Table 2 Comprehensive geriatric care models
Geriatric care model | POPS (Harari et al) [31] | POSH (McDonald et al) [15] | HELP (Inouye et al) [14] | gPCC (Ekman et al) [12] | LIFE (Hempenius et al) [13] | MDCa |
|---|---|---|---|---|---|---|
Author, study type | Partridge,[17]RCT | Chen [10], Cluster RCT | Olsson [24], Pre-post | Cronin [11], PC Tarazona-Santabalbina [19], RC Nussbaum, [16]RC Souwer [18], Pre-post | ||
Pre-operative | 1. CGA 2. Assessment of Cognitive Function, Frailty, Anaemia, Cardiac evaluation | 1. CGA 2. Risk assessment focused on -• Cognition• Mobility • Functional status • Co-morbidities Medications • Nutrition • Hydration • Pain • Advanced care planning | 1. CGA 2. Screened for 6 delirium risk factors: • Cognitive impairment • Immobility • Sleep deprivation • Dehydration • Vision impairment • Hearing impairment | 1. CGA includes: • Need for additional support after discharge • ADL level • Social lifestyle • Symptoms severity 2.Patient - provider joint Rx plan | 1. CGA 2. Checklist to standardize intervention • Mobility • Co-morbidities • Nutrition • Loss of vision & hearing •Medication • Depression •Incontinence • Cognitive, social & instrumental ADL • Delirium ICP | 2. Rehab care included training, dietary, cognitive, & emotional guidance [18] 3. Nutritional assessment [19] 4. Risk assessment for functional (VES) & polypharmacy status [11] |
Post-operative | • CGA • ICP • Home visit follow-up therapy | • Mx of co-morbidity & pain • Delirium assessment • Enhancement of mobility & nutrition • Counselling for discharge & post-hospital care assessment | • Orientation • Therapeutic activities • Early mobilization • Feeding assistance • Sleep enhancement • Vision & hearing reinforcement •Delirium | • Shared decision: Patient-provider partnership •Documentation: Decisions & assessments according to PCC | • Geriatric nurse daily visit | • Follow-up using postoperative order set assessing functionality, pain & medication [11] •Nutritional assessment & FTRP [16] |
Polypharmacy | NR | Reduction recorded | NR | NR | NR | Recorded [18] |
Delivery team | •Geriatrician • Nurse specialist •Occupational therapist | • Geriatrician • Nurse • Surgeons •Anaesthesiologists | • Geriatrician • Geriatric nurse • Pharmacist • Nutritionist • Rehab therapists • Trained volunteers | • Physicians • Surgeons • Nurse •Physiotherapists •Occupational therapists • Patient representatives | •Geriatrician • Geriatric nurse | •Geriatrician • Geriatric nurse • Oncology nurse • Surgeons • Residents • Dieticians • Physical therapists |