In this scoping review we identified 6 interventions that examined how to improve clinician and patient adherence to geriatric assessment recommendations and adherence depends on perceived relevance of the recommendations and patient-provider relationships.
ABSTRACT
Background
Comprehensive Geriatric assessment (CGA) improves the well-being of older adults, but evidence suggests not all recommendations are implemented by clinicians and patients. Currently, there is no review of interventions to improve clinician implementation and older adults’ adherence to CGA recommendations. Therefore, the aim of this scoping review is to identify interventions that have been evaluated to improve clinicians’ implementation of and patients’ adherence to CGA recommendations.
Methods
We used Arksey and O’Malley’s scoping review framework with the advancements made by Levac et al. We searched OVID MEDLINE, OVID EMBASE, EBSCO CINAHL, APA PsycINFO, and Cochrane Central from inception until November 14, 2024. Two independent reviewers were used for study selection using Covidence. We screened 11,404 titles and abstracts, 111 full texts, and included 16 total manuscripts (describing 6 intervention studies) in the review.
Results
Among the interventions intended to improve clinician implementation, such as strong recommendations by the geriatrician to primary care and patients, physician implementation of CGA recommendations ranged from 59% to 73.9% and patient adherence to recommendations ranged from 59% to 76%. Recommendations easier to implement, such as medication changes, were more adhered to than recommendations for lifestyle changes. Clinician implementation is likely influenced by concordance with patients, involvement during and/or degree of communication after the CGA. The studies suggest that patient adherence depends on perceived relevance of recommendations and patient-provider relationships.
Conclusion
There is a knowledge gap regarding the uptake of CGA recommendations in the context of contemporary healthcare systems. No interventions examined the value of digital technologies in improving implementation/adherence. Future efforts to increase clinician implementation of CGA recommendations and patient adherence to CGA recommendations should be considered in tandem.