More Than Admission Avoidance: What Does Frailty-Triggered CGA Actually Improve? A Systematic Review

Introduction:

Population ageing is increasing pressure on acute hospital services, with the proportion aged ≥65 years projected to rise from 10% to 16% by 2050. Whether frailty-triggered comprehensive geriatric assessment (CGA) improves outcomes and quality of life compared with usual front-door care is therefore increasingly important.

Methods:
PubMed, Embase and CINAHL were searched from inception to July 2026 for comparative studies of older adults attending acute hospital front-door services. Studies were included where frailty or geriatric-risk identification directly triggered CGA, compared with non-CGA admission or routine emergency department care. For each outcome, studies were grouped as favouring CGA, favouring usual care or showing no clear difference, then summarised narratively. Risk of bias was assessed using RoB 2 and ROBINS-I.

Results:

20 comparative studies (16 randomised; 4 non-randomised) involving 34,917 acute-care attendances by older adults were included. Frailty-triggered CGA most consistently benefited older adults by helping them avoid unnecessary hospital admission, spend less time in hospital, maintain function or quality of life, and return home rather than require long-term care. Admission avoidance or direct discharge was favoured in 64% of studies, shorter inpatient stay in 70%, improved function or quality of life in 71%, and favourable discharge outcomes in 89%. However, no clear reduction was found in readmission in 7 of 9 studies, emergency reattendance in 9 of 12, or mortality in 7 of 10. Importantly, reducing admission and length of stay did not appear to increase readmission, emergency reattendance or mortality. Overall, CGA appeared to make hospital care less burdensome for older adults, although longer-term benefits remained uncertain.

Conclusion: 
Frailty-triggered CGA supported person-centred acute care by helping older adults avoid burdensome admission, preserve independence and return home, while reducing pressure on hospital services. Benefits were concentrated during the index admission, with no clear sustained effect on reattendance or mortality.