老年综合评估在老年药物不良事件干预中的价值

目的探讨老年综合评估(CGA)对老年药物不良事件(ADEs)的干预价值。方法随机选取同济大学附属东方医院老年医学科2013年12月至2014年3月住院患者(≥60岁)为研究对象。研究分为二阶段,CGA于第二阶段介入干预。比较两阶段ADEs发生率及原因分布。结果 1研究期间共统计ADEs 72例,CGA干预前后,ADEs的发生率明显下降(P<0.001)。2CGA干预前后,由药物间相互作用、依从性差、药物代谢异常导致的ADEs的比例有不同程度下降。结论使用CGA,指导老年临床治疗策略,可有效降低ADEs发生,提高临床医疗安全。     

老年综合评估软件在社区老人多维评估中的实用性

目的了解成都市高新区中和社区老年人的健康状况,同时检验自制老年综合评估(CGA)软件的可操作性。方法按照人口学基本特征、日常生活能力、精神状态、感知觉与沟通、社会参与能力等设计问卷调查表对263名老年人(≥60岁)进行调查,每位老年人由经过统一培训的评估员采用老年人群疾病与功能评估的流程,完成CGA。结果 3.4%的老人能力完好,36.8%轻度失能,27.1%中度失能,32.7%重度失能。日常生活能力受损老人最多(90.5%),感知觉与沟通能力受损老人相对较少(71.1%)。年龄、文化程度、婚姻、宗教信仰、居住情况、经济来源与失能有相关性(P<0.05,P<0.01)。结论成都市高新区中和街道老年人的健康素养状况不容乐观,应采取相应的干预措施,提升老年人健康素养水平,以适应人口老龄化的需要。     

老年综合评估的临床应用

正传统的医疗评估仅局限于疾病评估,对老年病的治疗也仅仅停留在老年基础疾病的治疗,未能顾及老年人的功能、心理及社会环境等方面的问题,已不能满足老年人评估的需求,因此需要一个更全面的评估方法,以发现老年人更多的潜在问题,这就是老年综合评估(comprehensive geriatric assessment,CGA)。1 CGA的概念CGA是指采用多学科方法评估老年人的躯体健康、功能状态、心     

老年综合评估在慢性病与老年综合征关系研究中的应用价值

目的观察老年综合评估(CGA)在慢性病与老年综合征关系研究中的应用价值。方法选取2018年6月至2019年12月收治的老年患者107例,将伴有慢性患者68例纳入慢性病组,未伴有慢性病患者39例纳入非慢性病组,采用CGA各量表评价两组身体健康及功能状态,对比发生老年综合征慢性病与非老年综合征慢性病患者CGA各量表评分。结果慢性病组MiMi营养评估量表(MNA)、简易智能精神状态检查量表(MMSE)、跌倒风险评估量表(Tinetti)评分均低于非慢性病组,日常生活评估量表(ADL/IADL)评分高于非慢性病组,差异均有统计学意义(均P0.001);慢性病组合并老年综合征患者48例(70.59%),未发生老年综合征患者20例(29.41%);老年综合征慢性病患者MNA-SF、MMSE、Tinetti低于无老年综合征组,ADL/IADL高于无老年综合征组,差异均有统计学意义(均P0.001);绘制受试者工作特征(ROC)曲线结果显示,CGA各量表预测老年慢性病患者发生老年综合征均具有较高预测价值。结论老年群体中慢性病发病率较高,伴慢性病的患者发生老年综合征风险高,经CGA量表评估老年慢性病患者老年综合征发生风险有较高的应用价值,可在未来指导老年综合征的早期预测及干预治疗。     

住院军队离退休干部老年综合征调查分析

目的调查住院军队离退休干部老年综合征(CGA)的发病情况,为提高军队干部保健质量提供理论依据。方法选择火箭军总医院干部病房于2010年1月~2016年6月收治的65岁以上老年离退休干部进行老年综合征评估。内容包括一般情况、慢性疾病及老年综合征。结果接受调查的87例患者中,其中男性62例(71.3%),女性25例(28.7%);年龄65~90岁,平均年龄(83.08±7.3)岁。最常见的前3种慢性疾病患病率依次为高血压病62例(71.3%)、冠心病49例(56.3%)和糖尿病43例(49.4%)。老年综合征为焦虑抑郁状态(59例,67.8%)和自理能力下降(48例,55.2%)的患病率分别超过了入组病例的50%。慢性疼痛(43例,49.4%)、睡眠障碍(42例,48.3%)、尿失禁(42例,48.3%)和衰弱(38例,43.7%)四类症状占较高比例。营养风险(13例,19.4%)的发生比例最低。结论军队离退休干部是一类特殊的老年人群,其老年综合征的发病情况与地方老年人存在异同点,有必要建立与军队特色相匹配的军队离退休干部老年综合征评估模式和疾病管理体系。     

老年综合评估在经皮冠状动脉介入治疗冠心病患者中的应用

经皮冠状动脉介入( PCI)治疗冠心病(CHD)在缓解临床症状方面的疗效已得到充分肯定[1].老年综合评估( comprehensive geriatric assessment,CGA)是近年来在国外广泛应用的多维角度检测评估老年人健康功能水平的工具之一,主要包括全面的医疗评估、躯体功能评估、认知和心理功能评估及社会/环境因素评估4个方面,据此提高诊断率,完善治疗,改善预后,提高生活质量,改革卫生经济-效用模式[2,3].本文运用CGA评价老年CHD患者PCI后生活质量总体改善情况.     

老年综合评估在老年肿瘤患者中的应用

<正>预计到2030年,老年患者将占新发肿瘤患者的70%〔1〕。肿瘤是60⁷9岁人群死亡的最主要的原因。如果在治疗前对老年肿瘤患者进行详细的评估,能很好地了解癌症的治疗是否合适。目前,美国国立综合癌症网络(NCCN)老年肿瘤临床指南指出老年综合评估(CGA)是评估老年肿瘤患者的核心,本文就CGA在老年肿瘤中的应用做一综述。     

老年医学从业人员对医养结合的认识及我国开展医养结合现况的调查报告

目的了解目前我国老年医学从业人员对医养结合的认识及我国开展医养结合的现况。方法 2015年9月至2015年12月期间采用现况调查的方法,利用中国老年医学学会平台,对学会内从事老年医学各领域的委员进行问卷调查,共回收有效问卷1232份。结果调查对象来自全国31个省市。72.4%的调查对象年龄≥40岁,70.3%的调查对象拥有硕士及以上学历,76.6%的调查对象拥有高级职称。超过2/3的调查对象对医养结合的概念和服务内容有-定的了解,约有半数的调查对象参与到医养结合服务中。95.0%的调查对象认为有必要针对老年医学人才培养设置国家统一教材、培训基地、专科规范化培训和照护人员培训。而实际上仅有54.8%的医院针对护理人员开展老年专科培训、36.7%的医院针对护工开展老年专科培训,拥有教材的比例更低。共有175个(34.9%)医疗机构开展了医养结合服务,其形式主要集中在出院延伸服务(62.3%)、与养老机构合作(57.1%)、内设养老床位(40.6%)、配置家庭医生(38.3%)和开办养老机构/护理院(36.6%)。服务对象主要集中在出院患者(77.7%)、社区老年人(69.7%)和养老机构的老年人(60.0%)。具体服务内容包括慢病管理(88.0%)、指导用药(87.4%)、体检(78.3%)、康复与辅具适配(57.1%)、精神慰藉(53.1%)和临终关怀(52.6%)。绝大部分老年科及延伸服务入不敷出,需要医院和地方政策支持。结论目前我国老年医学从业人员对医养结合的认识和了解较好,但国家尚缺乏针对老年医学人才、基地等方面的配套建设。仍有较多的医疗机构未开展医养结合相关服务,且缺乏对医护人员的培训与人才建设体系。     

老年住院患者抑郁发病率

目的调查老年住院患者中抑郁的发病率。方法对≥60岁患者进行老年综合评估(CGA)、情绪评估采用老年抑郁量表(GDS-5),参与评估者共195例,排除拒绝和无法行情绪评估者26例,完成情绪评估者为169例。将入组患者按照年龄、性别、居住情况分组,分别统计抑郁发病率。结果调查发现老年住院患者抑郁发病率为26.0%,男性组为21.5%,女性组为37.5%。独居组为43.5%,非独居组为23.3%。60~69岁年龄组为0%,70~79岁年龄组为31.8%,80~89岁年龄组为26.7%,90岁以上年龄组为21.6%。结论抑郁在老年患者中发病率较高,老年女性患者抑郁发病率高于老年男性,独居老年患者发病率高于非独居老年患者,老年患者抑郁发病与年龄无明显相关性。     

老年综合评估对老年慢性心力衰竭病人生存及预后的影响

目的观察老年综合评估(comprehensive geriatric assessment,CGA)用于老年慢性心力衰竭(chronic heart failure,CHF)病人的临床价值。方法选取60岁以上的CHF病人102例,随机分为CGA组(n=51)和对照组(n=51)。对照组给予常规治疗及护理,CGA组同时进行CGA,并对病人进行多学科干预指导。观察2组1年后的终点事件(一级终点:全因死亡、心血管疾病死亡;二级终点:CHF再返院、发生心血管事件)发生情况。结果随访1年后,CGA组的全因死亡、CHF再返院及心血管事件发生率明显低于对照组(P0. 05); CGA组病人生存时间较对照组延长,且2组生存曲线差异明显。结论 CGA可降低老年CHF病人全因死亡风险,减少心血管事件发生和老年CHF病人的反复住院。     

In-Home Programs of Prevention and Comprehensive Geriatric Assessment: International Perspectives

Abstract. Innovative geriatric care programs have developed worldwide in the past two decades to better address the special problems and care needs of the growing elderly population. Many of these have been based in the home setting and involved basic concepts of prevention and comprehensive geriatric assessment (CGA). Some have focused on periodic screening of relatively healthy and independent elderly persons in their homes and provision of prevention-oriented services, others have targeted more frail and disabled individuals (eg. post-hospitalisation), still others involve entire population groups of elderly persons and provide both prevention and treatment. A common thread has been the use of CGA to evaluate patient problems, understand needs for care, help arrange for services and plan follow-up. Benefits have included more complete diagnosis, discovery of important treatable problems, improvement in drug regimens, reductions in use of hospitals and nursing homes, improved function and satisfaction and reduced mortality. Meta-analysis has confirmed some of the most important of these benefits: improved functional status, reduced mortality and reduced use of institutional services. In this symposium, reports on in-home prevention and geriatric assessment programs were presented from six countries: Australia, Denmark, Italy, Switzerland, the UK and the US.     

Implementation of consultative geriatric recommendations: the role of patient-primary care physician concordance

OBJECTIVES: To examine the effect on primary care physicians' implementation and their patients' adherence behaviors of patient-physician concordance about recommended geriatric health care. DESIGN: Case-series, independent interviews of patients and their physicians about their perceptions of the patients' health and the comprehensive geriatric assessment (CGA). SETTING: Community. PARTICIPANTS: Community-dwelling older patients (n = 111) who received consultative outpatient CGA and their primary care physicians. MEASUREMENTS: Concordance variables were generated using physician and patient responses to 10 questions on health- and CGA-related perceptions. An overall concordance score was generated by summing the total number of items on which patients and physicians agreed. Measures of the two dependent variables (physician implementation of and patient adherence to CGA recommendations) were by self-report. RESULTS: In multiple logistic regression analyses, overall concordance between patient and physician proved to be a significant and powerful predictor of physician implementation of (adjusted odds ratio (OR) = 2.7, 95% confidence interval (CI) = 1.6-4.6, P <.001) and patient adherence to (OR = 2.7, 95% CI = 1.7-4.2, P <.001) CGA recommendations, controlling for patient and physician gender and age, patients' functional status, duration of the patient-physician relationship, and frequency of visits in the previous year. Further analysis revealed that mutual patient-physician concordance on health-related perceptions was a significant predictor of these outcomes, whereas individual patient or physician perceptions were not. CONCLUSION: Concordance between older patients and their primary care physicians is a powerful predictor of physician implementation of and patient adherence to outpatient consultative CGA recommendations. Future research should focus on ways physicians can assess and negotiate patient-physician agreement on geriatric healthcare recommendations.     

住院患者老年综合评估规范及初步效果分析

目的：探讨在老年住院患者中进行老年综合评估（CGA）对于老年人全面综合管理的作用。方法制定标准的CGA流程,采用标准流程对北京协和医院老年病房2013年9月至2014年9月连续入院的≥65岁患者进行CGA,分析其筛查老年综合征的效果。结果标准化的评估流程便于临床使用,接受评估的179例患者中,年龄（72.5±8.1）岁。通过CGA发现,视力异常患者占62.0%,睡眠障碍41.3%,听力异常40.8%,慢性疼痛34.6%,跌倒25.7%,多重用药23.5%,便秘21.8%,抑郁焦虑18.4%,尿失禁16.2%,谵妄10.6%。以不同主诉入院的15例患者最终诊断为老年综合征,占8.4%。结论老年综合征在老年患者中普遍存在,运用标准化的CGA方法可以进行有效筛查,有利于老年患者的全人管理。     

Role of certified geriatric medical doctors in university hospitals in Japan

The role of certified specialists in geriatric medicine in Japanese University Hospitals is discussed in this section. First, they should act as geriatric general physicians to provide a comprehensive medical care for elderly patients against a background complicatedly divided medical departments in university hospitals. Second, they should create attractive undergraduate programs for geriatric education in medical schools and training programs in geriatric medicine for doctors to develop certified specialists in geriatric medicine in the future. Finally, they should perform clinical research to provide an evidence to construct better social policies to keep older people healthy.     

老年人综合评估的实施

老年人综合评估是全面关注和处理与老年患者健康和功能状态相关问题的重要研究方法.现对老年人综合评估的概念、目标人群、评估内容和实施方法进行介绍,同时介绍老年人综合评估成效的研究结果.     

Factors associated with long hospital stay in geriatric wards in Japan

Background:   To reduce the length of stay (LOS) in hospital, the factors associated with extended LOS have to be identified.
Methods:     A comprehensive geriatric assessment (CGA) of patients in a geriatric ward was carried out to identify the factors associated with LOS of more than 28 days.
Results:     Of 193 patients (> 65 years old) who had been admitted to the geriatric ward of Nagoya University Hospital from home, 118 patients had complete CGA data sets. The CGA items were studied within 1 week of admission and analysis was performed by Chi-squared followed by multilogistic analysis. Chi-squared analysis demonstrated that many of the basic activities of daily living (BADL) and instrumental ADL (IADL) had a significant association with longer LOS, but the contribution of psychological factors, assessed by mini-mental state examination and Geriatric Depression Scale-15, was relatively small. Multilogistic analysis showed that dependence on dressing assistance and medication assistance significantly increased the chance of having a LOS longer than 28 days.
Conclusion:     Intervention to improve the ability to dress and take medication independently may reduce LOS.     

Utilization of comprehensive geriatric assessment in cancer patients

A growing and diverse aging population, recent advances in research on aging and cancer, and the fact that a disproportional burden of cancer still occurs in people aged 65 years and older have generated great interest in delivering better cancer care for older adults. This is particularly true as more survivors of cancer live to experience cancer as a chronic disease. Cancer and its treatment precipitate classic geriatric syndromes such as falls, malnutrition, delirium, and urinary incontinence. Comprehensive Geriatric Assessment (CGA), by taking all patient's needs into account and by incorporating patient's wishes for the level of aggressiveness of treatment, offers a model of integrating medical care with social support services. It holds the promise of controlling health care costs while improving quality of care by providing a better match of services to patient needs. Three decades after the CGA was initially developed in England, oncologists have begun taking notice on the potential benefits that CGA might bring to the field of geriatric oncology. This article describes the utilization of the CGA in cancer patients with an eye toward promoting interdisciplinary care for older cancer patients. To set an initial context, a search of computerized databases took place, using "comprehensive geriatric assessment" and "cancer" as keywords. A selection of literature from between 1980 and 2003 was reviewed. Additional articles were identified through the bibliography of relevant articles.     

Undernutrition in elderly patients with cancer: target for diagnosis and intervention

In recent years, geriatricians and oncologists have worked together to evaluate elderly patients with cancer before and during treatment, to estimate the balance between the efficacy and safety of chemotherapy and to upgrade treatment in this population according to their comorbidity and physiological status. The clinical and biological factors of this population need to be assessed in multidisciplinary comprehensive geriatric assessment (CGA) in order to optimize treatment without inducing major adverse effects. We reviewed the nutritional aspects of this evaluation that highlight the impact of undernutrition on poor survival. In this paper we briefly describe tumoral cachexia (molecular and physiological), the impact of undernutrition on cancer prognosis (predictive factors), therapeutic effects of cancer on nutritional status, nutritional indicators (biological, anthropometric) and undernutrition in the elderly (specific needs of this population). The potential for nutritional intervention in geriatric oncology with regard to CGA is explored.     

A comprehensive geriatric intervention detects multiple problems in older breast cancer patients

Studies of comprehensive geriatric assessment (CGA) have shown the importance of follow-up for effectiveness, but this has not been tested in an oncology clinic. In this pilot study, we enrolled 15 early breast cancer patients, aged 70 and older. They received a multidisciplinary CGA every 3 months and structured follow-up from the SAOP nurse practitioner, dietitian, social worker, and pharmacist according to risk. Total follow-up was 6 months. Median age of evaluable patients was 79 years (range 72-87). Median number of comorbidities by Cumulative Index Rating Scale-Geriatric (CIRS-G) was 5 (3-9) at baseline. Ten patients were at pharmacological risk, five at psychosocial risk, and eight at nutritional risk. Patients presented on average six problems initially, and three new problems during follow-up. The intervention directly influenced oncological treatment in four cases. It ensured continuity/coordination of care in seven cases. Success rate in addressing problems was 87%. Mean Functional Assessment of Cancer Treatment-Breast (FACT-B) scores improved from 110.5 (S.D. 16.7) to 116.3 (S.D. 16.5) (t=0.025). Function and independence were maintained. CONCLUSIONS: Older patients with early breast cancer have a high prevalence of comorbidity. A CGA with follow-up has potential for improving the treatment and prognosis of these patients and is feasible in an academic oncology setting.     

Geriatric medicine in Sweden: a study of the organisation, staffing and care production in 2000-2001

OBJECTIVE: the organisation of long-term medicine and geriatric medicine has undergone many changes during the last 15 years. The aim of this study is to gain an overall perspective of the present organisation of geriatric medicine in Sweden. DESIGN: questionnaire survey. METHODS: The Swedish Society for Geriatric Medicine and Gerontology, in collaboration with the Federation of County Councils and the Swedish Association of Local Authorities, sent out a survey to people in all county councils in Sweden. The subject of the survey was the speciality of geriatric medicine in the Swedish healthcare system, with regard to healthcare organisation, staffing and care production in 2000/2001. RESULTS: there were 52 separate geriatric units, 41 independent 'clinics' and 11 'sections' within other departments. There were a total of 3,101 geriatric inpatient beds. On average, there was one geriatric bed for every 799 individuals within the local population aged 65 years and over, with a 10-fold variation between counties. Four counties had no geriatric provision. The 'geriatric clinics' were mainly located in university towns and averaged 85 beds per clinic, again with a 10-fold variation. There were 604 established positions for doctors within geriatrics, of which 63% were at geriatric clinics. On average, the clinics had 16 positions each (of which 75% were filled with geriatric specialists) with 7 beds per doctor. The corresponding averages for nurses and paramedics could not be summarised due to organisational differences between the county councils. In general, there were very few nurses with specialist training in geriatric medicine. CONCLUSIONS: the field of geriatric medicine in Sweden is very heterogeneous regarding terminology, designations, structure, staffing and care production. There is no overall structural plan for the role of geriatric medicine in Swedish healthcare, with the desired close connection between content and dimensioning of geriatric specialist training and the practical organisation of the activities. The county councils designate geriatric medicine so differently that it is hardly possible to compare different geriatric facilities today. Considering how many patients at hospitals today are elderly and suffer from multiple illnesses, it is a major quality issue to ensure that these patients have access to geriatric specialists.