How can we improve Comprehensive Geriatric Assessment for older people living with frailty in primary care and community settings? A qualitative study

Abstract

Objective With advancing age comes the increasing prevalence of frailty and increased risk of adverse outcomes (e.g. hospitalisation). Evidence for Comprehensive Geriatric Assessment (CGA), a multi-dimensional holistic model of care, is mixed in community settings. Uncertainties remain, such as the key components of CGA, who delivers it, and the use of technology. This study aimed to understand the perspectives, beliefs and experiences, of both older people and health professionals, to improve the current CGA, and explore factors that may impact on CGA delivery in community settings. Design A qualitative interview study was conducted with older people and health care professionals identified using a maximum variation strategy. Data were analysed using an abductive analysis approach. The Non-adoption, Abandonment, Scale-up, Spread and Sustainability (NASSS) framework and the Theoretical Framework of Acceptability guided the categorisation of the codes, and identified categories were mapped to the two frameworks. Setting England, United Kingdom Results Twenty-seven people were interviewed, constituting 14 older people and 13 healthcare professionals (HCPs). We identified limitations in the current CGA: a lack of information sharing between different healthcare professionals who deliver CGA; poor communication between older people and their HCPs; and a lack of follow-up as part of CGA. When we discussed the potential for CGA to utilise technology, HCPs and older people varied in their readiness to engage with it. Conclusions Viable solutions to address gaps in the current delivery of CGA include the provision of training and support to use digital technology and a designated comprehensive care coordinator. The next stage of this research will use these findings, existing evidence and stakeholder engagement, to develop and refine a model of community based CGA that can be assessed for feasibility and acceptability.