Table 3 Summary of quantitative health outcomes (n = 37)
Reference, Country | Design, Length of follow up, Setting | Comprehensive geriatric assessment (CGA) | Quantitative health outcomes | |
|---|---|---|---|---|
Conducted at, conducted by | Components | |||
Avlund et al. 2002 [31] Denmark Quality: Poor | RCT, 3 months 32 persons aged > 70 years at the medical wards. | At home Conducted by: General practitioner, home nurse, home helper, physiotherapist, and/or occupational therapist. | Health and medical problems. | Functional status (mean Barthel Index): ↑ |
Ballabio et al. 2008 [32] Italy Quality: Fair | Pre-post, 3 months 222 persons aged ≥75 years who were discharged from the emergency department. | Outpatient geriatric unit. Conducted by: Geriatrician, nurse and social worker. | Physical status, functional status, cognitive status, depression, cognitive dysfunction, caregiver stress, perceived QoL. | Functional status (ADLs, IADLS): > = < Quality of life (EuroQoL Analogic section): ↑ Mental health (Cornell scale and GDS): ↑ Cognition: All patients: > = < Among those with cognitive dysfunction): ↑ Chronic conditions (cumulative illness rating scale): > = < Nutritional status (MNAS): ↑ |
Bleijenberg et al. 2017 [33] Switzerland and Netherlands Quality: Fair | Pooled analysis of 2 RCTs, 9 months and 12 months. 461 persons aged ≥80 years, whereby 230 from UPROFIT had multimorbidity, polypharmacy and care gap in primary care of ≥3 years, and 231 from HCP were from healthcare organisations, local hospitals and social services. | At home and primary care Conducted by: Advance practice registered nurses. | Clinical assessment of health and family situation, symptoms of illness, frailty and falls, urinary incontinence, cognition, loneliness. | Functional status: ↑ |
Blom et al. 2016 [34] Netherlands | RCT, 1 year 59 practices with 7278 participants aged ≥75 years | General practice Conducted by: General practitioner or practice nurse. | Functional, somatic (health and illness), mental, and social Each domain contained 4–9 questions. | Functional status (BADLs and IADLs via GARS): > = < Quality of life (Cantril’s ladder): > = < Mental health (GDS-15, Loneliness scale of DJG): > = < |
Boult et al. 2001 [35] United States Quality: Good | RCT, 18 months 568 persons aged ≥70 years at a high risk of poor functional ability and high use of health services. | At an outpatient geriatric evaluation and management clinic (ambulatory clinic) in a community hospital. Conducted by: General nurse practitioner, geriatrician, and nurse. | Medical conditions, psychosocial status, functional ability, cognitive status, nutritional risk, use of alcohol, social network, gait and balance, environmental safety, medications, advance directives, hearing, vision. | Functional status: ↑ Mental health (GDS): ↑ Mortality rate: > = < |
Boult et al. 2013 [36] United States Quality: Good | RCT, 32 months 904 persons aged ≥65 years t high risk of using health services heavily during the following year, as estimated by the claims based hierarchical condition category (HCC) predictive model. | At home Conducted by: registered nurses with at least 3 years of clinical experience and who took a Guided Care preparatory course. | Not specified, but comprehensive assessments were conducted with individualised action plans designed. | Quality of life (physical and mental scores): > = < Mortality rate: > = < Self-rated health status: > = < |
Bouman et al. 2008 [37] Netherlands Quality: Good | RCT, 18 months 293 persons aged 70 to 84 years who lives at home and has poor health status. | At home Conducted by: Home nurses (auxiliary community nurses) under the supervision of public health nurses (community nurses). | Health problems and risks. | Functional status (ADLs): > = < Quality of life: > = < Self-rated health status: > = < |
Burns et al. 2000 [38] United States Quality: Fair | RCT, 2 years 128 persons aged ≥65 years with ADL deficits, chronic conditions, acute care hospitalisations in previous year, and on scheduled prescriptions. | Geriatric primary care Conducted by: Interdisciplinary care team. | Health status including mortality, global health perception, clinic visits and hospitalisations, functional status, global social activity, quality of life, life satisfaction, and cognition. | Functional status (IADL impairments, ADL scores): > = < Mortality rate: > = < Mental health (CES-D, well-being, life satisfaction): ↑ Health status (health perception): ↑ Cognition (MMSE): ↑ |
Byles et al. 2004 [39] Australia Quality: Good | RCT, 3 years 1082 veterans or war widows receiving full entitlements from the Australian Department of Veterans’ Affairs, and aged ≥70 years. | At home Conducted by: Nurses, social workers, psychologists, physiotherapists, and/or occupational therapists. | Use of hearing aids, vision, dental care and dentures, vaccinations, prescribed and over-the-counter medications, hypertension management, diabetes management, smoking status and desire to quit, BMI, problems with feet, problems with leaking urine, self-rated health, difficulty sleeping, use of community services, ANISIC, Medical Outcomes Study physical function scale (items to assess mobility), brief MMSE, Duke Social Support Index, Modified GDS. | Quality of life (physical and mental component summary scores): ↑ Mortality rate: > = < |
Chi et al. 2006 [40] Hong Kong Quality: Poor | RCT, 12 months 925 older Chinese adults aged ≥65 years who attend the elderly health centres of the department of Health, Hong Kong special Administrative Region. | At the elderly health centre Conducted by: Trained interviewers. | General functioning, cognitive function, social support, physical functioning, physical illnesses, living environment, formal service utilisation, medication. | Functional status (ADLs, IADLs, stamina): > = < Mental health (mood, behaviour): ↑ Cognition: > = <. Chronic conditions: Pain symptoms, pressure ulcer, bladder incontinence: > = < Bowel incontinence: ↓ |
Cohen et al. 2002 [41] United States Quality: Good | RCT, 1 year 1388 persons aged ≥65 years who were hospitalised on a medical or surgical ward, had length of stay of at least two days, and frailty. | Outpatient geriatric evaluation and management Conducted by: Geriatrician, social worker, and nurse. | Medical history and physical examination, functional, cognitive, affective, and nutritional status, caregiver’s capabilities, patient’s social situation, and geriatric syndromes such as incontinence or falls. | Functional status (BADLs, IADLs, physical performance): > = < Quality of life SF-36 scores for physical functioning, physical limitations, emotional limitations, and social activity, bodily pain: > = < SF-36 scores for energy, general health and mental health: ↑ Mortality rate: > = < |
Eckerbald et al. 2016 Sweden Quality: Fair | RCT, 24 months 242 persons aged ≥75 years with 3 or more concomitant medical diagnoses and 3 or more hospitalisations during the preceding year. | At home Conducted by: Trained registered nurses or a registered occupational therapist. | Medical, psychological, functional. | Chronic conditions (MSAS): > = < |
Ekdahl et al. 2015 [42] Sweden Quality: Good | RCT, 24 months 382 persons (208 intervention, 174 controls) aged ≥75 years who received inpatient hospital care 3 or more times in the previous 12 months and had 3 or more concomitant medical diagnoses. | At home Conducted by: Registered nurse and registered occupational therapist. | Hearing and vision problems, independence in ADLs, cognition, sense of security in care, health-related quality of life | Quality of life (HR-QoL): > = < Mortality rate: > = < |
Ekdahl et al. 2016 [43] Sweden Quality: Good | RCT, 36 months 382 persons (208 intervention, 174 controls) aged ≥75 years who received inpatient hospital care 3 or more times in the previous 12 months and had 3 or more concomitant medical diagnoses. | At home Conducted by: Registered nurse and registered occupational therapist. | Hearing and vision problems, independence in ADLs, cognition, sense of security in care, health-related quality of life | Mortality rate: ↑ (= improved = decreased mortality) |
Faul et al. 2009 [44] United States Quality: Fair | Pre-post, 12 weeks 73 persons aged ≥65 years with chronic conditions and no ongoing home health care. | At home Conducted by: Physical therapist, physical therapist student, social worker student. | Cognition, functional status, physical mobility, mental health, physical home environment, chronic diseases, self-management, self-rated health. | Functional status (function and physical mobility): ↑ Falls (physical home environment and falls hazards) ↑ Mental health (GDS): ↑ Self-rated health status: ↑ Chronic conditions (self-efficacy for chronic disease management) > =< |
Fenton et al. 2006 [45] United States Quality: Good | Case control, 20 months 583 persons (146 cases, 437 controls) aged ≥65 years who attended the 2 physician practices in the study and enrolled into the health plan from 2 years before their index visit with the geriatrician until either death or the end of the study. | Primary care practice Conducted by: Fellowship-trained geriatrician. | (1) standardized assessment of psychosocial, cognitive, and physical function and physical activity (2); screening for pain, depression, dementia, urinary incontinence, fall risk, and substance abuse (3); review for use of medications with frequent adverse side effects in elderly patients; and (4) focused physical examination. | Mortality rate: > = < Medications (rate of high-risk prescriptions): > = < |
Fletcher et al. 2004 [19] United Kingdom Quality: Good | RCT, 3 years 8797 persons aged ≥75 years from the general population. | At home Conducted by: Nurse. | Cognition, mental health, functional, physiological, social | Quality of life (mobility, social interaction and morale compared): ↑ Mortality rate: > = < |
Godwin et al. 2016 [13] Canada Quality: Poor | RCT, 12 months 143 persons aged ≥80 years functioning well cognitively and living independently in the community. | At home Conducted by: Primary Care Nurse Specialist | ADLs and IADL, symptomatology, medication usage, compliance and knowledge by medication review, safety issues, including risk of falls, use of stoves and other potentially dangerous appliance, general home and personal hygiene and maintenance, understanding of their medical/health conditions to determine their need for education, and need for community services. | Quality of life (SF-36, CASP-19): > = < Chronic disease (symptomology using the Comorbidity Symptom Scale): > = < |
Hebert et al. 2001 Canada Quality: Good | RCT, 1 year 494 persons on the Quebec Home Insurance Plan aged ≥75 years | At home Conducted by: Trained nurse. | Medication, cognitive function, depression, balance or risk of falling, orthostatic hypotension, environmental risks, social support, nutrition, arterial hypertension, vision, hearing, incontinence. | Functional status (SMAF, relative risk of functional decline): > = < Mental health (DGWBS on anxiety, depression, positive well-being, self-control, vitality, and general health): > = < |
Hoogendijk et al. 2016 [46] Netherlands Quality: Good | RCT, 24 months 1147 patients across 35 primary care practices, aged ≥65 years, and had a PRISMA-7 score of 3 or more. | At home Conducted by: Practice care nurse | Identification of care needs and health risks, including preventive health, Cardio-respiratory conditions, health promotion, depression and anxiety, urinary incontinence, pain, social functioning, falls, tobacco and alcohol use, medication management. | Functional status (ADL, IADL): > = < Quality of life (SF-12, EQ-5D): > = < Mental health (psychological well-being via 5-item RAND-36 mental health subscale): ↑ Self-rated health status: > = < |
Imhof et al. 2012 [47] Switzerland Quality: Fair | RCT, 9 months 413 persons aged ≥80 years who are german-speaking. | At home Conducted by: Advanced practice nurse. | Demographic variables, living situation, family network, and health status (mobility and falls, pain, vision and hearing ability, sleep pattern, bladder control, nutritional status, substance use, cognition, and use of medications and aides for mobility). Clinical tests were included for vision (Amsler-Gitter Test), gait, balance, and strength, tandem stand, timed five-chair-rise test, and screening for malnutrition (Mini Nutritional Assessment), and depression (GDS-4). | Quality of life: > = < Frailty/falls: ↑ (lower relative risk of falls and consequences of falls) Acute adverse events: ↑ (lower relative risk of acute events, defined as acute health symptoms that required action) |
Kang et al. 2020 [48] South Korea Quality: Fair | Pre-post, mean of 5.1 months 362 persons aged ≥65 years who regularly visited primary medical institutions at the regions where study was conducted. | Outpatient medical centre and public health centre Conducted by: Trained nurses | Comorbidity, physical function, cognitive function, quality of life, drugs, and nutrition. | Functional status (physical function, gait speed, grip strength): ↑ Quality of life (ED-5D): ↓ Polypharmacy: ↑ (decreased proportion with polypharmacy). Nutrition (MNA): ↑ (decreased risk of malnutrition or being malnourished). |
King et al. 2018 [49] New Zealand Quality: Fair | Controlled before-after study, 1 year before and after intervention 1400 persons aged ≥75 years enrolled in one of the primary healthcare practices that will implement the new care model. | At home Conducted by: Specialist Gerontology Nurse. | Body systems (respiratory, cardiac, neurological, gastrointestinal, musculoskeletal and bladder/bowel function), pain, medications, potential social issues, functional ability, cognitive impairment, depression. | Mortality rate: > = < |
Li et al. 2010 [50] Taiwan Quality: Fair | RCT, 6 months 310 persons aged ≥65 years living in neighbourhoods within 15 min walking distance from the community hospital. | Community hospital on an outpatient basis Conducted by: Nurses. | Geriatric syndromes (falls, incontinence, polypharmacy, sleep disturbance, nutrition, pain); cognition; depression; nutrition; functional (visual acuity); physical; orthostatic hypotension screening. | Functional status (Barthel Index): > = < Frailty (likelihood to have a better outcome and likelihood to deteriorate in frailty status measured with FFC): > = < |
Liimatta et al. 2019 [51] Finland Quality: Fair | RCT, 2 years 422 persons aged ≥75 years not receiving home help or nursing services. | At home. Conducted by: Nurse, physiotherapist, social worker. | Functioning, Mental Capability, health status, health and social services present, mobility, strength, ADLs, IADLs, financial and other social service needs. | Quality of life (15-dimensioanl assessment scale): ↑ Mortality rate: > = < |
Lin et al. 2012 [52] Taiwan Quality: Fair | Pre-post, 12 months Total of 140 persons aged ≥80 years with any health conditions, and aged ≥65 years with multiple complex care needs, or more than 3 co-morbid chronic diseases, or with geriatric syndrome. | Outpatient geriatric evaluation and management service in Taipei Veterans General, a tertiary medical centre. Conducted by: Research nurses | Physical Function, IADLs, cognitive function, mood status, delirium, falls, incontinence nutritional status, QoL, social care resource. | Quality of life: ↑ (QoL gained from the service model was estimated to be 4.1 QALY) Polypharmacy: ↑ (reduction in no. long-term medications) |
Mazya et al. 2019 [53] Sweden Quality: Good | RCT, 24 months 360 persons aged ≥75 years with 3 or more chronic conditions and 3 or more inpatient admissions the past 12 months. | At home and via phone Conducted by: Nurse and social worker (home), pharmacist (phone). | Medical, functional, psychological, cognitive, social. | Mortality rate: > = < Frailty: ↑ (intervention group had lower proportion of frail patients, higher proportion of pre-frail patients) |
Monteserin et al. 2010 [54] Spain Quality: Good | RCT, 18 months 620 persons aged ≥75 years who has access to primary care health centre. | Primary care health centre Conducted by: Nurse. | Socio-demographics, perceived health status, sensory evaluation (sight and hearing), falls, urinary incontinence, prescribed medications, comorbidity, functional status, IADL, neuropsychological status, cognitive status, nutritional status and social support. | Mortality rate: > = < Frailty: ↑ (intervention group had proportion of frail patients who went from not at risk for frailty to at risk for frailty, greater proportion who reserved frailty status) |
Ploeg et al. 2010 [55] Canada Quality: Good | RCT, 12 months 719 persons aged ≥75 years at risk of functional decline. | At home Conducted by: Nurse. | QoL, health status, costs of health and social services, functional status, self-rated health. | Functional status (ADLs): > = < Quality of life (QALY): > = < Self-rated health status: > = < |
Romskaug et al. 2020 [56] Norway Quality: Good | RCT, 24 weeks 158 persons aged ≥70 years who used at least 7 systemic medications taken regularly, and had their medications administered by the home nursing service. | Primary care practice Conducted by: Physician trained in geriatric medicine, supervised by a senior consultant. | Medical history, systematic screening for current problems, clinical examination of the patient, relevant supplementary test, and detailed review of each medication in use, with emphasis on indication, dosage, possible adverse effects, and interactions. | Functional status (functional independence measure): > = < Quality of life: > = < Falls (number of falls): > = < Mortality rate: > = < Mental health (relative stress, the number of days the patient spent in his or her own home during follow-up): > = < Chronic conditions: Orthostatic blood pressure, weight): > = < Medication appropriateness (assessed by the Medication Appropriateness Index and the Assessment of Underutilization): ↑ |
Rubenstein et al. 2007 [57] United States Quality: Good | RCT, 3 years 532 persons aged ≥65 years who had at least one clinic visit at the ambulatory centre in the previous 18 months and deemed high risk (impaired in 4 or more of 10 Geriatric Postal Screening Survey questions). | Over the phone and at a geriatric assessment clinic Conducted by: Physician assistant case manager (phone), and geriatric medicine faculty, physician assistant, and internal medicine house staff (at clinic). | Physical health, functional status, mental health, social and environmental status. | Functional status (ADLs, IADLs): > = < Falls (prevalence or severity of falls): > = < Chronic conditions (prevalence or severity of urinary incontinence): > = < Mental health: > = < Self-rated health status: > = < |
Stuck et al. 2000 [58] Switzerland Quality: Good | RCT, 3 years 791 persons aged ≥75 years in the health insurance list of community-dwelling residents in three zip code areas of Bern, and categorised as high-risk and low-risk for nursing home admission. | At home Conducted by: 3 certified registered nurses with an additional degree in public health nursing based on an 8-month postgraduate course (Nurse A, B, C) | Medical history, physical examination, haematocrit and glucose levels in blood, hearing, vision, nutritional status, oral health, appropriateness of medication use, safety in the home, ease of access to external environment, social support. | Functional status: Among low-risk subjects: ↑ Among high-risk subjects: > = < Among low-risk subjects visited by nurse A and nurse B: ↑ |
Suijker et al. 2016 [20] Netherlands Quality: Good | RCT, 24 months 2283 persons aged ≥70 years with complex care needs. | At home Conducted by: Community-care registered nurse. | Somatic, psychological, functional, and social. | Functional status (Katz-ADL index scores): > = < Quality of life (HR-QoL, emotional well-being, self-perceived QoL): > = < Mortality: > = < Falls (number of falls): > = < |
Suijker et al. 2017 [59] Netherlands Quality: Good | RCT, 12 months 2283 persons aged ≥70 years with complex care needs. | At home Conducted by: Community-care registered nurse. | Somatic, psychological, functional, and social. | Functional status (Katz-ADL index scores): > = < Quality of life (QALY): > = < |
van Hout et al. 2010 [60] Netherlands Quality: Good | RCT, 18 months 424 persons aged ≥75 years with frailty. | At home Conducted by: Trained community nurse. | Health risks and care needs using the Resident Assessment Instrument–Home Care version (RAI-HC). | Functional status (ADLs, IADLs): > = < Mortality rate: > = < |
van Leeuwen et al. 2015 [61] Netherlands Quality: Fair | RCT, 24 months 1147 frail older adults aged ≥65 years with PRISMA-7 scores of 3 or more. | At home Conducted by: Registered nurses with experience in geriatric nursing. | Health and care needs identified from the web-based Community Health Assessment version 9.1 of the Resident Assessment Instrument. | Functional status (ADLs, IADLs: > = < Quality of life (SF-12 physical and mental scales): > = < |