Clinical Case and Discussion Questions Issue #69 Comprehensive geriatric assessment for older adults admitted to hospital Clinical Case and Discussion Questions Created by William E Cayley, Jr Journal Club Editor Prevea Family Medicine Residency

Bobbie Bobbie is a 75 year old woman admitted to hospital for a non-displaced hip fracture after a fall at home when she tripped over a pet cat. When younger, Bobbie was in excellent health, however in recent years she has had an increasing number of health problems. She is now on medications for high blood pressure, for coronary artery disease, and for insomnia.

Bobbie Bobbie and her husband have lived for several decades in the home where they raised their family, and are very hesitant to consider a move. Neither Bobbie nor her husband smoke, but they enjoy a nightly glass of sherry before bed. Bobbie and her husband both continue to drive “but only close to home – our eyes are getting bad.”

Bobbie They do not have any close family living locally, but say they have “several friends” their own age who can help them should the need arise.

Bobbie In planning for Bobbie’s discharge from hospital, you have been working to coordinate plans with her adult son who has come to town since her hospital stay. With the complexity of her situation, you suggest that the hospital’s multidisciplinary geriatric assessment team meet with Bobbie and her family to develop a comprehensive care plan.

Bobbie Bobbie, her son, and her husband are skeptical of the need for additional care team members. “Doc, you’ve taken good care of us, we don’t want a bunch of other folks getting in the way!”

Bobbie In order to help clarify the benefits of a comprehensive inpatient geriatric assessment, and better inform your discussion with the family about the benefits of such assessment, you decide to refer to the latest update of a Cochrane Review titled… Comprehensive geriatric assessment for older adults admitted to hospital

Questions for discussion What do you think of the quality of evidence behind this review? Does this seem to be a cost-effective intervention? Why or why not? How much confidence do you have that the findings of this review are applicable to Bobbie and her family? To the patients you typically care for? Are there important questions about the outcomes of inpatient comprehensive geriatric assessment that are not answered by this review? What implications does this review have for Bobbie’s desire to stay in her own home? What specifically will you tell Bobbie and her family about the potential benefits of an inpatient comprehensive geriatric assessment?

Further Information How to cite the Cochrane Review: Ellis G, Gardner M, Tsiachristas A, Langhorne P, Burke O, Harwood RH, Conroy SP, Kircher T, Somme D, Saltvedt I, Wald H, O'Neill D, Robinson D, Shepperd S. Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane Database of Systematic Reviews 2017, Issue 9. Art. No.: CD006211. DOI: 10.1002/14651858.CD006211.pub3 Find out more about Cochrane Journal Club: http://www.cochranelibrary.com/more-resources/cochrane-journal-club-.html Share your thoughts about this Journal Club: Email: CochraneJournalClub@wiley.com This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.