Paper: "Comprehensive Geriatric Assessment (CGA) in Healthcare of older people in UK care homes"

When something is described as 'comprehensive' this might suggest the need for an aide-mémoire?

"Rubenstein et al defined CGA as a ’multidisciplinary diagnostic process intended to determine a frail older person’s medical, psychosocial and functional capabilities and limitations in order to develop an overall plan for treatment and long-term follow-up’. CGA has been shown to improve outcomes for older people in hospital and community settings. It encompasses health and social care needs and facilitates multidisciplinary working. However, evidence regarding its effectiveness in care homes is limited, and there are limited data describing what needs to be in place for uptake and sustained implementation in this setting."

individual

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INTERPERSONAL : SCIENCES

humanistic ----------------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

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group - population

Care home (Lived experience?) PURPOSEs  (synergy across the multidisciplinary team, consistency - communication) Resident access to expertise Ethics - PEACH project Individual reasoning [ What about the "Health Career" of residents? FROM: date of admission TO: date now. Residents who can perceive 'continuity of care' more likely to be assessed as having mental capacity. What of others? ]

Care home 425 000 people live in care homes Comprehensive assessment Realism, The situation, Context as it is (and across all the domains; e.g. all health care currently conducted amid Brexit uncertainty). Context-Mechanism-Outcome (CMO) configurations Coding NVIVO - reasoning & resource components Health-related Quality of Life (HRQoL) Programme theory (development) Frail Basic and personal care needs PROCESS Causes, Synthesis .Physical access

Care Homes PRACTICE Patient Public Involvement Proxy, Next of Kin Care plan Group reasoning "Mechanism reasoning developing a unified view and shared aims and goals for the resident."

Care Homes "Mechanism reasoning: delegation from the multidisciplinary team to care home staff provides authority to deliver care according to the care plan." POLICY Outcomes: Quality, Safety (Do see Conclusion of Paper)

The review sought papers on "multi-domain assessment".

"The practices and processes of assessment inform the whole CGA ... . Assessment of many domains of health status and impairments was represented as crucial in building a picture of an individual’s complex needs and views about their personal priorities and goals. Unlike discipline-specific needs assessment that may focus on a particular syndrome or care pathway, structured comprehensive assessment requires an overview of all domains."

Figure 2: Nested arrangement of  Context-Mechanism-Outcome (CMO) configurations

Ref.
Chadborn NH, Goodman C, Zubair M, et al Role of comprehensive geriatric assessment in healthcare of older people in UK care homes: realist review BMJ Open 2019;9:e026921. doi: 10.1136/bmjopen-2018-026921