Comprehensive geriatric assessment [CGA] and case management
Access to specialist interagency teams for a comprehensive geriatric assessment [CGA] and case management including the development of an emergency health care plan to coordinate care and optimise nutrition and hydration, bowel and bladder care, vision and hearing, cognition and dementia care, and end of life.
What works
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Benefits
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Useful resources
CGA BGS toolkit (primary care) http://www.bgs.org.uk/cga-toolkit/cga-toolkit-category/what-is-cga/cga-what
King’s Fund – case management https://www.kingsfund.org.uk/sites/default/files/Case-Management-paper-The-Kings-Fund-Paper-November-2011_0.pdf
NHS Scotland – Anticipatory Care Planning https://www.nhsinform.scot/campaigns/anticipatory-care-planning
Evidence Summaries
- Most people with dementia want to die in a care home or at home. Achieving this is more likely where goals of treatment are symptomatic relief only, indicating the importance of advance care planning – https://academic.oup.com/ageing/article-abstract/48/3/433/5365249 by guest on 20 January 2020
- Health Foundation (care home) – Encouraging results, including decreases in potentially avoidable emergency admissions to hospital of up to 27%, decreases in emergency admissions of up to 23% or reductions in A&E visits of up to 29% from care home residents, were found across three of the four sites – https://www.health.org.uk/press-release/new-analysis-finds-encouraging-results-in-reducing-emergency-admissions-from-care
- A well conducted review of CGA in community based people with multimorbidity found clinically important benefits for mortality and care home admissions, but limited effect on quality of life and no benefit for unscheduled care or functional outcomes – https://www.nice.org.uk/guidance/ng56
- A review of community-based complex interventions that included CGA demonstrated a reduction in both hospital and nursing home admissions in an older population with frailty.http://advantageja.eu/images/WP6-Managing-frailty-at-individual-level-a-Systematic-Review.pdf
- BMC geriatrics – https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-019-1196-x
Impact and Measures
We know that frailty has a significant impact of people, populations and health and care systems. Frail older people are highly susceptible to adverse health outcomes, such as falls, disabilities, institutionalisation, hospitalisation and death. However, trying to understand this impact on populations and health and care system is challenging due to poor recording of frailty status and the lack of information sharing and interoperability that exists. The following examples of impact are guestimates based on current intelligence.
- Potential Impact
- In the North east and North Cumbria, an additional 506 people may develop dementia due to increasing numbers of people with frailty.
- Comprehensive Geriatric Assessment (CGA) is estimated to avoid one long-term care placement for every 20 people with a CGA.https://www.england.nhs.uk/wp-content/uploads/2017/03/toolkit-general-practice-frailty-1.pdf
- Potential measures
- People aged 65 years and over with moderate or severe frailty who are recorded as having had a fall in the preceding 12 months
- People aged 65 years and over, with depression or dementia, and who have moderate or severe frailty
- Measurement of loneliness / reduced loneliness
- The proportion of people (aged 65+ years) who use services who have control over their daily life
- A&E attendance rates for patients aged 65 years and over
- Emergency hospital admission rates for patients aged 65 and over
For more information to aid local delivery see what works, resource links, benefits, evidence, local stories and case studies as well as impact/measures in ‘word version of draft frailty toolkit’ page 68