A comprehensive geriatric assessment (CGA) with a network, rather than organ-specific approach, is key to geriatric rehabilitation, states Professor Wilco P. Achterberg, in a commentary published in EClinicalMedicine.
In CGA, physical, functional, mental and social/environmental aspects are assessed, in addition to the specific disease history. There remains conflicting evidence on the benefits of CGA, especially for older post-hospital patients.
A Japanese nationwide retrospective cohort study with over 300,000 geriatric patients, described effects of CGA. Propensity score-matched analysis in over 50,000 pairs showed better outcomes of in-hospital mortality and long-term hospitalisation for patients who received CGA.
Only 21 per cent of patients received CGA. The mean stay in hospital was 20 days, and 10.1 per cent of stroke patients without CGA and 8.7 per cent for those who received CGA, stayed longer than 60 days. The hospital stay is much longer than other countries such as the UK, with an average stay of 9 days.
After acute neurological assessment, the focus should be on the rehabilitation of function, continuing treatment through a holistic geriatric approach, containing nurses, physiotherapists, occupational therapists, speech therapists and social workers who work with rehabilitation plans that include individualised goals.