HOSPITAL-WIDE COMPREHENSIVE GERIATRIC ASSESSMENT (CGA) FOR OLDER PEOPLE: A SURVEY OF UK HOSPITALS.

Abstract

CGA is widely recommended for older hospital inpatients. The UK National Institute for Health Research (NIHR) recently called for more research on the delivery of hospital wide CGA. We carried out a survey of acute hospitals in the UK with the assistance of the British Geriatrics Society, The Royal College of Physicians of London and the NIHR Ageing Clinical Research Network. We asked hospitals to identify services which provided CGA: “A multidimensional, multidisciplinary process which identifies medical, social and functional needs, and the development of an integrated / co-ordinated care plan to meet those needs.” 45 hospitals participated in the survey. All hospitals described the provision of CGA and returned descriptions of 82 services. The majority (78/82, 95%) of the services were led (60) or supported (18) by a consultant geriatrician. Teams were generally staffed by physiotherapists (81/82, 99%) and occupational therapists (80/82, 98%), with nurses (76/82, 93%) and health care assistants (73/82, 89%). The majority (73/82, 89%) used clinical assessment processes (such as consultant or specialist nurse review) to identify appropriate patients, in preference to screening tools (36/82, 44%) or admission criteria (38/82, 46%). Most services (58/82, 71%) did not use standard methods for measuring frailty, with little consistency of choice of instruments among those who did. Multidisciplinary team based CGA was available in all hospitals surveyed, generally led by geriatricians and staffed with therapists and nurses. These teams make extensive use of clinical assessment to select patients for their care. Relatively few measure or target frailty explicitly.