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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

Authors

Lídia Sousa

NEIL CHADBORN Neil.Chadborn@nottingham.ac.uk
Problem Based Learning Facilitator

Claire Goodman

Maria Zubair

Lidia Sousa

JOHN GLADMAN john.gladman@nottingham.ac.uk
Professor of Medicine of Older People

TOM DENING Tom.Dening@nottingham.ac.uk
Clinical Professor in Dementia Research

ADAM GORDON Adam.Gordon@nottingham.ac.uk
Professor of The Care of Older People



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., …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