Introduction
Methods
Study design
Step 1
Step 2
Step 3
Citation and country | Title | Population of participants undergoing CGA | Stakeholders involved in qualitative component | Setting of the CGA | Aim(s) | Methods | Description of the CGA process | Team composition | Specialist training |
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Barkhausen et al. 2015. Germany [40] | “It’s MAGIC”—development of a manageable geriatric assessment for general practice use | Older adults aged ≥ 72 years | General practitioner (n = 20) | OPD in General Practice | To develop a “manageable geriatric assessment – MAGIC”, specially tailored to the requirements of daily primary care | Mixed methods. Qualitative focus groups. Mind-mapping analysis | A brief comprehensive screening tool to facilitate identification of unidentified health problems in primary care amongst multimorbid older people | Not reported | Not reported |
Berkhout‐Byrne et al. 2023. The Netherlands [33] | Nephrology‐tailored geriatric assessment as decision‐making tool in kidney failure | Older people living at home aged ≥ 65 years, with chronic kidney disease stage G4‐G5, or a recent kidney transplantation | Older people (n = 18). Caregivers (n = 4). HCPs (n = 25) | Out-patient clinic in acute hospital setting | To explore the perspectives of patients and healthcare professionals on nephrology‐tailored geriatric assessment to fuel decision‐making for treatment choices in older patients with kidney failure | Qualitative- focus groups | Various methods of multidimensional assessments (e.g., functional, cognitive, psycho‐social, and somatic status) | Nephrologists, geriatricians, nurse practitioners, dialysis nurses, social workers and dieticians | Nephrologist and Geriatrician |
Cravens et al. 2005. United States [38] | Home-based comprehensive assessment of rural elderly persons: the CARE project | Older community residents aged ≥ 75 years | Physicians and nurse practitioners (n = unknown) | In-home | To develop and pilot a model of rural home-based CGA to determine whether successful urban models can be adapted to rural areas | Mixed-methods. Qualitative Interviews. Immersion-crystallization approach to content analysis, | Multidisciplinary CGA led by a remote geriatrician. An in-home comprehensive assessment was completed by a trained nurse which was proactive and goal orientated. The social worker contacted patients remotely for additional information. The MDT held weekly meetings whereby a problem list and recommendations were formed | Geriatrician, nurse, administrator, and a social worker | Two geriatricians involved. The nurse was trained to complete the CGA components by a project geriatrician |
Donaghy et al. 2023. United Kingdom [37] | General practitioner-led adapted comprehensive geriatric assessment for frail older people: a multi-methods evaluation of the ‘Living Well Assessment’ quality improvement project in Scotland | Older people living at home with moderate or severe frailty | General practitioners (n = 10) | In-home and then remotely due to COVID-19 restrictions | (1) To evaluate the impact of the LWA quality improvement project in primary care from the General practitioners’ and patients’ perspectives. (2) To determine whether there was a preference in the methods of delivery of the Living Well Assessment (CGA)(face to face and remote [telephone or video]) | Mixed-methods-survey, interviews and focus groups | One-hour face-to-face assessment led by a General practitioner guided by a checklist. Referrals to other members of the MDT were made if necessary. An MDT meeting was held once a month for complex patients. Home assessments had to be changed to remote (video/telephone due to COVID-19 restrictions) | General practitioner | Participating General practitioners received training on carrying out the assessment from the project lead, who also received training from a practice in Scotland |
Ericsson et al. 2021. Sweden [43] | “To be seen” – older adults and their relatives’ care experiences given by a geriatric mobile team (GerMoT) | Community-dwelling older people aged ≥ 75 years who have had 3 or more visits to the emergency care unit within the past 18 months and have ≥ 3 different diagnoses | Total sample N = 33. Older adults (n = 22) Relatives/caregivers (n = 11) | In-home and OPD in acute hospital | To obtain a better understanding, from the patients’ perspective, the experience of receiving CGA for both the participants and their relatives | Qualitative. Semi-structured qualitative interviews. Inductive qualitative content analysis | Individualised holistic interdisciplinary CGA including future care plan and follow-ups. An initial home visit is carried out by a nurse. A clinical pharmacist carried out a drug review. An out-patient medical assessment is carried out by a physician. Interdisciplinary meetings were held twice weekly where the patient's assessments were discussed and an individualised plan of care was made | Nurses, physicians, a physiotherapist, an occupational therapist, a pharmacist and a social worker | Not reported |
Gardner et al. 2019. United Kingdom [34] | Comprehensive Geriatric Assessment in hospital and hospital-at-home settings: a mixed-methods study | Older people after an acute medical event, who were not severely unwell | Focus groups: Older people (n = 8) Caregivers (n = 3) Relatives (n = 3). Semi-structured interviews: HCPs (n = 11) | In-home | To define and describe the structure, content and delivery of the CGA as practised in hospital and hospital-at-home-based settings, from the perspective of health-care professionals who deliver it and patients and caregivers who experience this type of health care | Mixed-methods. Comparative case study- focus groups with older people, semi-structured interviews with HCP's. Framework approach to comparative analysis | A multidomain medical and therapeutic service provided to patients at home. Medical care and acute nursing was provided for up to 2 weeks, while rehabilitation therapy was available for up to 6 weeks | Hospital at Home 1: geriatricians, nurses with expertise in health care for older people, physiotherapists, occupational therapists, therapy assistants, pharmacists, a social worker and mental health liaison member. Hospital at Home 2: nurses, geriatricians, mental health specialist nurse and a pharmacist | Geriatrician involved |
Ibrahim et al. 2022. United Kingdom [35] | The feasibility and acceptability of assessing and managing sarcopenia and frailty among older people with upper limb fracture | People aged ≥ 65 years with an upper limb fracture attending fracture clinics with sarcopenia and/or frailty | Total sample N = 22. Older people (n = 13) Orthopaedic consultants (n = 2) Nurses (n = 3) Geriatric practitioners (n = 4) | In-home | To evaluate the feasibility of assessing sarcopenia and frailty among people aged 65 + years attending fracture clinics with an upper limb fracture | Mixed-methods. Semi-structured interviews. Inductive thematic analysis | The majority of CGAs were conducted by geriatric. This involved a comprehensive assessment and MDT health and social care management pathway based upon individual assessment findings | Geriatrician and physiotherapist | Geriatrician involved. No other specific training involved |
Junius-Walke et al. 2019. Germany [41] | How older patients prioritise their multiple health problems: a qualitative study | Older people in general practices aged ≥ 70 years |
N = 34 older people
| OPD in General Practice | To explore what underlying reasons patients have when they assess the importance of their health problems | Qualitative. Semi-structured interviews. Content analysis | Multicomponent assessment of health conditions and activities of daily living in the domains of function, social health, medical problems, mood, life-style, immunization, medication, cognition. Patients were presented with their findings after the CGA | Not reported | Not reported |
King et al. 2017. New Zealand [42] | Implementation of a gerontology nurse specialist role in primary health care: Health professional and older adult perspectives | (1) Older adults aged ≥ 75 years who were enrolled in one of the 3 primary healthcare practices at risk of health and functional decline | Total (n = 11). General practitioner 's (n = 3) Nurse (n = 1) Hospital-based gerontological nurse specialist (n = 1) Primary healthcare gerontological nurse specialist (n = 1) Older people aged ≥ 75 years (n = 5) | In-home | To explore the new primary healthcare gerontological nurse specialist role from the perspectives of older people and health professionals | Qualitative. Semi-structured interviews. General descriptive inductive analysis | An in-home comprehensive holistic assessment targeting functional ability, cognitive impairment and depression with care co-ordination procedures was carried out by the Primary healthcare gerontological nurse specialist | Primary healthcare gerontological nurse specialist | The Primary healthcare gerontological nurse specialist received upskilling and mentorship as well as weekly case conferences and education sessions from the hospital-based specialist gerontology team |
Mäkelä et al. 2020. United Kingdom [36] | The work of older people and their informal caregivers in managing an acute health event in a hospital at home or hospital inpatient setting | Older people aged ≥ 65 years who presented to the hospital acute assessment unit | Total sample N = 63. Older people (n = 15 who received hospital at home) Caregivers (n = 12 for patients who received hospital at home) | In-home | To explore the work of patients and caregivers at the time of an acute health event, the interface with health professionals in hospital and Hospital at Home and how their experiences related to the principles that underpin CGA | Qualitative. Semi-structured interviews. Normalisation process theory analysis | Geriatrician-led admission avoidance hospital at home with CGA. This involved provision of healthcare by MDT members including MDT meetings and daily virtual ward rounds and direct access to elements of acute hospital care | Geriatrician, doctors, nurses, physiotherapists and occupational therapists and referral to other services if required | Geriatrician involved |
Rietkerk et al. 2019. Netherlands [30] | Explaining experiences of community-dwelling older adults with a pro-active comprehensive geriatric assessment program—a thorough evaluation by interviews | Home-dwelling frail older people aged ≥ 65 years | Older people (n = 25) | In-home or in OPD in General Practice | To explore and explain experiences of older adults who participated in a pro-active outpatient CGA program | Qualitative. Semi-structured interviews. Thematic analysis and cross-case analysis | The CGA included a multidomain assessment exploring psychological, social or functional needs. Additional allied health professional services were also offered when required. Individualised person-centred goals were devised from assessment findings. Written recommendations were offered to the older people and their general practitioners | Geriatric nurse or geriatric care physician. Other allied health professionals if required | Healthcare providers were trained in motivational interviewing. Geriatric nurse and geriatric care physician involved |
Silverman et al. 1994. United States [39] | Geriatric Assessment: Inisde the black box | Older adults aged 65–90 | Older people (n = 19) (n = 16 accompanied by a family member) HCPs (n = 22) | OPD in acute hospital | (1) To describe the treatment setting by identifying the similarities and differences in the four Geriatric Assessment Units (2) To describe and analyse the responses of providers, patients and family members to the CGA | Qualitative- process evaluation. Interviews. Analysis not clear | Not reported | Geriatrician, a geriatric social worker and a nurse | Geriatrician involved |
Stijnen et al. 2014. Netherlands [31] | Nurse-led home visitation programme to improve health-related quality of life and reduce disability among potentially frail community-dwelling older people in general practice: a theory-based process evaluation | Potentially frail community-dwelling older people aged ≥ 75 years | Practice nurses (n = 13) General practitioners (n = 14) Older people (n = 17) | Home-based CGA | To examine (1) the extent to which the 'Getting OLD the healthy way' home visitation programme was implemented as planned in general practices, and (2) the extent to which general practices successfully redesigned their care delivery | Mixed methods. Semi-structured interviews. General inductive approach and conventional content analysis | A home-based CGA conducted by a practice nurse in collaboration with a General Practitioner and multidisciplinary intervention and follow-up was conducted. More elaborate assessments could be completed if deemed appropriate | Practice nurse and General practitioner | Not clearly reported. Practice nurses completed two-day training session that focused on gaining knowledge and skills to carry out the home visitation programme |
Voorend et al. 2021. The Netherlands [32] | Perspectives and experiences of patients and healthcare professionals with geriatric assessment in chronic kidney disease: a qualitative study | Older adults ≥ 65 years living with end stage kidney disease | Six focus groups, N = 47. Older adults (n = 18) Caregivers (n = 4) Healthcare professionals (n = 25) | (1) out-patient clinic (2) home visit with telephone follow-up and (3) out-patient clinic | To explore perspectives and experiences of patients and professionals with geriatric assessment in the care for older (≥ 65 years) patients approaching end stage kidney disease, and to identify benefits, facilitators and barriers for implementation into routine nephrological care | Qualitative. Semi-structured focus groups. Inductive thematic analysis | (1) a yearly one-hour geriatric assessment in routine care for patients approaching end stage kidney disease performed in a university hospital conducted by a nurse practitioner or practice nurse (2) a three-hour geriatric assessment for patients approaching end stage kidney disease in a study setting conducted by a research nurse (3) a single-time point geriatric assessment among patients starting with or withholding from dialysis conducted by a nurse practitioner | Not reported | Not reported |
Step 4
Step 5
Step 6
Step 7
Patient and Public Involvement (PPI)
Results
Search outcomes
Characteristics of included studies
Quality appraisal
Synthesis
Citation | CGA is experienced as a holistic and personalised process | The home environment enhances CGA | Sufficient time, a proactive approach and interprofessional communication enable CGA in the community | Divergent experiences of the meaningful involvement of older adults, caregivers and family in the CGA process |
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Cravens et al. 2005. [38] | X | X | X | |
Barkhausen et al. 2015. [40] | X | |||
King et al. 2017.[42] | X | X | X | X |
Rietkerk et al. 2019. [30] | X | X | X | |
Stijnen et al. 2014. [31] | X | X | X | X |
Junius-Walke et al. 2019. [41] | X | |||
Ericsson et al. 2021. [43] | X | X | X | X |
Ibrahim et al. 2022. [35] | X | X | ||
Mäkelä et al. 2020. [36] | X | X | X | X |
Gardner et al. 2019. [34] | X | X | X | X |
Voorend et al. 2021. [32] | X | X | X | X |
Silverman et al. 1994. [39] | X | X | X | X |
Donaghy et al. 2023. [37] | X | X | X | X |
Berkhout‐Byrne et al. 2023. [33] | X | X |
CGA is experienced as a holistic process
“Because it has to do with being seen. That you really see the other person as a whole individual. That you are not just that pelvis, or that arm that is broken, or whatever, but that you see the human being. That is the most important thing for me…That you are not just an ailment that needs to be resolved. But that you are seen as a human being” [30].
“In terms of looking at caring for someone at home you have to have that comprehensive overview. You can’t possibly manage someone without knowing as much about them as possible. That obviously isn’t just medical, it is social aspects as well” [34].
“I went to [the ophthalmologist] and then they said “We can’t do anything for you anymore”. After two operations, on both eyes. {} {Then the Sage-atAge nurse advised to go to a vision-aid centre}. {} Then I thought, well, isn’t this something. You go to [the hospital], and they did not know what to do with me.”[30].
“GPs were not used to approaching older people in a proactive way. They usually offer care and/or treatment upon request, whereas PNs are more familiar with delivering preventive care” [31].
The home environment enhances CGA
“You see a lot during a home visit, for example: you observe the interaction between husband and wife, and between parents and concerned children” [32].
“... she has the time to spend with them in their own homes, so they will chat more to her” [42].
“I get the opportunity to enhance and develop their self-management skills which for chronic care conditions is a significant skill that needs to be optimised so that they can manage as well as they can” [42].
“Something that was appreciated was that the examinations could be done at home if the person had difficulty travelling to the clinic. Some persons put forward that it was better to get a home visit because it was sometimes difficult to gather one’s thoughts during a phone call” [43].
“ Aisla’s daughter valued avoiding additional distress from the unfamiliar surroundings of hospital, describing her own strategies for managing when her mother was being treated for delirium at home: “There’s bits where this isn’t her house and then all of a sudden, yeah, it is. . . if you’re here and you get confused that this isn’t the house, then we can talk about familiar things and it’s almost like you’re back in the room again” [36].
CGA in the community is enabled by interdisciplinary collaboration
“Any member of the team may carry out the initial CGA assessment, although specific disciplinary expertise might be drawn upon depending on patient need. A nurse explained it in the following terms: “It is a bit like a jigsaw . . . So we can actually work quite independently as practitioners, the therapy team, Age UK, so we all go off and do our own priorities in our own direction but then bring it back to the team” [34].
“She knew her subjects and knew what she could recommend as good for you. She put me on to several [other services] that were able to help me. I was thoroughly satisfied, I’d be quite happy if she came back” [42].
Divergent experiences of meaningful involvement of older adults, caregivers and family in the CGA process
“A clear explanation of the purpose and outcomes is important for patients” [32].
“Patients appreciated the attention during geriatric assessment for multiple aspects of health and daily functioning. They particularly valued the (extra) time and attention they received from professionals. Consequently, patients were able to share more fears and concerns about treatment choices” [32].
“Barriers for continuing the home visitation programme over time were the lack of an adequate reimbursement by health insurers of the costs of care for older people and the overall time investment of the home visitation programme” [31].
“Lack of continuity had disrupted rapport-building when different team members had come to the home and could be compounded by an approach of ‘being informed’, rather than ‘being included’, within discussions” [34].
“Patients mentioned that they did value discussing personal results and implications, but that in some hospitals feedback on results was lacking. Shortcomings in communication about the purpose in routine care were acknowledged by some professionals ” [32].
“Patients and caregivers did not recognise CGA as a process of assessment and planning that involved them. Family care-givers, even when involved in providing personal care and having daily contact with their relative, perceived they had not been invited to contribute to assessments on acute units, and that their knowledge of cognitive, communicative and physical functioning could have informed decision-making” [36].
“Caregivers striving to support their relative at home had not always felt able to raise the topic or ask about additional assistance if an opportunity for discussion had not been created by professionals within interactions” [34].
“For the clinicians, the families’ involvement can have distinct advantages. Families may be supportive of the treatment plan and help to facilitate it.” [39]
“A key concern raised by caregivers… was insufficient involvement in determining discharge arrangements. … conflicting communication from the team about discharge plans and lack of family involvement had raised anxiety” [34].