Comprehensive Geriatric Assessment in the Management of Frailty and Multimorbidity in Older Adults: A Systematic Literature Review

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IntroductionPopulation ageing is one of the most consequential demographic transformations of the twenty-first century.The World Health Organization projects that the proportion of the global population aged 60 years or older will nearly double from 12% to 22% between 2015 and 2050, with the fastest-growing cohort being those aged 80 years and above 1 .This epidemiological shift is driving a parallel rise in age-related syndromes, most prominently frailty and multimorbidity, which together impose substantial demands on health and social care systems worldwide.Frailty is a clinically recognisable state characterised by reduced physiological reserve and increased vulnerability to stressors, manifesting as fatigue, unintentional weight loss, muscle weakness, slowness, and low physical activity 2 .It affects approximately 10% of community-dwelling adults aged 65 years and over, rising to 25-50% among those aged 85 years and older 3 .Critically, frailty is not an inevitable consequence of ageing but a dynamic, potentially modifiable condition whose trajectory can be altered through timely clinical intervention 4 .A landmark review by Kim and Rockwood published in the New England Journal of Medicine in 2024 29 reinforced that assessing frailty enables clinicians to tailor clinical care, including decisions Abstract Frailty and multimorbidity are prevalent, interrelated geriatric conditions whose co-occurrence substantially elevates the risk of disability, hospitalisation, and mortality in older adults.Comprehensive Geriatric Assessment (CGA) is a multidisciplinary diagnostic process proposed as the gold standard for managing these complex conditions.A systematic literature review was conducted following PRISMA 2020 guidelines, searching PubMed, MEDLINE, EMBASE, CINAHL, Web of Science, and Google Scholar for peer-reviewed articles published between 2018 and 2025.Fourteen articles meeting predefined inclusion and exclusion criteria were selected and appraised using the Critical Appraisal Skills Programme (CASP) framework and an evidence-grading matrix.Included studies confirmed a bidirectional relationship between frailty and multimorbidity, mediated by chronic low-grade inflammation, immunosenescence, hormonal dysregulation, and sarcopenia.CGA was consistently effective in quantifying frailty severity, guiding individualised care planning, reducing hospital length of stay, and delaying frailty progression.Updated evidence from 2024 and 2025 confirms that CGA significantly reduces mortality risk and preserves independence in activities of daily living across hospital and community settings.The geriatric triangle, the interplay between frailty, multimorbidity, and polypharmacy, represents an important emerging framework for integrated geriatric management.Standardised CGA implementation, supported by validated digital frailty indices and multidisciplinary teams, is recommended to optimise outcomes.

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