Role of comprehensive geriatric assessment in healthcare of older people in UK care homes: realist review
Objectives Comprehensive geriatric assessment (CGA) may be a way to deliver optimal care for care home residents. We used realist review to develop a theory-driven account of how CGA works in care homes.Design Realist review.Setting Care homes.Methods The review had three stages: first, interviews w...
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BMJ Publishing Group
2019-04-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/9/4/e026921.full |
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| author | Claire Goodman Tom Dening Neil H Chadborn Maria Zubair Lídia Sousa John R F Gladman Adam, L Gordon |
| author_facet | Claire Goodman Tom Dening Neil H Chadborn Maria Zubair Lídia Sousa John R F Gladman Adam, L Gordon |
| author_sort | Claire Goodman |
| collection | DOAJ |
| description | Objectives Comprehensive geriatric assessment (CGA) may be a way to deliver optimal care for care home residents. We used realist review to develop a theory-driven account of how CGA works in care homes.Design Realist review.Setting Care homes.Methods The review had three stages: first, interviews with expert stakeholders and scoping of the literature to develop programme theories for CGA; second, iterative searches with structured retrieval and extraction of the literature; third, synthesis to refine the programme theory of how CGA works in care homes.We used the following databases: Medline, CINAHL, Scopus, PsychInfo, PubMed, Google Scholar, Greylit, Cochrane Library and Joanna Briggs Institute.Results 130 articles informed a programme theory which suggested CGA had three main components: structured comprehensive assessment, developing a care plan and working towards patient-centred goals. Each of these required engagement of a multidisciplinary team (MDT). Most evidence was available around assessment, with tension between structured assessment led by a single professional and less structured assessment involving multiple members of an MDT. Care planning needed to accommodate visiting clinicians and there was evidence that a core MDT often used care planning as a mechanism to seek external specialist support. Goal-setting processes were not always sufficiently patient-centred and did not always accommodate the views of care home staff. Studies reported improved outcomes from CGA affecting resident satisfaction, prescribing, healthcare resource use and objective measures of quality of care.Conclusion The programme theory described here provides a framework for understanding how CGA could be effective in care homes. It will be of use to teams developing, implementing or auditing CGA in care homes. All three components are required to make CGA work—this may explain why attempts to implement CGA by interventions focused solely on assessment or care planning have failed in some long-term care settings.Trial registration number CRD42017062601. |
| format | Article |
| id | doaj-art-ceb8b0c1cb6d4eb08d060279c4524a9c |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2019-04-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-ceb8b0c1cb6d4eb08d060279c4524a9c2025-02-07T00:35:13ZengBMJ Publishing GroupBMJ Open2044-60552019-04-019410.1136/bmjopen-2018-026921Role of comprehensive geriatric assessment in healthcare of older people in UK care homes: realist reviewClaire Goodman0Tom Dening1Neil H Chadborn2Maria Zubair3Lídia Sousa4John R F Gladman5Adam, L Gordon63 Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UKMental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK2 National Institute of Health Research Collaboration for Leadership in Applied Health Research and Care East Midlands, Nottingham, UK5 Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK6 Santa Maria University Hospital, Lisbon, PortugalNIHR Applied Research Collaboration – East Midlands, Nottingham, UK2 National Institute of Health Research Collaboration for Leadership in Applied Health Research and Care East Midlands, Nottingham, UKObjectives Comprehensive geriatric assessment (CGA) may be a way to deliver optimal care for care home residents. We used realist review to develop a theory-driven account of how CGA works in care homes.Design Realist review.Setting Care homes.Methods The review had three stages: first, interviews with expert stakeholders and scoping of the literature to develop programme theories for CGA; second, iterative searches with structured retrieval and extraction of the literature; third, synthesis to refine the programme theory of how CGA works in care homes.We used the following databases: Medline, CINAHL, Scopus, PsychInfo, PubMed, Google Scholar, Greylit, Cochrane Library and Joanna Briggs Institute.Results 130 articles informed a programme theory which suggested CGA had three main components: structured comprehensive assessment, developing a care plan and working towards patient-centred goals. Each of these required engagement of a multidisciplinary team (MDT). Most evidence was available around assessment, with tension between structured assessment led by a single professional and less structured assessment involving multiple members of an MDT. Care planning needed to accommodate visiting clinicians and there was evidence that a core MDT often used care planning as a mechanism to seek external specialist support. Goal-setting processes were not always sufficiently patient-centred and did not always accommodate the views of care home staff. Studies reported improved outcomes from CGA affecting resident satisfaction, prescribing, healthcare resource use and objective measures of quality of care.Conclusion The programme theory described here provides a framework for understanding how CGA could be effective in care homes. It will be of use to teams developing, implementing or auditing CGA in care homes. All three components are required to make CGA work—this may explain why attempts to implement CGA by interventions focused solely on assessment or care planning have failed in some long-term care settings.Trial registration number CRD42017062601.https://bmjopen.bmj.com/content/9/4/e026921.full |
| spellingShingle | Claire Goodman Tom Dening Neil H Chadborn Maria Zubair Lídia Sousa John R F Gladman Adam, L Gordon Role of comprehensive geriatric assessment in healthcare of older people in UK care homes: realist review BMJ Open |
| title | Role of comprehensive geriatric assessment in healthcare of older people in UK care homes: realist review |
| title_full | Role of comprehensive geriatric assessment in healthcare of older people in UK care homes: realist review |
| title_fullStr | Role of comprehensive geriatric assessment in healthcare of older people in UK care homes: realist review |
| title_full_unstemmed | Role of comprehensive geriatric assessment in healthcare of older people in UK care homes: realist review |
| title_short | Role of comprehensive geriatric assessment in healthcare of older people in UK care homes: realist review |
| title_sort | role of comprehensive geriatric assessment in healthcare of older people in uk care homes realist review |
| url | https://bmjopen.bmj.com/content/9/4/e026921.full |
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