Comprehensive Geriatric Assessment in the perioperative setting; where next?

Area of Science:

• Geriatric Medicine
• Surgical Care
• Health Services Research

Background:

• Comprehensive Geriatric Assessment (CGA) is crucial for optimizing outcomes in older surgical patients.
• Workforce shortages in geriatric medicine prompt exploration of non-geriatrician delivery of CGA.
• The HOW-CGA project aimed to create a toolkit for perioperative CGA by non-geriatricians.

Purpose of the Study:

• To assess the feasibility and implementation of a toolkit designed for non-geriatricians to deliver perioperative Comprehensive Geriatric Assessment (CGA).
• To identify barriers and facilitators to the uptake of the HOW-CGA toolkit in two hospital settings.

Main Methods:

• Development of the HOW-CGA toolkit for non-geriatrician delivery of perioperative CGA.
• Implementation and evaluation of the toolkit across two hospital sites.
• Qualitative assessment of barriers including face validity, behavioral, and cultural factors.

Main Results:

• Limited uptake and implementation of the HOW-CGA toolkit were observed.
• Barriers included lack of face validity, behavioral and cultural resistance, and the perceived essential role of geriatric medicine expertise.
• An expansion of geriatrician-led CGA services for older surgical patients in the UK was noted.

Conclusions:

• Non-geriatrician delivery of perioperative CGA using the HOW-CGA toolkit faced significant implementation challenges.
• Geriatrician expertise is considered key for effective CGA and optimization in the perioperative setting.
• Future research should integrate implementation science, health services research, and big data from linked national audits to demonstrate perioperative CGA effectiveness.