老年综合征的中外评估现状及展望

随着全世界人口老龄数量不断地壮大, 老年人的医疗问题日益突出 ,传统的医疗评估仅仅是疾病评估,根本不能满足老年人健康评估的需要,因此需要一个更全面的评估方法去发现老年人更多的潜在问题,这就是老年综合评估CGA。它可以为老年患者制定科学、合理和有效的预防、保健、治疗、康复和护理计划,促进老年患者各种功能状态的改善,从而提高老年患者的生活质量和健康期望寿命。本文就老年综合征的中外评估方法和各类量表,以及对国内目前的老年综合征评估和研究进行了进行综述;并提出老年综合征评估内容的选择、评估的方式、及有梯度递进式的评估值得我们进一步探索,也是今后老年综合征研究的重要课题。     

非药物干预改善社区老年人衰弱状况的研究进展

衰弱是常见的老年综合征之一,近年来在国内外老年护理领域受到了越来越多的关注。及时采取干预方式改善社区老年人衰弱状况,对于维持老年人功能的独立性,提高老年人生活质量具有重要意义。本文将介绍社区老年人的衰弱状况及其对健康的影响和衰弱的识别方法,并重点从运动锻炼、营养干预、老年综合评估和综合护理干预等方面介绍社区老年人衰弱的非药物干预进展。     

老年衰弱的护理评估及研究进展

有研究显示衰弱是反映老年人健康问题和医疗需术的一种新的临床指标。但目前衰弱综合征在我国老年人群中的研究尚处于起步阶段,现就老年衰弱的相关概念、诊断标准、护理评估工具及现有的护理干预进行综述。     

老年衰弱的护理评估及研究进展

有研究显示衰弱是反映老年人健康问题和医疗需术的一种新的临床指标。但目前衰弱综合征在我国老年人群中的研究尚处于起步阶段,现就老年衰弱的相关概念、诊断标准、护理评估工具及现有的护理干预进行综述。     

综合医院老年评估门诊评估量表的应用

老年综合评估是老年医学核心技术之一,是全方位、多维度地对老年人的躯体功能、认知、精神、心理及社会环境进行评估,及时发现老年综合征和老年问题,提供干预措施,以减少衰弱和失能,尽可能保证老年人的生活质量。综合医院老年评估门诊针对有老年共病、部分失能的患者,进行老年综合评估发现老年综合征及老年问题,及时给予干预处理。但是,目前国内尚缺乏适合综合医院老年评估门诊使用的统一有效的量表。老年评估门诊使用的量表既要有高度的测量效度和信度,又需要符合老年认知和身体状况特点,方便可行。     

在整体护理中加深对老年衰弱综合征的认知与管理

随着老年医学研究的深入,人们逐渐发现衰弱综合征不仅会影响老年人的生理健康问题,也可能是造成一些老年慢性非致死性疾病的恶化或不愈的重要因素。其复杂的临床表现给医疗护理人员构成了极大的挑战。同时,整体护理是一种考虑多方面因素的工作模式,非常适合于在临床工作中感知衰弱综合征,并付诸相应的、有针对性的干预,提供最恰当的护理。目前尽管用来识别衰弱的工具还处在初步发展阶段,但也存在一些可供实践的措施能够帮助护理人员在临床工作中意识到衰弱综合征的存在以及其对临床护理造成的影响。本研究就衰弱综合征的临床意义、临床评估、筛选手段以及如何在整体护理工作模式下管理老年衰弱综合征进行综述。通过综合评估能更确切地反映老年人的慢性健康和医疗护理需求,预测残疾,减少意外伤害,解释康复效果,提高生活质量。     

老年综合征评估在老年患者临床护理中的应用

目的 探讨老年综合征评估在老年患者临床护理中的作用.方法 采用SPICES评估表对308例老年患者进行评估并开展有针对性的护理干预.结果 由于在护理工作中采取了主动的护理干预,避免了医源性损伤的出现,提高了护理质量.结论 老年综合征评估在老年患者护理中具有实用性,值得在临床护理工作中推广应用.     

老年综合评估门诊在老年人健康管理中的作用

随着我国进入老龄化社会,老年人口迅速增多,老年人的健康已经成为全民健康的重要组成部分。增龄所致的器官功能变化,老年人常见的共病、老年综合征、精神心理以及社会角色的变化,使老年人的躯体功能也随之发生着改变,逐渐造成衰弱、甚至失能。老年综合评估(CGA)多维度地评估老年人整体健康水平,旨在及时尽早发现老年人存在的健康相关问题和风险,给予合理干预,减慢衰弱的发生,延缓老年人的失能。老年综合评估门诊是老人进行CGA的场所之一,是老年人健康管理的重要组成部分。本文就老年综合评估门诊在老年健康管理中的作用作一个综述。     

住院病人老年综合征共患情况调查

[目的]了解住院病人老年综合征罹患现况,为下一步的综合管理提供参考。[方法]对成都市某两家三级医院老年科住院病人376例进行老年综合评估。[结果]住院病人老年综合征发生前5位的分别是日常生活能力下降、营养不良风险及营养不良、慢性疼痛、多重用药、慢性便秘。不同性别老年病人跌倒高风险、慢性疼痛发生率比较差异有统计学意义(P0.05)。不同年龄老年病人跌倒高风险、尿失禁、多重用药、慢性便秘、慢性疼痛、压疮风险发生率比较差异有统计学意义(P0.05)。不同婚姻状况老年病人慢性疼痛发生率比较差异有统计学意义(P0.05)。老年人患老年综合征(4.71±2.13)种,310例(82.45%)老年人同时患3种及以上老年综合征。[结论]随着年龄增加,老年人患老年综合征数量增加,老年综合征共患问题明显,医务工作者应在未来的工作中加强对老年综合征的评估及管理,推进老年人照护发展。     

中西部社区老年人老年综合征发生情况及相关因素分析

目的了解我国中西部社区老年人老年综合征发生情况及相关因素,为社区照护及卫生管理提供依据。方法调查中西部地区7个城市16个社区的1 076名老年人的老年综合征发生情况。结果 1 076名老年人中老年综合征发生率高达66.54%,视力下降(36.34%)、听力下降(31.60%)、睡眠障碍(31.32%)占前3位。单因素分析提示不同年龄、婚姻状况、文化程度、收入情况、疾病种类、健康自我评价、家庭功能评分的老年人发生老年综合征情况不同(P0.01或P0.05),多因素分析显示高龄、无配偶、疾病种类多、健康自我评价差是老年综合征发生的影响因素,良好的家庭功能是社区老年人老年综合征发生的保护因素。结论中西部社区老年人老年综合征发生率高,社区照护中需要加强健康监测、建立老年综合征评估档案,对高龄、无配偶、疾病种类多、健康自我评价差、家庭功能不良的老年人应加强管理,从而提高老年人的生活质量。     

社区老年护理人才现状及需求调查

目的：了解社区老年护理人才现状及需求,为高校培养社区老年护理人才提供依据。方法自设问卷对浙江省284家社区卫生服务中心（站）进行调查。结果72．5％认为现有社区老年护理人才数量不能满足老年护理工作需求,67．6％认为专业素质不能满足工作需求;现有老年护理人才大专学历占44．5％,中专学历占39．8％,未来2年招聘以大专学历为主,达61．2％;社区老年护理人才需要老年护理和技术等12方面知识,社区老年护理人才应具备老年常见病和用药反应护理观察能力等9项核心能力。结论目前社区老年护理人才数量和专业素质不能满足老年护理需求,需以社区老年护理知识、核心能力需求为导向,通过专业设置、构建课程体系,改革教学及实践方式等进行培养,以适应人口老龄化需求。     

Assessment of geriatric knowledge: an online tool for appraising entering APN students.

As the percentage of elderly in the U.S. rises, the need for primary health care for the aging population increases. Knowledge of special characteristics of older persons, as well as demographics of the aging population, resources and principles of care are important in the provision of effective, professional primary health care by advanced practice nurses. In response to this increasing need for geriatric health care expertise, a tool was developed to evaluate basic geriatric knowledge of students entering advanced practice nursing study, Self Assessment of Geriatric Knowledge. The Self Assessment, derived from AACN's recommended geriatric competencies for BSN graduates, may be accessed on-line. Immediate test results are received on-line. Tests completed by 158 advanced practice students over a three year period showed geriatric knowledge deficits: myths of aging, prevention strategies and risk factors of elders; roles and responsibilities for care of elderly persons in the community; health policies that affect elder care; and, demographics of the geriatric population. These data may contribute to faculty awareness of curricular needs for preparing students for competent geriatric nursing care of the growing older population.     

Potentially inappropriate prescribing for the elderly: effects of geriatric care at the patient and health care system level

BACKGROUND: Many studies have identified patient characteristics associated with potentially inappropriate prescribing in the elderly (PIPE), however, little attention has been directed toward how health care system factors such as geriatric care may affect this patient safety issue. OBJECTIVE: This study examines the association between geriatric care and PIPE in a community dwelling elderly population. RESEARCH DESIGN: Cross-sectional retrospective database study. SUBJECTS: Veterans age > or =65 years who received health care in the VA system during Fiscal Years (FY99-00), and also received at medications from the Veterans Administration in FY00. MEASURES: PIPE was identified using the Zhan adaptation of the Beers criteria. Geriatric care penetration was calculated as the proportion of patients within a facility who received at least 1 geriatric outpatient clinic or inpatient visit. ANALYSES: Logistic regression models with generalized estimating equations were used to assess the relationship between geriatric care and PIPE after controlling for patient and health care system characteristics. RESULTS: Patients receiving geriatric care were less likely to have PIPE exposure (odds ratio, 0.64; 95% confidence interval, 0.59-0.73). There was also a weak effect for geriatric care penetration, with a trend for patients in low geriatric care penetration facilities having higher risk for PIPE regardless of individual geriatric care exposure (odds ratio, 1.14; 95% confidence interval, 0.99-1.30). CONCLUSIONS: Although geriatric care is associated with a lower risk of PIPE, additional research is needed to determine if heterogeneity in the organization and delivery of geriatric care resulted in the weak effect of geriatric care penetration, or whether this is a result of low power.     

Geriatric problems and their management. The nursing perspective

Geriatric problems and its Nursing care is not like any other speciality which deals with one group of diseases. Older adults suffer from various disabilities and diseases. Geriatric group will lose memory power, bearing, eyesight, etc. The Nurse who deals with geriatric patients is expected to be well versed in all the aspects. She approaches the patients through Nursing process. She plans and directs the day-to-day Nursing care according to the situation that arises. Because of the scientific knowledge and modern techniques acquired by the Nurses and health care workers they are able to give a fairly comfortable life to the elderly people.     

Using nurse practitioners to implement best practice care for the elderly during hospitalization: the NICHE journey at the University of Virginia Medical Center

The Nurses Improving Care to Health System (NICHE) program has provided a valuable framework for developing initiatives that address the needs of the elderly. Three NICHE models have been implemented within the University of Virginia Health System since 1992. These include the Geriatric Resource Nurse model, the Acute Care of the Elderly model, and, most recently, the Geriatric Consultation Service model. Nurse practitioners (NPs) with geriatric expertise have provided the leadership in implementing these initiatives to achieve the goal of improving geriatric care delivery within the health system. Each NP functions in a broad role that is tailored to meet the needs of the patients and staff and includes the role components of clinician, educator, team leader, and care coordinator. Sustainability and growth of NICHE is contingent upon demonstrating favorable outcomes that can be directly attributed to NICHE.     

The geriatric emergency literature 2019

Geriatric Emergency Medicine is an important frontier for study and innovation by emergency practitioners. The rapid growth of this patient population combined with complex medical and social needs has prompted research ranging from which tests and screening tools are most effective for geriatric evaluation to how we can safely manage pain in the elderly or address goals of care in the Emergency Department. This review summarizes emergency medicine articles focused on the older patient population published in 2019, which the authors consider critical to the practice of geriatric emergency medicine.     

Gerontology and geriatric issues and trends in U.S. nursing programs: a national survey.

Elderly persons in the United States constitute an increasing proportion of our population impacting nursing education. The purpose of this study was to survey geriatric and gerontology issues and trends in U.S. baccalaureate schools of nursing since the advent of the American Association of Colleges of Nursing's (AACN's) Older Adults: Recommended Baccalaureate Competencies and Curricular Guidelines for Geriatric Nursing Care. A national mail survey of all accredited AACN baccalaureate programs was conducted, resulting in 202 responses and a 36% response rate. The results show that half of the respondents reported integrating geriatrics/gerontology, and half reported having stand-alone geriatric/gerontology courses. Results indicate key issues that warrant further investigation. These include: (1) faculty preparation related to geriatrics and gerontology; (2) gaps in implementing the AACN's Older Adults: Recommended Baccalaureate Competencies and Curricular Guidelines for Geriatric Nursing Care in both stand-alone courses and integrated curricula; and (3) the extent to which the AACN's Older Adults: Recommended Baccalaureate Competencies and Curricular Guidelines for Geriatric Nursing Care is addressed in undergraduate curricula. Trends noted include planning to offer and retaining required stand-alone geriatric/gerontology courses. These results may be useful to nurse educators and researchers who are grappling with nursing education issues concerning geriatric and gerontology preparation. Of importance is that nursing curricula reflect nursing faculty's commitment to addressing the health care needs of the burgeoning number of elderly persons in society.     

Implementing a multidimensional geriatric curriculum in a physical medicine and rehabilitation residency program

ABSTRACT: Residency training in physical medicine and rehabilitation may not contain a formal curriculum in geriatric patient care. A multidimensional geriatric curriculum to third and fourth year physical medicine and rehabilitation residents was implemented to enhance their knowledge in and attitude toward geriatrics. The curriculum consisted of a 12-wk clinical rotation at various sites of geriatric care including outpatient geriatric clinic, skilled nursing facility, continuing care retirement community, and home visits. Six online self-learning modules and multiple didactic sessions were also created. The residents' knowledge and attitude were assessed by pretest and posttest design using the Geriatric Knowledge Test, the Geriatric Attitude Scale, and the Attitudes Toward Teamwork in Healthcare Scale. In addition, the residents completed rotation evaluations to rate their learning experiences. Ten postgraduate year 3 and 4 physical medicine and rehabilitation residents participated in the geriatric curriculum, which included a required rotation. The Geriatric Knowledge Test score at baseline was 67.2%. With the completion of the curriculum, the Geriatric Knowledge Test scores showed improvement to 72.7%, although not statistically significant. The residents showed more favorable attitudes toward the geriatric population and interdisciplinary teamwork as measured by the Geriatric Attitude Scale and the Attitudes Toward Teamwork in Healthcare Scale. Overall, they rated the learning experiences highly on a 1-9 rating scale, with 9 being the highest rating; the residents assigned an average rating of 7.06 to specific learning activities within the rotation and an average rating of 6.89 to the organizational aspects of the rotation itself. The implementation of this geriatric curriculum allowed for improved geriatric training in physical medicine and rehabilitation residents.     

Geriatric pain competencies and knowledge assessment for nurses in long term care settings

Pain in older adults is a prevalent problem that affects quality of life and challenges nurses, particularly those caring for older adults living in long term care settings. Despite the national priority of pain management, insufficient knowledge of nurses about geriatric pain is a documented barrier to effective geriatric pain management in all long term care settings. To address this knowledge gap, a website (GeriatricPain.org) was developed by the National Geriatric Pain Collaborative with a grant from the MayDay Fund to provide a single site for evidenced-based, easy-to-use, downloadable resources on pain management. This paper describes the development of the most recent addition to the website, a set of evidence-based core geriatric pain management competencies and a geriatric pain knowledge assessment, and discusses their potential uses in improving pain care for older adults. Geriatric Pain Competencies and Knowledge Assessment for Nurses in Long Term Care Settings.     

Preparing the Front Line for the Increase in the Aging Population: Geriatric Curriculum Development for an Emergency Medicine Residency Program

Background: Emergency Departments (EDs) are common entry points to the health care system for elders. Emergency Medicine residents need specialized education about geriatric patients to maximize health outcomes. Objectives: To determine whether geriatric education provided to residents in Emergency Medicine results in improved knowledge of and attitudes toward geriatric patients. Method: A pre- and post-intervention survey was conducted in a 3-year university-based residency program in Emergency Medicine. Participants were Emergency Medicine residents (PGY 1–3). The curriculum “Care of the Aging Patient in Emergency Medicine” was introduced. Topic selection was based upon geriatric curriculum recommendations and resident surveys. Before starting the curriculum and at its conclusion, residents completed Geriatric Clinical Decision-making Assessments and the Geriatric Attitude Scale Survey. Pre- and post-assessments were compared. Residents also completed written assessments for each educational activity in the curriculum. Results: After participating in the program, residents demonstrated improved knowledge of the geriatric patient, and their attitudes toward caring for geriatric patients had shifted from negative to neutral or positive. One statistically relevant change centered on the item, “Taking a medical history from an elderly patient is an ordeal” (p = 0.033) Pre-intervention, 8.3% (n = 3) of residents strongly agreed with the statement. After the intervention, strong disagreement with the statement increased from 2.8% (n = 1) to 11% (n = 4) on the educational surveys. In addition, an increase in the percentage of neutral responses was observed. Conclusions: Using familiar educational formats with heavy emphasis on “hands-on” activities to present the geriatric care curriculum had a positive impact on resident knowledge and confidence in dealing with geriatric patients.