Effectiveness Of Comprehensive Geriatric Assessment Research Articles

Baseline Characteristics of Frailty and Disease Stage in Older People Living With CKD

IntroductionThe GOAL trial, a cluster-randomised controlled trial, investigated the effect of comprehensive geriatric assessment (CGA) on frail older people with chronic kidney disease (CKD). This paper describes (1) participant baseline characteristics, and (2) their relationship with CKD stage and frailty severity. MethodsSixteen kidney outpatient clinics (clusters) were randomly allocated 1:1 to CGA or usual care. Enrolled frail older people with CKD (Frailty Index >0.25; aged ≥65 years or ≥55 if First Nations people) received the intervention allocated to their cluster. CKD was defined as moderate (stages 3/4) or severe (stage 5/5D), and frailty categorised as moderate (>0.25 to <0.36), severe (0.36 to <0.45) or very severe (≥0.45). Participant characteristics were analysed using descriptive statistics. Statistical methods appropriate for type of outcome were used to describe the association of frailty and CKD categories with participant characteristics. ResultsOver a 27-month period, 240 people were recruited (55.7% male, 82.9% white/European). Mean age was 76.9 (SD: 6.6) and median FI was 0.39 (IQR: 0.32 – 0.47). The median EQ-5D-5L quality of life index score was worse in those with very severe frailty (0.57, IQR: 0.28 – 0.83) compared to severe frailty (0.85, IQR: 0.67 – 0.92) and moderate frailty (0.90, IQR: 0.82 – 0.93) (overall P <0.001). Median EQ-5D-5L was also worse in those with severe CKD (0.79, IQR: 0.40 – 0.89), compared to moderate CKD (median 0.87, IQR: 0.73 – 0.92; P 0.001). ConclusionThis cohort demonstrated poorer quality of life scores in those with more severe frailty and more advanced CKD.

Effectiveness of comprehensive geriatric assessment adapted to primary care when provided by a nurse or a general practitioner: the CEpiA cluster-randomised trial

BackgroundThe benefits of comprehensive geriatric assessment (CGA) are well established for hospital care but less so for primary care. Our primary objective was to assess the effect of two multifaceted interventions based on a CGA adapted for primary care on a composite criterion combining all-cause mortality, emergency department visits, unplanned hospital admissions, and institutionalisation.MethodsThis open-label, pragmatic, three-arm, cluster-randomised controlled trial involved 39 general practices in France. It included 634 patients aged 70 years or over with chronic health conditions and/or an unplanned hospital admission in the past 3 months, between 05/2016 and 08/2018. Interventions were in arm 1: a systematic nurse-led CGA; arm 2: a GP-led CGA, at the GP’s discretion; arm 3: standard care. The primary composite endpoint was assessed at 12 months. The secondary endpoints included: components of the composite endpoint, health-related quality of life (Duke Health Profile), functional status (Katz Activities of Daily Living Index) and medications (number) at 12 months. Pairwise comparisons between the experimental groups and the control were tested. The main analysis was performed on the intention-to-treat (ITT) population, after imputing missing information and adjusting for baseline imbalances by mixed effects regressions.ResultsFor the primary composite outcome, no statistically significant difference was found between arm 1 and the control (adjusted odds ratio [aOR] = 0.81 [95%CI 0.54–1.21], P = 0.31), whereas arm 2 and the control differed significantly (aOR = 0.60 [0.39–0.93], P = 0.022). A statistically lower risk of unplanned hospital admission in arm 2 vs control (aOR = 0.57 [0.36–0.92], P = 0.020)) was observed, while no statistically significant differences were found for the other components and between arm 1 and the control. None of the other secondary endpoints differed between arms.ConclusionsOur study led in community-dwelling older patients with chronic conditions found no significant effect of a CGA adapted for primary care on mortality, functional independence and quality of life, but suggests that a GP-led CGA may reduce the risk of unplanned hospital admission. Our study demonstrates the feasibility of incorporating CGA into clinical practice and highlights its potential benefits when applied on a case-by-case basis, guided by the GPs who develop the resulting PCP.Trial registrationNCT02664454.

Impact of comprehensive geriatric assessment on treatment strategies and complications in older adults with colorectal cancer considering surgery.

This study aimed to assess the effectiveness of Comprehensive Geriatric Assessment (CGA) in customizing care for elderly cancer patients, specifically focusing on colorectal cancer. The research compared treatment strategies and outcomes in older adults considered for surgery before and after the initiation of a Geriatric Oncology Service (GOS). Conducting a comparative study, two cohorts of consecutive colorectal cancer patients aged 75 or older were examined: the control group (n = 156) and the GOS group (n = 158). Upon the treating surgeon's GOS consultation request, a geriatrician and an oncologist performed CGA, guiding treatment decisions and perioperative interventions. Postoperative complications were compared using propensity score matching (PSM). In the GOS group, 91% (n = 116) underwent CGA consultations, influencing decisions to forego surgery in 12 patients. After PSM for surgical cases (controls n = 146, GOS n = 146), each group comprised 128 patients. Perioperative physical therapy and pharmacist referrals were more frequent in the GOS group. The GOS group exhibited a significantly lower incidence of postoperative complications (22%) compared to the control group (33%) (p = 0.0496). Patients undergoing colorectal surgery post-GOS implementation experienced a notable reduction in postoperative complications, highlighting the positive impact of personalized geriatric assessment on surgical outcomes in the elderly.

Effect of comprehensive geriatric assessment on hospitalizations in older adults with frailty initiating curatively intended oncologic treatment: The PROGNOSIS-RCT study

IntroductionFrailty constitutes a risk for unplanned hospitalizations in older adults with cancer. This study examines whether comprehensive geriatric assessment (CGA) as an add-on to standard oncologic care can prevent unplanned hospitalizations in older adults with frailty and cancer who initiate curative oncological treatment. Materials and MethodsThis randomized controlled trial included older adults aged ≥70 with frailty (Geriatric 8 [G8] ≤14), and solid cancers who initiated curative oncological treatment. Participants were randomized 1:1 to either standard oncologic care (control) or standard oncologic care supplemented with CGA-guided interventions (intervention). Baseline characteristics were retrieved prior to randomization. The primary endpoint, the between-group rate ratio of unplanned hospitalizations within six months of treatment initiation, was analyzed using negative binominal regression. Analyses were performed using an intention-to-treat approach, followed by per-protocol analysis, including participants receiving CGA within 30 days of randomization, and preplanned subgroup analyses based on treatment modality and Geriatric 8 screening. Secondary endpoints included acute hospital contacts, treatment adherence, and toxicity. ResultsFrom November 1, 2020 to May 31, 2023, 173 participants were enrolled. Median age was 75 (interquartile range 72–79), 51.5% were female, 58% had a G8 score > 12, and 84% had Eastern Cooperative Oncology Group performance status 0–1. The most common cancer sites were lung (23%), upper gastrointestinal (15%), and breast (13%). The rate (per person-years) of unplanned hospitalization was 1.32 in the intervention group and 1.81 in the control group, with a between-group rate ratio of 0.74 (95% confidence interval [CI] 0.45–1.23, P = 0.25) favoring the intervention. The between-group rate ratio increased in the per-protocol analysis (0.64 [95% CI 0.37–1.10, P = 0.10]). Similarly, no significant between group differences were found in treatment adherence, rate of acute hospital contacts, or toxicity. DiscussionIn this study, CGA did not significantly reduce the rate of unplanned hospitalizations. Furthermore, no between-group differences were found in treatment adherence, toxicity lead hospitalizations, or treatment completion in older adults with cancer and frailty. However, per-protocol analysis suggests that increasing adherence to CGA may improve the outcome. Larger studies ensuring higher CGA adherence are warranted to confirm our findings.

Effects of Comprehensive Geriatric Assessment (CGA) Guided Care vs. Usual Care on Overall Survival (OS) and Health-Related Quality of Life (HRQL) for Older Adults with Cancer: A Systematic Review of Randomized Trials (RCTs)

There is evidence from RCTs demonstrating that our current models of CGA guided care can reduce treatment related toxicity effectively. However, it is unclear if CGA guided care can improve OS and HRQL. We aimed to determine the effect of CGA guided care compared with usual care on OS and HRQL. We searched MEDLINE, EMBASE, CENTRAL and CINAHL from date of inception to October 2022 for RCTs comparing CGA guided care with usual care for patients with cancer who were 60 years old and greater on OS and HRQL. We assessed the risk of bias using Cochrane ROB 2 tool. We performed the meta-analysis using random-effects models. The I2 statistic was adopted to assess heterogeneity between studies. We adopted the Synthesis without meta-analysis approach for data not amenable for meta-analysis. The certainty of evidence was rated using the GRADE approach. This study is registered with Cochrane Database of Systematic Reviews. We found 15 eligible RCTs including 3507 participants. There are variations in types of CGA used with 4 trials using CGA to recommend oncology treatment regimen and 10 trials making no recommendation on oncology treatment. The implementation of CGA recommendations were carried out by a geriatrician in 14 trials, but by the primary oncologist in 1 trial. Six, five and four RCTs were judged to have low, unclear and high risk of bias respectively. Eleven and six RCTs reported OS and HRQL outcomes respectively. There was no significant difference between CGA guided and usual care for OS (Hazard Ratio 1.02, 95% CI (0.90 to 1.15), I2 = 0%; moderate certainty). There was significant variation in the measurement of HRQL in terms of instruments, summary measures and time points. EORTC QLQ C30 and ELD 14 were used in 3 RCTs. The effects of CGA guided care on HRQL were inconsistent. Two trials using FACT-G or Elderly Functional Index (ELFI) reported significant improvement in HRQL at 3 and 6 months post randomization. Meta-analysis of the mean difference in the change of the EORTC QLQ C30 and E14 HRQL scores relative to baseline at 6 months post randomization demonstrated no significant difference between CGA guided and usual care for HRQL across various domains (moderate certainty evidence). The current models of CGA guided care did not improve OS and had variable effects on HRQL when compared to usual care in older patients with cancer. The inconsistent effects of CGA guided care on HRQL suggest that CGA guided care may have more significant effects on the social and functional outcomes domains, aspects of HRQL that is predominantly measured in FACT-G and ELFI score respectively. There is also heterogeneity in how CGAs are performed and implemented. Future research should focus on developing new models of CGA guided care to improve OS and HRQL.

Effects of comprehensive geriatric assessment (CGA) guided care versus usual care on overall survival (OS) and health-related quality of life (HRQL) for older adults with cancer: A systematic review of randomized trials (RCTs).

e24014 Background: There is evidence from RCTs demonstrating that our current models of CGA guided care can reduce treatment related toxicity effectively. However, it is unclear if CGA guided care can improve OS and HRQL. We aimed to determine the effect of CGA guided care compared with usual care on OS and HRQL. Methods: We searched MEDLINE, EMBASE, CENTRAL and CINAHL from date of inception to October 2022 for RCTs comparing CGA guided care with usual care for patients with cancer who were 60 years old and greater on OS and HRQL. We assessed the risk of bias using Cochrane ROB 2 tool. We performed the meta-analysis using random-effects models. The I2 statistic was adopted to assess heterogeneity between studies. We adopted the Synthesis without meta-analysis approach for data not amenable for meta-analysis. The certainty of evidence was rated using the GRADE approach. This study is registered with Cochrane Database of Systematic Reviews (DOI: 10.1002/14651858.CD014875). Results: We found 15 eligible RCTs including 3507 participants. There are variations in types of CGA used with 4 trials using CGA to recommend oncology treatment regimen and 10 trials making no recommendation on oncology treatment. The implementation of CGA recommendations were carried out by a geriatrician in 14 trials, but by the primary oncologist in 1 trial. Six, five and four RCTs were judged to have low, unclear and high risk of bias respectively. Eleven and six RCTs reported OS and HRQL outcomes respectively. There was no significant difference between CGA guided and usual care for OS (Hazard Ratio 1.02, 95% CI (0.90 to 1.15), I2 = 0%; moderate certainty). There was significant variation in the measurement of HRQL in terms of instruments, summary measures and time points. EORTC QLQ C30 and ELD 14 were used in 3 RCTs. The effects of CGA guided care on HRQL were inconsistent. Two trials using FACT-G or Elderly Functional Index (ELFI) reported significant improvement in HRQL at 3 and 6 months post randomization. Meta-analysis of the mean difference in the change of the EORTC QLQ C30 and E14 HRQL scores relative to baseline at 6 months post randomization demonstrated no significant difference between CGA guided and usual care for HRQL across various domains (moderate certainty evidence). Conclusions: The current models of CGA guided care did not improve OS and had variable effects on HRQL when compared to usual care in older patients with cancer. The inconsistent effects of CGA guided care on HRQL suggest that CGA guided care may have more significant effects on the social and functional outcomes domains, aspects of HRQL that is predominantly measured in FACT-G and ELFI score respectively. There is also heterogeneity in how CGAs are performed and implemented. Future research should focus on developing new models of CGA guided care to improve OS and HRQL.

A multicenter randomized controlled trial (RCT) for the effectiveness of comprehensive geriatric assessment (CGA) with extensive patient coaching on quality of life (QoL) in older patients with solid tumors receiving systemic therapy: G-oncoCOACH study.

12000 Background: CGA is internationally recommended in the care for older patients with cancer (e.g. ASCO). Only a few recent RCTs have examined the impact on patient’s QoL. Aim of this study is to evaluate the effectiveness of CGA coordinated by a geriatric team combined with intensive patient coaching ( = intervention group (IG)) versus standard of care, which is CGA coordinated by an oncology team ( = control group (CG)) on QoL in older patients with solid tumors receiving systemic therapy. Methods: The G-oncoCOACH study was a multicenter RCT in two academic Belgian hospitals (NCT04069962). Eligibility criteria were 70+ years, solid tumor, systemic therapy with curative or non-curative intent (first/second-line), and physician-estimated life expectancy &gt; 6 months. IG patients received CGA coordinated by the geriatric team in close collaboration with the oncology team, increasing multidisciplinary care and in combination with intensive patient coaching to increase patient compliance. This supports patient empowerment by improving self-efficacy and supporting self-management of age-related problems. It included an individual counselling session at start of systemic therapy to discuss CGA results and recommendations with the patient and to determine their priorities, followed by individual counselling organized at 2, 4.5, 8 and 10 months. Primary endpoint was global health status (GHS) of the European Organisation for Research and Therapy of Cancer (EORTC) QOL questionnaire measured at 6 months after start of systemic therapy. Sample size calculation required &gt; 195 included patients for primary endpoint (≥10 points QoL change at 6 months) for 80% power at 2-sided 5% significance level. After exclusion of multicollinearity, the change in QoL GHS between baseline and 6 months follow-up was analyzed with a mixed model. Results: From 10/2019 to 9/2021, 212 participants were enrolled (CG (n = 107); IG (n = 105)). Mean age was 76.8 years; 52.4% were female (n = 111). The 3 most common tumor types were digestive (n = 65; 30.7%), thorax (n = 44; 20.8%), and urogenital (n = 33; 15.6%). Cancer therapy was started mostly with non-curative intent. After 6 months, the difference between CG and IG in change of adjusted QoL GHS versus baseline amounted 12.8 points in favor of the IG (95%CL 6.7-18.8; p &lt; 0.0001). This difference consisted of an improvement of 4.5 point versus baseline in the IG and decline of 8.2 points in the CG. Secondary endpoints (e.g. QoL at 3 and 12 months, patient satisfaction, severe systemic therapy-related adverse events, survival) will be presented at the meeting. Conclusions: CGA coordinated by a geriatric team combined with extensive patient coaching improves QoL GHS in older patients with cancer compared to CGA coordinated by an oncology team. Clinical trial information: NCT04069962 .

Does CGA Improve Health Outcomes in the Community? An Umbrella Review.

To perform an umbrella review of systematic reviews with meta-analyses (MAs) examining the effectiveness of comprehensive geriatric assessment (CGA) delivered within community settings to general populations of community-dwelling older people against various health outcomes. Umbrella review of MAs of randomized controlled trials (RCTs). Systematic reviews with MAs examining associations between CGA conducted within the community and any health outcome, where participants were community-dwelling older people with a minimum mean age of 60years or where at least 50% of study participants were aged ≥60years. Studies focusing on residential care, hospitals, post-hospital care, outpatient clinics, emergency department, or patients with specific conditions were excluded. We examined CGA effectiveness against 12 outcomes: not living at home, nursing home admission, activities of daily living (ADLs) and instrumental ADLs (IADLs), physical function, falls, self-reported health status, quality of life, frailty, mental health, hospital admission, and mortality, searching the MEDLINE/PubMed, Cochrane Library, CINAHL, Embase databases from January 1, 1999, to August 10, 2022. AMSTAR-2 was used to assess the quality of included systematic reviews, including risk of bias. We identified 10MAs. Only not living at home (combined mortality and nursing home admission) demonstrated concordance between effect direction, significance, and magnitude. Significant effects were more typically observed in earlier rather than later studies. Given the widespread adoption of CGA as a component of usual care within geriatric medicine, the lack of strong evidence demonstrating the protective effects of CGA may be indicative of a cohort effect. If so, future RCTs examining CGA effectiveness are unlikely to demonstrate significant findings. Future studies of CGA in the community should focus on implementation and adherence to key components. Study protocol registered in PROSPERO 2020 CRD42020169680.

Comprehensive Geriatric Assessment for younger outpatients with severe mental illness: protocol for a feasibility study

IntroductionIndividuals with severe mental illness are at risk of becoming prematurely frail. There is a critical unmet need for an intervention that reduces the risk of frailty and minimises the...

Effect of comprehensive geriatric assessment for frail elderly patients operated for colorectal cancer—the colorectal cancer frailty study: study protocol for a randomized, controlled, multicentre trial

BackgroundColorectal cancer (CRC) is the third most common cancer worldwide, with a median age of 72–75 years at diagnosis. Curative treatment usually involves surgery; if left untreated, symptoms may require emergency surgery. Therefore, most patients will be accepted for surgery, despite of high age or comorbidity. It is known that elderly patients suffer higher risks after surgery than younger patients, in terms of complications and mortality. Assessing frailty and offering frail elderly patients individualized treatment according to the comprehensive geriatric assessment (CGA) and care concept has been shown to improve the outcome for frail elderly patients in other clinical contexts.MethodsThis randomized controlled multicentre trial aims to investigate if CGA and care prior to curatively intended surgery for CRC in frail elderly patients will improve postoperative outcome. All patients ≥ 70 years with surgically curable CRC will be screened for frailty using the Clinical Frailty Scale (CFS-9). Frail patients will be offered inclusion. Randomization is stratified for colon or rectal cancer. Patients in the intervention group are, in addition to standard protocol, treated according to CGA and care. This consists of individualized assessments and interventions, established by a multiprofessional team. Patients in the control group are treated according to best known practice as stipulated by Swedish colorectal cancer treatment guidelines, within an enhanced recovery after surgery (ERAS) setting. The primary outcome is 90-day mortality. Secondary outcomes are the length of hospital stay and total number of hospital days within 3 months, discharge destination, 30-day readmission, ADL, safe medication assessment, CFS-9 score, complications, Health-Related Quality of Life (HRQoL) at 2-month follow-up in comparison to baseline measurements, health economical calculations including cost-effectiveness analysis based on costs of hospital care and primary care, mortality and HRQoL at baseline, 2- and 12-month follow-up and all-cause 1-year mortality.DiscussionThe trial is the first of its size and extent to investigate intervention with CGA and care prior to surgery for CRC in frail elderly patients. If this addition proves to be favourable, it could have implications on future care of frail elderly patients with CRC.Trial registrationClinicalTrials.gov NCT04358328. Registered on 4 February 2020

SIOG2022-0114 - Effects of Comprehensive Geriatric Assessment on Physical Function in Older Patients with Advanced Cancer –the PROGNOSIS-RCT study

SIOG2022-0114 - Effects of Comprehensive Geriatric Assessment on Physical Function in Older Patients with Advanced Cancer –the PROGNOSIS-RCT study

Integrated Geriatric Assessment and Treatment Effectiveness (INTEGERATE) in older people with cancer starting systemic anticancer treatment in Australia: a multicentre, open-label, randomised controlled trial

The effectiveness of comprehensive geriatric assessment (CGA) in improving health outcomes in cancer settings is unclear. We evaluated whether CGA can improve health-related quality of life (HRQOL) in older people with cancer who are starting systemic anticancer treatment. INTEGERATE is a multicentre, open-label, pragmatic, parallel-group, randomised controlled trial that was done at three hospitals in Australia. Participants aged 70 years and older with solid cancer or diffuse large B-cell lymphoma planned for chemotherapy, targeted therapy, or immunotherapy, were randomly assigned (1:1; using a central computer-generated minimisation algorithm with a random element, balancing treatment intent, cancer type, age, sex, and performance status) to receive CGA integrated into oncology care (integrated oncogeriatric care) or usual care only. Group assignment was not concealed from the participants and clinicians. The primary outcome was HRQOL over 24 weeks, assessed at baseline, week 12, week 18, and week 24, using the Elderly Functional Index (ELFI; score range 0-100). Analyses were by intention to treat. The trial is registered with ANZCTR.org.au, ACTRN12614000399695, and is completed. Between Aug 18, 2014, and Sept 5, 2018, 154 participants were randomly assigned to integrated oncogeriatric care (n=76) or usual care (n=78). 13 participants died by week 12 and 130 (92%) of the remaining 141 participants completed two or more ELFI assessments. Participants assigned to integrated oncogeriatric care reported better adjusted ELFI change scores over 24 weeks compared with those in the usual care group (overall main effect of group: t=2·1, df=213, p=0·039; effect size=0·38), with maximal between-group differences at week 18 (mean difference in change 9·8 [95% CI 2·4-17·2]; p=0·010, corrected p=0·030, effect size=0·48). The integrated oncogeriatric care group also had significantly fewer unplanned hospital admissions at 24 weeks (multivariable-adjusted incidence rate ratio 0·60 [95% CI 0·42-0·87]; p=0·0066). No statistically significant between-group difference was observed in overall survival. CGA led to better quality of life and health-care delivery in older people receiving systemic anticancer treatment. Routine CGA-based interventions should be considered in at-risk older people starting systemic anticancer treatment. National Health and Medical Research Council (Australia), Monash University, and Eastern Health.

Effectiveness of Perioperative Comprehensive Evaluation of Hip Fracture in the Elderly.

Objective The objective is to observe the effect of Comprehensive Geriatric Assessment (CGA) in the perioperative period of hip fracture. Methods From October 2018 to October 2021, 155 patients over the age of 65 diagnosed with hip fracture and treated with surgery at the Department of Trauma Orthopaedics of General Hospital of Ningxia Medical University were randomly divided into two groups using a prospective research method. A total of 70 cases in the CGA group received a perioperative comprehensive assessment of the geriatric, and 85 cases in the control group received routine medical consultation. Results Elderly patients with hip fractures have a high comorbidity index. Patients with abnormal daily activity before injury accounted for 55%, the abnormal rate of nutrition was 58.1%, the abnormal rate of cognition, anxiety, and depression was 81.8%, and 77.3% of the patients were in a weak state. There was no significant difference in age, gender, ASA grade, fracture type, and operation mode between the two groups, but there were significant differences in operation rate at 48 h (χ2 = 22.153; P ≤ 0.001), preoperative waiting time (Z = −6.387; P ≤ 0.001), total hospital stay (Z = −11.756; P ≤ 0.001), and incidence of postoperative delirium (χ2 = 23.897; P ≤ 0.001). Conclusions The implementation of CGA shortened the preoperative waiting time and total hospital stay, increased the 48 h operation rate, and reduced the incidence of postoperative delirium.

COMPrehensive geriatric AsseSSment and multidisciplinary team intervention for hospitalised older adults (COMPASS): a protocol of pragmatic trials within a cohort

IntroductionThere is an increased demand for services for hospitalised older patients with acute medical conditions due to rapidly ageing population. The COMPrehensive geriatric AsseSSment and multidisciplinary team intervention for hospitalised...

Comparative study of two cohorts of older adults with advanced cancer treated before and after implementation of a geriatric oncology service.

12036 Background: A comprehensive geriatric assessment (CGA) has been recommended by guidelines for older adults with cancer for whom chemotherapy is considered. As a quality assessment effort, we examined the effect of CGA conducted by a geriatric oncology service (GOS) in routine practice on clinical outcomes. Methods: This was a comparative study of two cohorts of consecutive patients aged ≥ 70 years with unresectable, locally advanced or metastatic cancer who were referred to medical oncology for first-line chemotherapy before (September 2015-August 2018) and after (September 2018-March 2021) the establishment of a GOS at a single institution in Japan. When the treating physician requested a consultation, the GOS conducted a CGA and provided recommendations for the oncologic treatment plan and geriatric interventions. We compared time to treatment failure (TTF) rates at 30, 60 and 90 days as well as 6-month overall survival (OS) rates between the two cohorts adjusting for potential confounders. TTF was defined as the time from start of first-line chemotherapy to discontinuation of first-line chemotherapy for any reason. Results: The study population consisted of 342 patients. Median age was 75 years (range: 70-95 years) and 85% had gastrointestinal tract cancer including gastroesophageal (43%) and colorectal (41%). Baseline characteristics of the patients treated before (n = 151) and after (n = 191) GOS implementation were similar with regard to age, sex, cancer type, and performance status. In the after GOS cohort, 82 patients (43%) received CGA before the treatment decision and oncologic treatment plans were changed after consultation in 49 patients (60%). For the majority of these patients, the treatment plan was adjusted to a less intensive option. Two hundred and eighty-two patients received chemotherapy (n = 128 before, n = 154 after GOS cohort) and 60 patients were treated with best supportive care only (n = 23 before, n = 37 after GOS cohort). More patients in the after GOS cohort were treated with reduced-intensity chemotherapy compared with those in the before GOS cohort (55% vs. 39%, P = 0.007). TTF event rates at 30 days (5.7% after vs. 14% before, P = 0.02), 60 days (13% after vs. 29% before, P = 0.001) and 90 days (26% after vs. 36% before, P = 0.06) were lower in the after GOS cohort compared to the before GOS cohort. Among patients receiving chemotherapy, significantly more patients were alive at 6 months in the after GOS cohort compared to the before GOS cohort (84% vs. 72%, P = 0.01). In all patients receiving CGA (n = 94), 219 interventions to address health problems were recommended and 97 interventions were conducted with an overall implementation rate of 44%. Conclusions: In this before-and-after quality assessment study, implementation of the GOS was associated with improved TTF and OS in older adults with advanced cancer receiving first-line chemotherapy.

A Pilot Study of the Effects on an Inpatient Geriatric Consultation Team on Geriatric Syndrome Patients.

PurposeTo evaluate the effect of comprehensive geriatric assessment performed by an inpatient aging consultation team on older patients with geriatric syndromes.MethodsFifty-nine patients with ≧65 years, Barthel Index score ≦60, at least one geriatric syndrome, and admitted to non-geriatric wards were enrolled. By their preference, 16 were in the intervention group with comprehensive geriatric assessment and instructions from the consultation team. And 43 were in the control group, receiving standard care from non-geriatric-specialist physicians. Outcomes were readmission and mortality within one year after discharge.ResultsThe mean age of the intervention and control groups was 78.35 (8.54) and 80.23 (6.36) years (p = 0.36), with female of 62.5% and 60.5%, respectively. Compared to control, intervention is not significantly associated with attenuated risk for readmission (adjusted hazard ratio (aHR): 0.256, 95% confidence interval (CI): 0.12–1.78, p = 0.256) and mortality (aHR: 2.13, 95% CI: 0.29–15.7, p = 0.457) within one year after discharge. Multivariate analysis showed that patients with a fall history ≧1 in the past one year had a lower risk of readmission (aHR: 0.28, 0.07–0.6, p = 0.004) or mortality (aHR: 0.11, 95% CI: 0.01–0.97, p = 0.047), and disability is associated with mortality (aHR: 5.37, 95% CI: 0.87–33.12, p = 0.07).ConclusionIntervention is not significantly associated with outcomes in our pilot study. But fall history ≧1 in the recent one year is associated with a lower risk of readmission and mortality among all included patients. More participants and longer follow-up are needed for better elucidation.

EFFECTIVENESS OF A COMPREHENSIVE GERIATRIC ASSESSMENT TO IMPROVE THE LIFE QUALITY OF THE ELDERLY AND TO EASE THE CAREGIVERS BURDEN

In the modern world, the number of elderly people with various diseases is growing, they need an appropriate care. Care implementation requires special knowledge, mental and economic expenditures. Ensuring a decent old age for the elderly is one of the problems of modern society. Comprehensive geriatric assessment is a multidimensional interdisciplinary diagnostic process for assessing the physical, psychological, functional and socio-economic problems of elderly people in order to develop a comprehensive individual plan for their treatment and rehabilitation. Comprehensive geriatric assessment benefits the elderly population, but the effectiveness of comprehensive geriatric assessment to improve the life quality of the elderly remains unclear. The article provides an overview of studies devoted to studying the effectiveness of using comprehensive geriatric assessment. The article discusses the influence of a comprehensive geriatric assessment on determining the life quality of the elderly, the duration of their stay in the hospital, and relieving the caregivers' burden. In addition, the influence of a comprehensive geriatric assessment on the ability to determine life expectancy, to conduct early diagnosis of major geriatric syndromes, the risk of morbidity and mortality in elderly patients is being considered. It is important that on the basis of a comprehensive geriatric assessment, appropriate rehabilitation programs can be drawn up, and technologies for rehabilitation can be determined.

Costs and effects of comprehensive geriatric assessment in primary care for older adults with high risk for hospitalisation

BackgroundThe healthcare system needs effective strategies to identify the most vulnerable group of older patients, assess their needs and plan their care proactively. To evaluate the effectiveness of comprehensive geriatric assessment (CGA) of older adults with a high risk of hospitalisation we conducted a prospective, pragmatic, matched-control multicentre trial at 19 primary care practices in Sweden.MethodsWe identified 1604 individuals aged 75 years and older using a new, validated algorithm that calculates a risk score for hospitalisation from electronic medical records. After a nine-month run-in period for CGA in the intervention group, 74% of the available 646 participants had accepted and received CGA, and 662 participants remained in the control group. Participants at intervention practices were invited to CGA performed by a nurse together with a physician. The CGA was adapted to the primary care context. The participants thereafter received actions according to individual needs during a two-year follow-up period. Participants at control practices received care as usual. The primary outcome was hospital care days. Secondary outcomes were number of hospital care episodes, number of outpatient visits, health care costs and mortality. Outcomes were analysed according to intention to treat and adjusted for age, gender and risk score. We used generalised linear mixed models to compare the intervention group and control group regarding all outcomes.ResultsMean age was 83.2 years, 51% of the 1308 participants were female. Relative risk reduction for hospital care days was − 22% (− 35% to − 4%, p = 0.02) during the two-year follow-up. Relative risk reduction for hospital care episodes was − 17% (− 30% to − 2%, p = 0.03). There were no significant differences in outpatient visits or mortality.Health care costs were significantly lower in the intervention group, adjusted mean difference was € − 4324 (€ − 7962 to − 686, p = 0.02).Conclusions and relevanceOur findings indicate that CGA in primary care can reduce the need for hospital care days in a high-risk population of older adults. This could be of great importance in order to manage increasing prevalence of frailty and multimorbidity.Trial registrationclinicaltrials.gov Identifier: NCT03180606, first posted 08/06/2017.

Predictive Value of Comprehensive Geriatric Assessment on Early Postoperative Complications Following Lumbar Spinal Stenosis Surgery

Prospective cohort study. The aim of this study was to evaluate the predictive value of comprehensive geriatric assessment (CGA) for early postoperative complications in elderly patients (aged 65 years or older) following lumbar spinal stenosis surgery. CGA is a multidisciplinary evaluation modality proven to be effective in various fields of geriatrics. However, limited evidence exists on the effectiveness of CGA in lumbar spinal stenosis patients in the literature. We prospectively enrolled consecutive patients who were at least 65 years' old and were scheduled to undergo elective surgery for lumbar spinal stenosis. One day before the operation, multidomain CGA was performed on the patient's functional status, comorbidities, nutrition, cognition, and psychological status. Patients with deficits in three or more CGA domains were defined as frail. The occurrence of postoperative complications (Clavien and Dindo grade 2 or higher) within 30 days after the surgery was assessed as the outcome. The predictive value of CGA was evaluated using crosstab and logistic regression analysis and compared to that of other risk stratification systems, including modified Frailty Index-5, -11, and American Society of Anesthesiologists Physical Classification System. A total of 261 patients were included in the study, and 25 (9.6%) patients were assigned to the "frail" group. There were 27 (10.3%) patients with a postoperative complication (general: n = 20, 7.7%, surgical: n = 7, 2.7%) within postoperative 30 days. Patients with a complication showed significantly more deficits on preoperative CGA than those without complications (P = 0.004). On multivariate logistic regression analysis, frailty based on CGA (odds ratio = 3.51, P = 0.031) and the modified Frailty Index-11 (odds ratio = 3.13, P = 0.038) were associated with the occurrence of general complications. Frailty based on CGA was significantly associated with early general complications following surgery for lumbar spinal stenosis in patients older than 65 years. 2.

Effects of comprehensive geriatric assessment in predicting the fall risk among the aged

Objective To explore the effects of comprehensive geriatric assessment in predicting the fall risk among the aged. Methods From January 2016 to June 2017, the comprehensive geriatric assessment handbook was used to evaluate a total of 139 patients in department of geriatrics at Beijing Hospital. The self-designed handbook was used to comprehensively assess the physical condition, functional status, mental health and social environment among the aged. We explored the correlation between evaluation results and incidence of fall in the aged. Results Among 139 elderly patients, 21 of them fell within the past year with 15.1% for the incidence. Single factor analysis showed that there were statistical differences in the incidences of fall among patients with different results in timed up and go test, walking speed test and frailty grades (P<0.05) . Logistic regression analysis showed that the score of activities of daily living (ADLs) and timed up and go test were the independent influencing factors of fall among the aged. Conclusions Comprehensive geriatric assessment carries out comprehensive assessment from multi-angle and multi-dimension which effectively assess the fall risk in the aged comprehensively. Key words: Aged; Comprehensive assessment; Fall risk; Incidence