Abstract
BackgroundComprehensive geriatric assessment for older patients admitted to dedicated wards has proven to be beneficial, but the impact of comprehensive geriatric assessment delivered by mobile inpatient geriatric consultation teams remains unclear. This review and meta-analysis aims to determine the impact of inpatient geriatric consultation teams on clinical outcomes of interest in older adults.MethodsAn electronic search of Medline, CINAHL, EMBASE, Web of Science and Invert for English, French and Dutch articles was performed from inception to June 2012. Three independent reviewers selected prospective cohort studies assessing functional status, readmission rate, mortality or length of stay in adults aged 60 years or older. Twelve studies evaluating 4,546 participants in six countries were identified. Methodological quality of the included studies was assessed with the Methodological Index for Non-Randomized Studies.ResultsThe individual studies show that an inpatient geriatric consultation team intervention has favorable effects on functional status, readmission and mortality rate. None of the studies found an effect on the length of the hospital stay. The meta-analysis found a beneficial effect of the intervention with regard to mortality rate at 6 months (relative risk 0.66; 95% confidence interval 0.52 to 0.85) and 8 months (relative risk 0.51; confidence interval 0.31 to 0.85) after hospital discharge.ConclusionsInpatient geriatric consultation team interventions have a significant impact on mortality rate at 6 and 8 months postdischarge, but have no significant impact on functional status, readmission or length of stay. The reason for the lack of effect on these latter outcomes may be due to insufficient statistical power or the insensitivity of the measuring method for, for example, functional status. The questions of to whom IGCT intervention should be targeted and what can be achieved remain unanswered and require further research.Trial registration: CRD42011001420 (http://www.crd.york.ac.uk/PROSPERO)
Highlights
The proportion of older persons admitted to the hospital is increasing as a result of the aging of the population
The individual studies show that an inpatient geriatric consultation team intervention has favorable effects on functional status, readmission and mortality rate
The meta-analysis found a beneficial effect of the intervention with regard to mortality rate at 6 months and 8 months
Summary
The proportion of older persons admitted to the hospital is increasing as a result of the aging of the population. The clinical value of the second type of CGA, the ‘CGA team model’, remains unclear Within this model, frail older patients are hospitalized on a nongeriatric ward - based on the patient’s main medical reason for admission - and evaluated by ‘a multidisciplinary team which assesses, discusses, and recommends a plan of treatment for frail older inpatients’. Frail older patients are hospitalized on a nongeriatric ward - based on the patient’s main medical reason for admission - and evaluated by ‘a multidisciplinary team which assesses, discusses, and recommends a plan of treatment for frail older inpatients’ This CGA model is typically referred to as the inpatient geriatric consultation team (IGCT), inpatient geriatric consultation service, geriatric assessment team or geriatric liaison team. This review and meta-analysis aims to determine the impact of inpatient geriatric consultation teams on clinical outcomes of interest in older adults
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