Comprehensive geriatric assessment in older people: an umbrella review of health outcomes
Authors: Veronese Nicola , Custodero Carlo , Demurtas Jacopo , Smith Lee , Barbagallo Mario , Maggi Stefania , Cella Alberto , Vanacore Nicola , Aprile Pierangelo Lora , Ferrucci Luigi , Pilotto Alberto ,   The Special Interest Group in Systematic Reviews of the European Geriatric Medicine Society (EuGMS), Alberto Pilotto , Maria Cristina Polidori , Alves Mariana , Benzinger Petra , Berg Nicolas , Brach Julie , Cardoso Irwin , Cella Alberto , Chefi Ben , Ciurea Annette , Cornejo Lingan Ana Maria , Cotobal Rodeles Santiago , Cruz-Jentoft Alfonso , Curiale Vito , Custodero Carlo , Danielova Libuse , Davies Franco , De Groot Aafke , De Groot Cathrine , De Lepeleire Jan , De Vries Benjamin , Decock Anne-marie , Denkinger Michael , Dikmeer Ayse , Dini Simone , Durand Amaury , Fatin Ami , Fernandes Marilia , Ferrara Nicola , Francis Bahaa , Fratiglioni Laura , Freiberger Ellen , Galvin Rose , Garmendia Blanca , Gillain Sophie , Gomez Pavon Javier , Goudzwaard J.A. , Greco Antonio , Gruner Heidi , Gunther Bernd , Happe Lisa , Hermush Vered , Huibregtse Bimmel Jan-Kees , Indiano Ilaria , Isaak Julia , Jaramillo Javier , Kerminen Hanna , Laocha Aoife Ni , Lau Sandra , Lozano Isabel , Madeira Sarmento Ana Teresa , Mangoni Arduino , Marques da Silva Pedro , Mars Patricia , Matejovska-Kubesova Hana , Mattace Raso Francesco , Moeskops Simone , Molnar Andrea , Musacchio Clarissa , Nagaratnam Kiruba , Nieminen Uomo , O’Connor Margaret , Özge Kayhan Koçak Fatma , Paccalin Marc , Palikhe Anil , Pavic Tajana , Per Nordnes Raymond , Platon Izabela , Polinder Harmke , Prada Gabriel , Ragnheim Ragnhild , Ramsawak Lisa , Rewiuk Krzysztof , Rodrigues Carlos , Roller-Wirnsberger Regina , Rossinen Juhani , Ruotolo Giovanni , Ruppe Georg , Ryan Dan , Sabba Carlo , Sanchez Elisabet , Savas Sumru , Schmid Veronika , Schroderus Kaisa , Siegrist Monica , Smedberg Daniel , Smit Orla , Soulis George , Tampaki Maria , Tenkattelaar Natasia , Thiem Ulrich , Topinkova Eva , Tromp Jorien , Van Beek Michiel , Van Heijningen Lars , Vandeelen Bob , Vanderhulst Heleen , Vankova Hana , Verissimo Rafaela , Vonk Merel , Vrabie Calin , Wearing Paul , Weiss Michael , Welmer Anna-Karin , Werle Berenice , Ylmaz Ozlem , Shoaib Muhammad Zaidi , Zamfir Mihaela , Zanom Ilo , Zuidhof Jen ,   The Special Interest Group in Meta-analyses and Comprehensive Geriatric Assessment of the European Geriatric Medicine Society (EuGMS), Nicola Veronese , Lee Smith , Alves Mariana , Avcy Suna , Bahat-Ozturk Gulistan , Balci Cafer , Beaudart Charlotte , Bruyère Olivier , Cherubini Antonio , Da Cruz Alves Mariana , Firth Joseph , Goisser Sabine , Hursitoglu Mehmet , Hurst Christopher , Kemmler Wolfgang , Kiesswetter Eva , Kotsani Marina , Koyanagi Ai , Locquet Médéa , Marengoni Alessandra , Nida Mahwish , Obretin Florian Alexandru , O’Hanlon Shane , Okpe Andrew , Pedone Claudio , Petrovic Mirko , Pizzol Damiano , Prokopidis Konstantinos , Rempe Hanna , Sanchez Rodrigues Dolores , Schoene Daniel , Schwingshackl Lukas , Shenkin Susan , Solmi Marco , Soysal Pinar , Stubbs Brendon , Thompson Trevor , Torbahn Gabriel , Unim Brigid 
Published: April 2022

Abstract

Background
Comprehensive geriatric assessment (CGA) has been in use for the last three decades. However, some doubts remain regarding its clinical use. Therefore, we aimed to capture the breadth of outcomes reported and assess the strength of evidence of the use of comprehensive geriatric assessment (CGA) for health outcomes in older persons.

Methods
Umbrella review of systematic reviews of the use of CGA in older adults searching in Pubmed, Embase, Scopus, Cochrane library and CINHAL until 05 November 2021. All possible health outcomes were eligible. Two independent reviewers extracted key data. The grading of evidence was carried out using the GRADE for intervention studies, whilst data regarding systematic reviews were reported as narrative findings.

Results
Among 1,683 papers, 31 systematic reviews (19 with meta-analysis) were considered, including 279,744 subjects. Overall, 13/53 outcomes were statistically significant (P &lt; 0.05). There was high certainty of evidence that CGA reduces nursing home admission (risk ratio [RR] = 0.86; 95% confidence interval [CI]: 0.75–0.89), risk of falls (RR = 0.51; 95%CI: 0.29–0.89), and pressure sores (RR = 0.46; 95%CI: 0.24–0.89) in hospital medical setting; decreases the risk of delirium (OR = 0.71; 95%CI: 0.54–0.92) in hip fracture; decreases the risk of physical frailty in community-dwelling older adults (RR = 0.77; 95%CI: 0.64–0.93). Systematic reviews without meta-analysis indicate that CGA improves clinical outcomes in oncology, haematology, and in emergency department.

Conclusions
CGA seems to be beneficial in the hospital medical setting for multiple health outcomes, with a high certainty of evidence. The evidence of benefits is less strong for the use of CGA in other settings.