PRESERVING INDEPENDENCE - THE EFFECTIVENE SS OF COMPREHENSIVE GERIATRIC ASSESSMENT

Comprehensive geriatric assessment (CGA) is defined as the process of determining an elderly person's medical, psychosocial, functional, and environmental resources and problems, linked with an overall plan for treatment and followup, The principles of geriatric assessment, inclu ding the advantages and disadvantages of using quantitative instrument s for multidimensional evaluation, are reviewed. The findings of a rec ently published meta-analysis on comprehensive geriatric assessment ar e discussed and its policy implications addressed. The meta-analysis i ncludes data of 28 controlled trials comprising 4959 subjects allocate d to one of five CGA types, and 4912 control subjects. Original invest igators provided additional unpublished data from published reports to supplement the data base of this meta-analysis. The combined odds rat ios of outcomes in CGA-assessed patients versus control patients were obtained by pooling data from individual trials with a multivariate lo gistic regression approach. The combined odds ratio (95% confidence in terval) of home survival at 1 to 4-year follow-up was 1.7 (1.2-2.3) fo r inpatient geriatric evaluation and management units, 1.5 (1.1-2.0) f or post-discharge home assessment services, and 1.2 (1.1-1.4) for prev entive in-home assessment services. Based on these research findings, the establishment of interdisciplinary units with staff trained in mul tidimensional geriatric assessment for inpatient evaluation and manage ment of frail elderly patients, is recommended. In addition, research to improve geriatric assessment technology and promote its integration into primary care has a great potential for disability prevention and nursing home use reduction in older persons.