ArticleFrontiers in public health2025
Integrating comprehensive geriatric assessment into routine nursing care for older adults with type 2 diabetes: implementation fidelity and clinical outcomes.
Article in Frontiers in public health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Comprehensive geriatric assessment (CGA) offers promise for improving diabetes management in older adults; however, its real-world effectiveness depends on implementation fidelity, which remains poorly understood. This study examined fidelity variations and their associations with clinical outcomes in nurse-led CGA for older adults with type 2 diabetes at a tertiary care hospital in China. Methods: This cross-sectional implementation study enrolled 3,351 adults aged ≥65 years with type 2 diabetes from Shanghai Jiading District Central Hospital between March 2021 and February 2025. Implementation fidelity was assessed using five validated dimensions yielding a composite score (mean 0.64, SD 0.19; range 0.28-0.94). Primary outcome was glycated hemoglobin (HbA1c); secondary outcomes included cardiometabolic parameters, patient-centered measures, healthcare utilization, and hypoglycemic events. Linear regression models with robust standard errors adjusted for confounders; mediation analysis examined functional status pathways. Results: Fidelity demonstrated variation within the hospital (mean 0.64, SD 0.19; range 0.28-0.94), with higher educational attainment, provider experience, and CGA training completion associated with better implementation quality. Higher fidelity was associated with lower HbA1c (adjusted β -0.38 per 0.10-unit increase, 95% CI -0.47 to -0.29; Conclusion: High-fidelity CGA integration is associated with substantial clinical benefits and lower healthcare utilization; while suggestive of economic advantages, a formal cost-effectiveness evaluation was not undertaken. These associations support an institutional focus on provider training, experience development, and patient education to optimize geriatric diabetes care quality.
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