There is increasing recognition of the needs of frail older people in health care systems, as they represent a high proportion of those at risk of harms and high resource use. Comprehensive Geriatric Assessment (CGA) has developed over the last 30 years in response to concern that problems experienced by older people were not being recognised or acted upon.
CGA is a problem-solving approach requiring input from a mix of professionals. It involves a multidimensional assessment of a person’s needs, including their living situation and social support, and the development of a plan to address those needs. CGA improves outcomes for frail older people, including survival, cognition, quality of life and reduced length of stay, readmission rates, long term care use and costs.
However, there is continued uncertainty about how to target suitable recipients in a hospital-wide manner, and what the most appropriate and cost-effective form of CGA is for different settings. Therefore, the aim of the Hospital-wide Comprehensive Geriatric Assessment programme is to provide high-quality evidence to support the delivery of CGA on a hospital-wide basis.
Our work at the Nuffield Trust includes analysis to help characterise and identify people who could benefit from CGA, and to identify the costs of providing CGA in hospitals. More specifically:
- to use different methods for identifying people who could benefit from CGA by using routinely collected hospital patient data, including the development and validation of an electronic hospital frailty score
- to quantify the long-term impacts and costs of frailty for individuals and the health service
- to identify the components and costs of providing CGA in hospitals.
Further information on the whole programme is available here.
Our progress to date
January 2018
Report on project findings submitted to the National Institute for Health Research (NIHR) for peer review.
January 2018
'What is comprehensive geriatric assessment (CGA)? An umbrella review'. Parker SG, McCue P, Phelps K, McCleod A, Arora S, Nockels K, Kennedy S, Roberts H, Conroy S. Age Ageing 2018; 47(1):149–155. doi: 10.1093/ageing/afx166. https://www.ncbi.nlm.nih.gov/pubmed/29206906
April 2018
'Development and validation of a Hospital Frailty Risk Score focusing on older people in acute care settings using electronic hospital records: an observational study.' Gilbert T, Neuburger J, Kraindler J, Keeble E, Smith P, Ariti C, Arora S, Street A, Parker S, Roberts HC, Bardsley M and Conroy S. The Lancet. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30668-8/fulltext
September 2018
'Comprehensive geriatric assessment: needs assessment tool'. Nuffield Trust. Fisher E, Keeble E, Kraindler J, https://www.nuffieldtrust.org.uk/research/comprehensive-geriatric-assessment-needs-assessment-tool
April 2019
'Comprehensive geriatric assessment for frail older people in acute hospitals: the HoW-CGA mixed-methods study.' Health Serv Deliv Res 2019;7(15). Conroy S P, Bardsley M, Smith P, Neuburger J, Keeble E, Arora S, Kraindler J, Ariti C, Sherlaw-Johnson C, Street A, Roberts H, Kennedy S, Martin G, Phelps K, Regen E, Kocman D, McCue P, Fisher E & Parker S. https://www.journalslibrary.nihr.ac.uk/hsdr/hsdr07150/#/full-report
This work uses data provided by patients and collected by the NHS as part of their care and support. Read more on our website.