Role of comprehensive geriatric assessment in healthcare of older people in UK care homes: realist review

Sousa, Lídia; Chadborn, Neil H; Goodman, Claire; Zubair, Maria; Sousa, Lidia; Gladman, John R F; Dening, Tom; Gordon, Adam, L

Abstract

Objectives
Comprehensive Geriatric Assessment (CGA) may be a way to deliver optimal care for care home residents. We used realist review to develop a theory-driven account of how CGA works in care homes.

Design
Realist review

Setting
Care homes

Methods
The review had three stages: first, interviews with expert stakeholders and scoping of the literature to develop programme theories for CGA ; second, iterative searches with structured retrieval and extraction of the literature; third, synthesis to refine the programme theory of how CGA works in care homes.
We used the following databases: Medline, CINAHL, Scopus, PsychInfo, Pubmed, Google Scholar, Greylit, Cochrane Library, and Joanna Briggs Institute.

Results
130 articles informed a programme theory which suggested CGA had three main components: structured comprehensive assessment, developing a care plan, and working towards patient-centred goals. Each of these required engagement of a multi-disciplinary team (MDT). Most evidence was available around assessment, with tension between structured assessment led by a single professional and less structured assessment involving multiple members of an MDT. Care planning needed to accommodate visiting clinicians and there was evidence that a core MDT often used care-planning as a mechanism to seek external specialist support. Goal-setting processes were not always sufficiently patient-centred and did not always accommodate the views of care home staff. Studies reported improved outcomes from CGA affecting resident satisfaction, prescribing, healthcare resource use and objective measures of quality of care.

Conclusion
The programme theory described here provides a framework for understanding how CGA could be effective in care homes. It will be of use to teams developing, implementing or auditing CGA in care homes. All three components are required to make CGA work – this may explain why attempts to implement CGA by interventions focussed solely on assessment or care planning have failed in some long-term care settings.
Registration details
PROSPERO (PROSPERO 2017:CRD42017062601).

Citation

Sousa, L., Chadborn, N. H., Goodman, C., Zubair, M., Sousa, L., Gladman, J. R. F., Dening, T., & Gordon, A. L. (2019). Role of comprehensive geriatric assessment in healthcare of older people in UK care homes: realist review. BMJ Open, 9(4), 1-9. https://doi.org/10.1136/bmjopen-2018-026921

• Journal Article Type: Article
• Acceptance Date: Feb 14, 2019
• Online Publication Date: Apr 8, 2019
• Publication Date: 2019-04
• Deposit Date: Feb 28, 2019
• Publicly Available Date: Apr 24, 2019
• Journal: BMJ Open
• Electronic ISSN: 2044-6055
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 9
• Issue: 4
• Article Number: e026921
• Pages: 1-9
• DOI: https://doi.org/10.1136/bmjopen-2018-026921
• Keywords: Comprehensive Geriatric Assessment; care homes; older people
• Public URL: https://nottingham-repository.worktribe.com/output/1550109
• Publisher URL: https://bmjopen.bmj.com/content/9/4/e026921
• Contract Date: Feb 28, 2019