patients receive care at the end of life when in an outpatient care setting compared to usual care?FindingsCGA does not affect the causes of death. CGA affects the frequency of referral to specialised palliative care teams, but CGA does not affect the quality of palliative care given to the patients. These effects are measured in outpatient care settings and in comparison with usual care.MessageFurther studies are needed to evaluate the CGA effects on causes of death and palliative care quality in outpatient care settings.

Highlights

In Europe in 2014, the deaths among old people, over 65 years, were dominated by cerebrovascular and cardiovascular diseases, which answered for 40.4%
The study shows that comprehensive geriatric assessment (CGA) in outpatient care means a higher rate of specialised palliative care, but the study cannot show any effects on the palliative quality parameters measured
The present study contains a retrospective examination of all electronic medical records (EMRs) (Cambio Cosmic which contain records from all public care services in the region and private primary care services that are contracted to the public care services) for the participants in the original CGA-based study that died during the intervention period and up to 1 year afterwards, comparing causes of death and different aspects of palliative care

Summary

Introduction

In Europe in 2014, the deaths among old people, over 65 years, were dominated by cerebrovascular and cardiovascular diseases, which answered for 40.4%. A meta-analysis from 1993 drew the conclusion that CGA-based care, given by a team controlling the medication and monitoring, improves survival rates, at least in the short term [11]. Another meta-analysis found reduced mortality at 6 and 8 months after discharge from CGA-based care but not before and after that period [7]. It is interesting to conduct a subanalysis of the data from Ekdahl et al ́s study by including the patients that did not survive to compare the causes of death, in an effort to find out if CGA could affect this. It would be interesting to see if CGA could affect the place, where the participants died and the quality of the palliative care given

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Conclusion