title: Three Decades of Comprehensive Geriatric Assessment: Evidence Coming From Different Healthcare Settings and Specific Clinical Conditions.
abstract: Comprehensive geriatric assessment (CGA) is a multidisciplinary diagnostic and treatment process that identifies medical, psychosocial, and functional capabilities of older adults to develop a coordinated plan to maximize overall health with aging. Specific criteria used by CGA programs to evaluate patients include age, medical comorbidities, psychosocial problems, previous or predicted high healthcare utilization, change in living situation, and specific geriatric conditions. However, no universal criteria have been agreed upon to readily identify patients who are likely to benefit from CGA. Evidence from randomized controlled trials and large systematic reviews and meta-analyses suggested that the healthcare setting may modify the effectiveness of CGA programs. Home CGA programs and CGA performed in the hospital were shown to be consistently beneficial for several health outcomes. In contrast, the data are conflicting for posthospital discharge CGA programs, outpatient CGA consultation, and CGA-based inpatient geriatric consultation services. The effectiveness of CGA programs may be modified also by particular settings or specific clinical conditions, with tailored CGA programs in older frail patients evaluated for preoperative assessment, admitted or discharged from emergency departments and orthogeriatric units or with cancer and cognitive impairment. CGA is capable of effectively exploring multiple domains in older age, being the multidimensional and multidisciplinary tool of choice to determine the clinical profile, the pathologic risk and the residual skills as well as the short- and long-term prognosis to facilitate the clinical decision making on the personalized care plan of older persons.
authors.affiliation: Department of Geriatric Care, OrthoGeriatrics and Rehabilitation, Frailty Area, E.O. Galliera NR-HS Hospital, Genova, Italy; Geriatrics Unit, Azienda ULSS 16 Padova, S. Antonio Hospital, Padova, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Pilotto
authors.affiliation: Department of Geriatric Care, OrthoGeriatrics and Rehabilitation, Frailty Area, E.O. Galliera NR-HS Hospital, Genova, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Cella
authors.affiliation: Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Pilotto
authors.affiliation: Geriatrics Unit, Azienda ULSS 16 Padova, S. Antonio Hospital, Padova, Italy.
authors.forename: Julia
authors.initials: J
authors.lastname: Daragjati
authors.affiliation: Department of Medicine, Geriatrics Section, University of Padova, Padova, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Veronese
authors.affiliation: Department of Geriatric Care, OrthoGeriatrics and Rehabilitation, Frailty Area, E.O. Galliera NR-HS Hospital, Genova, Italy.
authors.forename: Clarissa
authors.initials: C
authors.lastname: Musacchio
authors.affiliation: Department of Geriatric Care, OrthoGeriatrics and Rehabilitation, Frailty Area, E.O. Galliera NR-HS Hospital, Genova, Italy.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Mello
authors.affiliation: Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy; Department of Clinical Research in Neurology, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, Tricase, Lecce, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Logroscino
authors.affiliation: Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Padovani
authors.affiliation: Department of Geriatric Care, OrthoGeriatrics and Rehabilitation, Frailty Area, E.O. Galliera NR-HS Hospital, Genova, Italy.
authors.forename: Camilla
authors.initials: C
authors.lastname: Prete
authors.affiliation: Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy; Department of Clinical Research in Neurology, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, Tricase, Lecce, Italy; Geriatric Unit and Gerontology-Geriatrics Research Laboratory, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy. Electronic address: geriat.dot@geriatria.uniba.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Panza
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D060825:Cognitive Dysfunction / Q000175:diagnosis; D005260:Female; D015577:Geriatric Assessment / Q000266:history*; D006268:Health Facilities; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D008297:Male; D009140:Musculoskeletal Diseases / Q000175:diagnosis
keywords: Frailty; cancer; cognitive impairment; emergency medicine; geriatrics; orthopedics