Comprehensive geriatric assessment for older adults admitted to the hospital as emergencies: a meta-analysis of randomized controlled trials

To evaluate the effects of comprehensive geriatric assessment (CGA) on mortality, readmission, activities of daily living (ADL) improvement, and length of hospital stay in acutely hospitalized older patients.

In accordance with the guidelines from the Cochrane recommendations and PRISMA guidelines, we conducted a search of seven databases: PubMed, Web of Science, Embase, CINAHL, ProQuest, ScienceDirect, and Cochrane Library, aiming to identify eligible studies published from the time of database inception up to February 23, 2024. The quality of the included studies was assessed using the Cochrane Risk of Bias (RoB) 2.0. Following the literature search, two researchers independently performed data extraction and quality assessment, and conducted meta-analysis using Review Manager 5.4 software, pooling risk ratios (RR) and 95 % confidence intervals (CI). Heterogeneity among studies was evaluated using the I² statistic.

Twenty-three trials involving 9,477 participants were identified. The final meta-analysis showed that CGA did not significantly reduce mortality overall. However, subgroup analyses revealed that older patients living alone who underwent CGA had a lower risk of mortality at 6 months (RR 0.43, 95 % CI 0.21 to 0.90; P = 0.03). At six months post-discharge, CGA reduced readmission rates (RR 0.49, 95 % CI 0.36 to 0.68; P < 0.0001), and improved ADL outcomes in targeted populations (RR 3.04, 95 % CI 1.05 to 8.79; p = 0.04), though no differences were observed in length of stay (MD 0.50, 95 % CI -1.98 to 2.98; P = 0.69).

CGA may improve short-term survival and reduce rates of readmission following acute hospitalization. These findings highlight CGA's potential to enhance geriatric nursing practice through comprehensive evaluations addressing both functional status and social vulnerabilities. Further research is needed to explore multicenter, standardized CGA frameworks with long-term follow-up, which are essential for establishing evidence-based clinical guidelines to facilitate seamless integration of CGA into routine geriatric care pathways.