Abstract
Recent years have seen increased use of acute hospitals by older people. The effectiveness of CGA for inpatients is well established, but delivery of hospital wide CGA is not extensively described. The UK National Institute for Health Research recently called for more research on the delivery of hospital wide CGA. We performed an umbrella review of reviews of inpatient CGA [PROSPERO 2015:CRD42015019159] which identified evidence syntheses published between 2009 and 2015. We also reviewed research papers and abstracts published since the most recent included review (2013–2015). We searched the Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews and Effects, MEDLINE and EMBASE, for recent trials (RCTs), evaluations and conference abstracts describing CGA for hospital inpatients over 65 years. We used content analysis to create an overview of recently reported trends in hospital wide CGA We screened 715 publications and selected 12 reviews, 17 papers and 34 abstracts for review. The umbrella review identified that frailty is not widely examined as a target for, or a determinant of CGA outcome. Recent papers and abstracts describe team based interventions, adjustment of skill mix and the use of protocols. Settings included the ED, acute assessment, surgical and oncology units. We found no recent RCTs which evaluated the effectiveness of CGA in these acute inpatient settings. Specific care processes for delirium, risk screening, medications and daily ward / board rounds were described. New CGA trials which stratify participants for frailty and evaluate effectiveness in new hospital wide settings and services are justified.