Can comprehensive geriatric assessment be delivered without the need for geriatricians? A formative evaluation in two perioperative surgical settings
David Kocman,Emma Regen,Kay Phelps,Graham Martin,Stuart G Parker,Thomas Gilbert,Simon Conroy +6 more
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TLDR
Clinical toolkits designed to empower non-geriatric teams to deliver CGA were received with initial enthusiasm, but did not fully achieve their stated aims due to the need for an extended period of service development with geriatrician support, competing priorities, and divergent views about appropriate professional domains.Abstract:
Introduction the aim of this study was to design an approach to improving care for frail older patients in hospital services where comprehensive geriatric assessment (CGA) was not part of the clinical tradition. Methods the intervention was based on the principles of CGA, using quality improvement methodology to embed care processes. Qualitative methods and coproduction were used to inform development of the intervention, which was directed towards the health care professionals involved in peri-operative/surgical cancer care pathways in two large UK teaching hospitals. A formative, qualitative evaluation was undertaken; data collection and analysis were guided by normalisation process theory. Results the clinicians involved agreed to use the toolkit, identifying potential benefits including improved surgical decision making and delivery of interventions pre-operatively. However, sites concluded that pre-operative assessment was not the best place for CGA, and at the end of the 12-month trial, implementation was still nascent. Efforts competed against the dominance of national time-limited targets, and concerns relating to patients' immediate treatment and recovery. Some participants involved in the peri-operative pathway felt that CGA required ongoing specialist input from geriatricians, but it was not clear that this was sustainable. Conclusions clinical toolkits designed to empower non-geriatric teams to deliver CGA were received with initial enthusiasm, but did not fully achieve their stated aims due to the need for an extended period of service development with geriatrician support, competing priorities, and divergent views about appropriate professional domains.read more
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Clinical Effectiveness of the Elder-Friendly Approaches to the Surgical Environment Initiative in Emergency General Surgery
Rachel G. Khadaroo,Lindsey M. Warkentin,Adrian Wagg,Raj Padwal,Fiona Clement,Xiaoming Wang,William D. Buie,Jayna Holroyd-Leduc +7 more
TL;DR: The findings suggest the clinical effectiveness of a novel elder-friendly surgical care delivery redesign by reducing major complications or death, decreasing hospital stays, and returning patients to their home residence.
Journal ArticleDOI
Comprehensive geriatric assessment for frail older people in acute hospitals: the HoW-CGA mixed-methods study
Simon Conroy,Martin Bardsley,Paul Smith,Jenny Neuburger,Eilís Keeble,Sandeepa Arora,Joshua Kraindler,Cono Ariti,Chris Sherlaw-Johnson,Andrew Street,Helen C. Roberts,Sheila Suess Kennedy,Graham Martin,Kay Phelps,Emma Regen,David Kocman,P. McCue,Elizabeth Fisher,Stuart G Parker +18 more
TL;DR: CGA remains the gold standard approach to improving a range of outcomes for older people in acute hospitals and has moderate agreement with the Fried and Rockwood scales.
Journal ArticleDOI
Impact of geriatric co-management programmes on outcomes in older surgical patients: update of recent evidence
Bastiaan Van Grootven,Bastiaan Van Grootven,Daniel A. Mendelson,Mieke Deschodt,Mieke Deschodt +4 more
TL;DR: There was a shorter length of stay, less mortality and a lower readmission rate in older patients undergoing a surgical procedure, however, there was uncertainty whether the results are clinically relevant and the grade of evidence was low.
Journal ArticleDOI
Comprehensive Geriatric Assessment in the perioperative setting; where next?
TL;DR: In order to demonstrate the effectiveness of perioperative CGA services, implementation science should be combined with health services research methodology and the use of big data through linked national audit.
Journal ArticleDOI
Biomarkers of aging in real life: three questions on aging and the comprehensive geriatric assessment
Marta Zampino,M. Cristina Polidori,Luigi Ferrucci,Desmond O'Neill,Alberto Pilotto,Manfred Gogol,Laurence Z. Rubenstein +6 more
TL;DR: In this article , the benefits of employing the multidimensional prognostic index (MPI), which collects information about eight domains relevant for the global assessment of the older person (functional and cognitive status, nutrition, mobility and risk of pressure sores, multi-morbidity, polypharmacy, and co-habitation), in the evaluation of the functional status, and in the prediction of health outcomes for older adults.
References
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TL;DR: K Kathy Charmaz's excellent and practical guide to grounded theory in nursing and how to do qualitative research in nursing is welcomed.
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Developing and evaluating complex interventions: The new Medical Research Council guidance
TL;DR: The Medical Research Council's evaluation framework (2000) brought welcome clarity to the task and now the council has updated its guidance.
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The effect of emergency department crowding on clinically oriented outcomes
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Normalisation process theory: A framework for developing, evaluating and implementing complex interventions
Elizabeth Murray,Shaun Treweek,Catherine Pope,Anne MacFarlane,Luciana Ballini,Christopher Dowrick,Tracy Finch,Anne Kennedy,Frances S. Mair,Catherine A. O'Donnell,Bie Nio Ong,Tim Rapley,Anne Rogers,Carl May +13 more
TL;DR: It is suggested that the NPT can act as a sensitising tool, enabling researchers to think through issues of implementation while designing a complex intervention and its evaluation, and may improve trial design by highlighting potential problems with recruitment or data collection.
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Comprehensive geriatric assessment for older adults admitted to hospital
Graham Ellis,Michael P. Gardner,Apostolos Tsiachristas,Peter Langhorne,Orlaith Burke,Rowan H. Harwood,Simon Conroy,Tilo Kircher,Dominique Somme,Ingvild Saltvedt,Heidi L. Wald,Desmond O'Neill,David Robinson,Sasha Shepperd +13 more
TL;DR: This update of a previously published Cochrane review sought to critically appraise and summarise current evidence on the effectiveness and resource use of CGA for older adults admitted to hospital, and to estimate its cost-effectiveness.