Comprehensive geriatric assessment programmes: Possibilities, realities and outcomes
| Author | Kwang Lim,Briony Dow,Suzanne Hodgkin,Irene Blackberry,Virginia Lewis,Karrie Long,Pauline Savy,Rene Melis,John Furler |
| DOI | 10.1177/1035719X19876153 |
| Date | 01 September 2019 |
| Published date | 01 September 2019 |
| Subject Matter | Academic Article |
https://doi.org/10.1177/1035719X19876153
Evaluation Journal of Australasia
2019, Vol. 19(3) 115 –133
© The Author(s) 2019
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DOI: 10.1177/1035719X19876153
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Comprehensive geriatric
assessment programmes:
Possibilities, realities and
outcomes
Pauline Savy
Suzanne Hodgkin
La Trobe University, Australia
Karrie Long
Melbourne Health, Australia
Rene Melis
Radboud University Medical Center, The Netherlands
Virginia Lewis
La Trobe University, Australia
John Furler
The University of Melbourne, Australia
Kwang Lim
The Royal Melbourne Hospital, Australia
Briony Dow
The University of Melbourne, Australia
Irene Blackberry
La Trobe University, Australia
Corresponding author:
Suzanne Hodgkin, John Richards Centre for Rural Ageing Research, La Trobe Rural Health School, La
Trobe University, PO Box 821, Wodonga, VIC 3689, Australia.
Email: s.hodgkin@latrobe.edu.au
876153EVJ0010.1177/1035719X19876153Evaluation Journal of AustralasiaSavy et al.
research-article2019
Academic Article
116 Evaluation Journal of Australasia 19(3)
Abstract
Interventions based on comprehensive geriatric assessment (CGA) have been
implemented in many countries. These interventions, based on the premise that
such assessment will delay individual decline and reduce demand on medical and
institutional care, generally result in equivocal or modest outcomes. This article
presents findings from a critical realist review of a sample of reported interventions
to offer insights into the macro- and micro-factors that affect the implementation
and outcomes of CGA-based endeavours. The findings hold particular relevance for
informing Australian policy which provides for annual, clinical assessment of people
above the age of 75.
Keywords
75+ health assessment, ageing populations, comprehensive geriatric assessment,
critical realist reviews, primary health care
Introduction
This article problematises the implementation and evaluation of primary health inter-
ventions based on comprehensive geriatric assessment (CGA). It does this through a
review of a sample of published reports which describe international interventions and
through the use of critical realist review (CRR) methodology to highlight the critical
elements that bear on programme outcomes. Over several decades, a variety of inter-
ventions have been trialled with the paired aims of supporting elders to live indepen-
dently and to reduce demand on acute health and long-term care services. These
interventions are based on CGA which involves the administration of a range of tools
by several kinds of health professionals. This multidisciplinary assessment provides
holistic information about physical, social, psychological and environmental condi-
tions that may support or jeopardise independent living. The CGA initially targeted
frail and vulnerable elders admitted to hospital; however, over the past two decades,
its focus has extended to community-dwelling older people and to the implementation
of preventive care and programmes across various settings (Welsh, Gordon, &
Gladman, 2014). This focus aligns with policy and service philosophies such as
Ageing-in-Place, Person Centred Care and Consumer Directed Care.
Internationally, the benefits of CGA-based interventions conducted with commu-
nity-dwelling older people are difficult to compare and discern. While such interven-
tions generally share similar aims, they employ different assessment tools,
methodologies, implementation processes and measurement tools, and significantly,
they are delivered within distinct health care contexts, systems and to culturally differ-
ent populations (Metzelthin et al., 2013b). Regardless of contextual differences, and
even when interventions are well designed and monitored, only modest results are
reported (Fletcher et al., 2004; Parsons et al., 2012). Few published studies show sig-
nificant effect on disability, progression of frailty, hospitalisation, aged-care admis-
sions and mortality, and most do not report long-term effects (Metzelthin et al., 2013b).
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