老年综合评估快速筛查软件的设计及应用

目的 自主研发老年综合评估(CGA)快速筛查软件,将该软件应用于临床并进行效果评价.方法 借助计算机网络及信息技术,由老年医学、护理学专家与信息技术人员共同研发快速筛查的CGA软件.比较软件应用前后病人进行CGA的平均时间、准确率及病人满意率. 结果 快速筛查的CGA软件使用后,评估所用时间由原先的79.5(53.0,...     

老年综合评估及其应用

<正>随着人口老龄化进展加快,老年患者逐年增加,临床医师的接诊量也随之增长。这些老年患者不仅患有多种慢性疾病和老年综合征,而且还存在复杂的心理和社会问题。随着增龄和各器官系统的逐渐老化,老年人会出现一系列非特异性症状,许多被认为"老化"的症状,可能就是老年疾病和潜在问题的不同表现,甚至可能是老年患者功能丧失前的早期唯一表现。随着增龄,越来越多的老年人处于亚健康或疾病状态,具有多病共存、多系统功能障碍、     

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进展

正随着世界老龄化的步伐,中国已进入了老龄化社会,根据我国第六次全国人口普查数据,60岁人口已占13.26%,65岁人口占8.87%,生活不能自理的老年人口比例接近3%。全国老龄委办公室公布数据提示,到2013年底,中国老年人口总数已2亿。为了更好地改善老年人群的健康状况,提高生活质量,作为老年科医     

老年综合评估在老年高血压患者综合治疗中的应用

目的研究老年综合评估在老年高血压患者综合治疗中的应用。方法选取122例老年原发性高血压患者,随机分为试验组61例和对照组61例。试验组在口服降压药物治疗的同时进行老年综合评估,并依据评估结果实施相应干预措施。观察2组治疗前和治疗后的血压变化情况,并进行分析。结果试验组和对照组治疗后偶侧收缩压/舒张压均较治疗前降低[(132. 72±10. 53)/(69. 28±6. 49) mm Hg(1 mm Hg=0. 133 k Pa) vs (165. 54±9. 28)/(82. 46±8. 87) mm Hg,(147. 21±8. 85)/(69. 61±4. 63) mm Hg vs (164. 26±8. 99)/(81. 92±9. 74) mm Hg,P 0. 01];试验组偶测收缩压较对照组下降更明显(P 0. 01)。试验组和对照组治疗后24 h收缩压/舒张压较治疗前降低[(131. 57±10. 14)/(69. 05±6. 04) mm Hg vs (161. 33±10. 10)/(80. 84±7. 86) mm Hg,(144. 30±8. 69)/(70. 51±4. 88) mm Hg vs (161. 28±8. 92)/(80. 10±7. 73) mm Hg,P 0. 01];试验组24 h收缩压较对照组下降更明显(P 0. 01)。2组治疗后的血压变异性均较治疗前明显降低,且试验组降低更为明显(P 0. 05,P 0. 01)。结论高血压患者进行老年综合评估,能够提高或维持其生活质量,使降压治疗效果更优化。     

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。     

老年综合评估在老年肿瘤病人中的应用

<正>恶性肿瘤与机体衰老有关,在老年人群中高发,是老年人的常见病,也是主要的死亡原因。由于老年人常多病共存,恶性肿瘤的症状有时不明显,在治疗过程中,多病体质又影响病人对药物治疗的耐受性~([1])。因此,对于老年肿瘤病人,需要评估病人的功能状态,以指导病人选择合理的化疗方案。老年综合评估(comprehensive geriatric assessment,CGA)已在国际上被广     

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。     

老年综合评估研究进展

<正>老年综合评估(CGA)被广泛运用于临床研究,尤其肿瘤领域〔1~4〕。这些研究可归为4类〔5~18〕:1发现潜在的健康问题;2预测治疗结果及存活状况;3实现多学科联合干预;4CGA的可行性。见表1。本文对运用CGA的临床研究进行综述。     

Assessing falls in older adults: a comprehensive fall evaluation to reduce fall risk in older adults

Falls account for significant morbidity and mortality in the older adult population. A comprehensive fall evaluation (CFE) is proposed, particularly for use in recurrent fallers, those who seek medical attention for a fall, and those with a gait and/or balance disorder. The CFE focuses on key factors in the medical and fall history, review of systems, and physical examination. Interventions utilize a multifactorial model, although balance exercise may be the most critical component. While some components may be marginally successful when presented individually as an intervention (such as correction of vision impairment or environmental hazard reduction), when presented together, fall risk can be significantly reduced.     

Preliminary evaluation of a self-guided fall risk assessment tool for older adults

Falls are a major health problem for older adults with significant physical and psychological consequences. The first step of successful fall prevention is to identify those at risk of falling. Recent technology advancement offers the possibility of objective, lowcost and self-guided fall risk assessment. The present work evaluated the preliminary validity and usability of a Kinect camera-based selfinitiated fall risk assessment system in a hospital setting. A convenience sample of 29 female participants (77.5 ± 7.9 years old) enrolled in this study. This low-cost self-guided system included a Kinect depth-sensing camera, a PC-based computer, and custom-built software. An onscreen Fall Risk Assessment Avatar (FRAAn) utilizing visual and verbal instructions led participants through a fall risk assessment consisting of self-report measures and clinically validated balance and mobility tests. Participants also completed clinical fall risk evaluation (Timed-Up and Go, and Berg Balance Scale) led by a researcher. User experience was evaluated by the System Usability Scale (SUS). Results indicate that FRAAn-based outcome measures (postural sway metrics, and sit-to-stand speed) were highly correlated with clinical fall risk measures, and were able to differentiate individuals with increased fall risk. Additionally, 83% participants reported high usability (SUS > 80), indicating the system is well received among older users. Overall, our results indicate that the FRAAn system has promise for providing a self-guided fall risk assessment, and is well received by older users. This affordable, portable and self-guided system has potential to facilitate objective fall risk assessment in older adults in various settings.     

Smoking-cessation advice delivered to older adults accessing primary care: a qualitative study

BackgroundThe health benefits of smoking cessation in older adults, defined in most developed societies as a chronological age of 65 years or over, are well documented and show that gains in health and quality of life can be achieved among older smokers with long-term smoking histories. However, older adults rarely access smoking-cessation services, and little is known about the factors that affect involvement in attempts to quit in this group. The aim of this study was to explore issues surrounding engagement of older smokers with smoking-cessation support delivered in primary care.MethodsQualitative face-to-face interviews with smokers aged over 65 years who were registered at a general practice in a large city in the UK were conducted during December, 2014, guided by a semi-structured schedule of discussion points. Interviews were recorded, transcribed verbatim, and analysed with thematic framework analysis. Ethics approval was granted by NRES Committee North East - Tyne & Wear South.Findings68 eligible older smokers were identified, and seven participants with a median age of 69 years (IQR 71·5–67·2) were recruited. Although all participants reported awareness of the harms of smoking and the benefits of quitting, most (n=5, 71%) felt strongly about smoking as a personal choice that should be respected, and reported not to have acted on smoking-cessation advice provided by clinicians in the past. Some (3, 43%) questioned the validity of the information provided by primary care clinicians and expressed doubts about the effectiveness of evidence-based smoking-cessation support. Many (6, 86%) stated that they would consider stopping smoking only after the onset of substantial smoking-related disease. Potential barriers to quitting mentioned included a lack of motivation (5, 71%), uncertainties related to ageing and mobility (4, 57%), and the older person's social arrangements—eg, living with another smoker (4, 57%).InterpretationPrimary care clinicians should provide consistent personalised advice on the benefits of quitting in later life, and counteract misconceptions about the effectiveness of smoking-cessation treatments to improve the impact of advice. Our results indicate that older people with a longstanding smoking history can be difficult to engage in attempts to quit.FundingThis study was supported by NHS Nottingham City Clinical Commissioning Group via Research for Patient Benefit funding from the National Institute for Health Research.     

The application of a generativity model for older adults

Generativity is a concept first introduced by Erik Erikson as a part of his psychosocial theory which outlines eight stages of development in the human life. Generativity versus stagnation is the main developmental concern of middle adulthood; however, generativity is also recognized as an important theme in the lives of older adults. Building on the work of Erikson, McAdams and de St. Aubin (1992) developed a model explaining the generative process. The aims of this article are: (a) to explore the relationship between generativity and older adults as it appears in research literature; and (b) to examine McAdam's model and use it to explain the role of generativity in older adults who share life stories with gerontology students through an oral history project.     

Characteristics of older adults living with HIV accessing home and community care services in British Columbia,Canada

ABSTRACT

Over half of people living with HIV (PLHIV) engaged in care in British Columbia (BC) are age ≥50. The public home and community care (HCC) system offers formal support that PLHIV may turn to as they age, but little is known about access specific to PLHIV. Using data from the STOP HIV/AIDS cohort, which includes linked treatment and demographic records for PLHIV accessing care in BC, we compared older PLHIV (defined as those age ≥50) who did and did not access HCC services. We estimated adjusted odds ratios (aORs) for factors associated with HCC service utilization using logistic regression. This study included 5,603 PLHIV age ≥50, 837 (14.94%) of whom accessed any HCC service between 2005 and 2015. Services most commonly used were community nursing (8.98%, n?=?503) and rehabilitation (7.73%, n?=?433). Those who received HCC were more likely to be female (aOR?=?1.56, 95% CI?=?1.24, 1.98), have a history of injection drug use (aOR?=?1.88, 95% CI?=?1.57, 2.25), have a higher Charlson comorbidity score (aOR?=?1.11, 95% CI:1.07, 1.15) and to have visited a general practitioner in the past year (aOR?=?2.17, 95% CI?=?1.77, 2.67). Approximately 15% of older PLHIV have accessed HCC, but the extent of potential unmet need for these services requires further research.     

A medical care model using comprehensive geriatric assessment for community-dwelling older Korean adults

BackgroundThe quality of life of older adults deteriorates when they lose their ability to perform activities of daily living. Therefore, the older adults should be assessed to identify risk factors for functional decline and to correct these factors so that they may live as independently as possible in the community. We developed a medical care model using comprehensive geriatric assessment (CGA) for community-dwelling older patients.MethodsThree hundred and ninety-one older adults who were frail or likely to be frail were selected. CGA was performed before and after the interventions to determine the effect of the interventions. Three interventions—exercise training, nutritional education, and medication reconciliation—were performed for 5.1 ± 0.6 months.ResultsA comparison of the results of the first and second assessments revealed that the participants showed improvement in physical function, quality of life, medication, and nutrition. The average gait speed had increased from 0.77 ± 0.17 m/s to 0.89 ± 0.20 m/s (P < 0.001). For health-related quality of life, the average EuroQol-5 dimension-3L score for each domain decreased significantly. The number of patients with polypharmacy decreased from 181(50 %) to 155(43 %) (P = 0.001). The number of patients who were at risk of malnutrition or malnourished decreased from 72(20 %) to 45(12 %) (P < 0.001). The majority of participants were highly satisfied and were willing to participate again.ConclusionOur medical model based on CGA showed a significantly positive effect on the physical function and quality of life of community-dwelling older adults. Our model may be a promising strategy for improving the care of them.