Impacts of geriatric evaluation and management programs on defined outcomes: overview of the evidence
Abstract
Comprehensive geriatric assessment is a technique for multidimensional diagnosis of frail elderly people with the purpose of planning and/or delivering medical, psychosocial, and rehabilitative care. When comprehensive geriatric assessment is coupled with some therapy, then the term geriatric evaluation and management (GEM) will be used. Following a brief history of comprehensive geriatric assessment, we describe the varied patterns of GEM program organization and review the literature of studies examining GEM effectiveness. Program diversity complicates drawing firm conclusions about GEM effects; however, the vast majority of studies report positive, if not uniformly significant, results. Our analysis suggests that much of the variability in findings is due to sample size limitations In order to reach conclusions of program effects across studies and to avoid problems of small sample sizes, we undertook a formal meta‐analysis. In this initial meta‐analysis, we sought to evaluate the effect of GEM programs on a single outcome: mortality. We pooled all published GEM controlled trials into four major groups: inpatient consultation services, inpatient GEM units, home assessment services, and outpatient GEM programs. Meta‐analysis of 6‐month mortality demonstrates a 39% reduction of mortality for inpatient consultation services (odds ratio 0.61, 95% confidence interval 0.46–0.81, P = 0.0008) and a 37% reduction of mortality for inpatient GEM units (odds ratio 0.63, 95% CI 0.42–0.93, P = 0.02). Home assessment services reduced mortality by 29% (odds ratio 0.71, 95% CI 0.55–0.90, P = 0.005). On the other hand, no significant survival effect was found for outpatient GEM programs (odds ratio 0.96, 95% confidence interval 0.61–1.49). Further use of meta‐analytic techniques should be employed to clarify the effect of GEM on other important outcomes (eg, functional status, use of hospitals and nursing homes) as well as to identify program characteristics most effective in achieving these benefits.
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Comprehensive geriatric assessment has been applied successfully beyond elderly care medicine.
“has been applied successfully beyond elderly care medicine (112, 113).”
From Frailty in elderly people (2013) · cites this paper as [112]
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- Authors
- Rubenstein, L. Z., Stuck, A. E., Siu, A. L., & Wieland, D.
- Affiliations
- University of California, Los Angeles (US)
- VA Sepulveda Ambulatory Care Center (US)
- Corresponding author
- Rubenstein, Laurence Z.
- Venue
- Journal of the American Geriatrics Society
- Publisher
- Wiley
- Published
- 1991-09
- Volume
- 39
- Issue
- S1
- Pages
- 8S-16S; discussion 17S
- ISSN
- 0002-8614 (ISSN-L)
- 1532-5415
- OpenAlex
- W2090645934
- Cited by
- 597
- References
- 65
- Citations by year
- 2026: 13 · 2025: 16 · 2024: 32 · 2023: 36 · 2022: 33 · 2021: 57 · 2020: 29 · 2019: 30 · 2018: 31 · 2017: 35 · 2016: 30 · 2015: 27 · 2014: 22 · 2013: 13 · 2012: 22
- FWCI
- 15.10
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of the American Geriatrics Society (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Keywords
- geriatric evaluation and management, comprehensive geriatric assessment, frail elderly, mortality, program effectiveness, sample size limitations
- MeSH terms
- Aged, Health Services for the Aged, Humans, Outcome and Process Assessment, Health Care, United States, Meta-Analysis as Topic, Geriatric Assessment, Survival Analysis, Frail Elderly
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