Abstract
Background: Comprehensive Geriatric Assessment (CGA) as an early assessment is a key and a starting point to provide an effective care plan. The completeness of the CGA assessment tools is vital to fulfilling the comprehensive diagnoses and appropriate intervention for an older patient to obtain the best care outcome. Some of the common care outcomes related to older patients are readmission, length of stay, and in-hospital death. Several studies have been conducted to look at CGA applications for the results of treatment, and they turned out to have inconsistent conclusions.Aim: Evaluate the completeness of CGA in relation to care outcomes (readmission, length of stay, and in-hospital death) in hospitalized older patients.
Methods: The retrospective design with the stratified random sampling method was utilized to evaluate 222 older patients’ medical records of one hospital in Jakarta, Indonesia who discharge from 1st January to 31st December 2018. The self-developed observational checklist had been tested for validity and reliability by the content validity index, internal consistency, and interrater reliability tests. Independent t-test, Mann-Whitney U-test, correlation Pearson r, Spearman, and Chi-square were utilized to analyze the data based on the scale of the data. Linear and logistic regression has also been utilized for the multivariate analysis.
Results: The average completeness rate of CGA was 68.19%, range 52.38-85.71, where the rate was significantly higher in the geriatric ward than in the non-geriatric ward (71.99% vs. 64.52%). The highest completeness was in the socio-environmental domain, and the lowest was psychological health. There were 6.3% older patients who had 30-day readmission, 8% in the non-geriatric ward, and 4.6% from the geriatric ward. The relationship between the completeness of CGA in the physical health domain and 30-day readmission was positive statistically significant in the geriatric ward. There was an 8.1% incidence of death, where 13.8% has happened in the geriatric ward, and 2.7% happened in the non-geriatric ward. The relationship between the completeness of CGA and in-hospital death was not statistically significant. However, multiple logistic regression results showed that older patients in the geriatric ward had the odds seven times to die in hospital. The median length of stay was eight days range between 2-62 days, where patient in the geriatric ward significantly stay longer in the geriatric ward than in the non-geriatric ward. The completeness of CGA had a significant impact on the length of stay in the geriatric ward, which means every one-unit increase in the completeness of CGA score will increase the length of stay for about two days.
Conclusions: Data about the completeness of CGA have significant impact on the length of stay of hospitalized older patients in the geriatric ward. There was no significant relationship between the completeness of CGA and 30-day readmission or in-hospital death. However, the result showed that the tendency to have higher completeness of CGA performed in patients would avoid readmission or dying in the hospital.
| Date of Award | 2020 |
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| Original language | English |
| Supervisor | Ching-Min Chen (Supervisor) |