Quality statement 2: Comprehensive geriatric assessment

Quality statement

Older people with complex needs have a comprehensive geriatric assessment started on admission to hospital.

Rationale

Older people make up a significant proportion of hospital admissions and many have complex medical, functional, psychological and social needs. Carrying out a comprehensive assessment helps practitioners to develop a long-term plan to manage those needs. This could reduce the length of hospital stay and help people regain their independence sooner and maintain it for longer.

Quality measures

Structure

Evidence of local arrangements to ensure that older people with complex needs have a comprehensive geriatric assessment started on admission to hospital.

Data source: Local data collection.

Process

Proportion of older people with complex needs who have a comprehensive geriatric assessment started on admission to hospital.

Numerator – the number in the denominator where a comprehensive geriatric assessment is started on admission to hospital.

Denominator – the number of hospital admissions of older people with complex needs.

Data source: Local data collection.

Outcome

a) Length of hospital stay for older people with complex needs.

Data source: Local data collection.

b) Delayed transfers of care for older people with complex needs.

Data source: Local data collection. National Delayed transfers of care data is published by NHS England.

c) Permanent admissions to residential and nursing care homes in the 12 months after hospital admission.

Data source: Local data collection. National data on permanent admissions to residential or nursing care are available as part of the Adult social care outcomes framework – indicator 2A.

What the quality statement means for service providers, health and social care practitioners, and commissioners

Service providers (hospitals) ensure that systems are in place to start comprehensive geriatric assessments when older people with complex needs are admitted to hospital.

Health and social care practitioners (such as geriatricians) ensure that they start a comprehensive geriatric assessment when older people with complex needs are admitted to hospital.

Commissioners (clinical commissioning groups) ensure that they commission services in which older people with complex needs have a comprehensive geriatric assessment started when they are admitted to hospital. For emergency admissions, this supports NHS England's Seven day services clinical standards, standards 2 and 3.

What the quality statement means for patients and carers

Older people with complex needs have a thorough review of their needs when they go into hospital. This is done by healthcare professionals with specialist knowledge in caring for older people. The aim is to make a long-term plan to provide the support they need after they leave hospital.

Definitions of terms used in this quality statement

Older people with complex needs

Older people who need a lot of support because of physical frailty, chronic conditions or multiple impairments (including dementia). Many will be affected by other factors linked to poverty, disadvantage, nationality, ethnicity and lifestyle. Older people are generally people who are 65 or older, but could include people who are younger, depending on their general health, needs and circumstances.

The presence of 1 or more of the following in older people should trigger a comprehensive geriatric assessment:

  • falls

  • immobility

  • delirium and dementia

  • polypharmacy

  • incontinence

  • end of life care.

[Adapted from NICE's guideline on transition between inpatient hospital settings and community or care home settings for adults with social care needs, British Geriatric Society (2012) Quality care for older people with urgent and emergency care needs: 'The silver book' and Joseph Rowntree Foundation (2013) A better life: valuing our later years]

Comprehensive geriatric assessment

A comprehensive geriatric assessment is an interdisciplinary diagnostic process to determine the medical, psychological and functional capability of someone who is frail and old. The aim is to develop a coordinated, integrated plan for treatment and long-term support.

[NICE's guideline on transition between inpatient hospital settings and community or care home settings for adults with social care needs, glossary]