Ambulantes Geriatrisches Assessment in der allgemeinärztlichen Sprechstunde - Wie häufig werden therapeutische Konsequenzen gezogen?

 

 Buy Article Permissions and Reprints

Diese Studie widmete sich der Fragestellung, ob sich ein geriatrisches Assessment in der Hausarztpraxis lohnt. In 67 Allgemeinpraxen aus dem Hannoverschen und Leipziger Raum wurden 446 ältere Patienten untersucht, wobei 4250 medizinische, 374 psychiatrische und 528 soziale Probleme festgestellt wurden. 45,4 % der medizinischen, 61,8 % der psychiatrischen and 56,8 % der sozialen Probleme waren den Ärzten bislang im Rahmen ihrer Routinebetreuung unbekannt geblieben. Die Ergebnisse ergaben wichtige Hinweise, welche Maßnahmen im Praxisalltag erfolgreich umzusetzen sind.

Aims: To evaluate the geriatric assessment of preventable disabilities in primary care. Methods: We used the Ages assessement instrument, a geriatric preventive screening examination with a patient, nurse and doctor administered questionnaire including various indicators of physical, emotional and social functions as well as laboratory exams. The assessment procedure was tested in 67 practices around Hannover and Leipzig, Germany. Results of the assessment procedure in 446 patients aged 70 and over revealed a high prevalence of treatable health problems. In these patients we found 4250 medical, 374 psychiatric and 528 social problems. 45,4 % of medical, 61,8 % of psychiatric and 56,8 % of social problems were hitherto unkown to the GPs. However the proportion of specific medical reactions of general practioners was considerably lower. In most instances the doctors adopted a wait and see strategy with no intervention. Doctors most often choose interventions which are efficient and easy to implement in daily practice.

Conclusions: Broad asessment instruments may detect a lot of morbidity previously unknown to the GP but they do not lead to therapy in all cases. Future research is needed to develop short instruments which focus on health problems both relevant to the elder persons quality of life and to the GPs appreciation of manageable interventions after geriatric assessment. Items to be included in future geriatric assessment procedures should be selected according to evidence based medicine (e.g. the number needed to treet for a desired outcome).

Literatur

• 1 Alessi CA, Stuck AE, Aronow HU, Yuhas KE, Bula CJ, Madison R. et al. . The process of care in preventive in-home comprehensive geriatric assessment.  J Am Geriatr Soc. 1997;  45 1044-1050
  PubMedGoogle Scholar
• 2 Applegate WB, Graney MJ, Miller ST, Elam JT. Impact of a geriatric assessment unit on subsequent health care charges.  Am J Public Health. 1991;  81 1302-1306
  PubMedGoogle Scholar
• 3 Bernabei R, Landi F, Gambassi G. et al. . Randomised trial of impact of model of integrated care and case management for older people living in the community.  BMJ. 1998;  316 1348-1351
  PubMedGoogle Scholar
• 4 Bula CJ, Berod AC, Stuck AE. et al. . Effectiveness of preventive in-home geriatric assessment in well functioning, community-dwelling older people: secondary analysis of a randomized trial.  J Am Geriatr Soc. 1999;  47 389-395
  PubMedGoogle Scholar
• 5 Devor M, Wang A, Renvall M. et al. . Compliance with social and safety recommendations in an outpatient comprehensive geriatric assessment program.  J Gerontol. 1994;  49 M168-M173
  PubMedGoogle Scholar
• 6 Esmail R, Brazil K, Lam M. Compliance with recommendations in a geriatric outreach assessment service.  Age Ageing. 2000;  29 353-356
  CrossrefPubMedGoogle Scholar
• 7 Fabacher D, Josephson K, Pietruszka F. et al. . An in-home preventive assessment program for independent older adults: a randomized controlled trial [see comments].  J Am Geriatr Soc. 1994;  42 630-638
  PubMedGoogle Scholar
• 8 Hay WI, Ineveld C van, Browne G. et al. . Prospective care of elderly patients in family practice. Is screening effective?.  Can Fam Physician. 1998;  44 2677-2687
  PubMedGoogle Scholar
• 9 Leveille SG, Wagner EH, Davis C. et al. . Preventing disability and managing chronic illness in frail older adults: a randomized trial of a community-based partnership with primary care.  J Am Geriatr Soc. 1998;  46 1191-1198
  PubMedGoogle Scholar
• 10 Lorig KR, Sobel DS, Stewart AL. et al. . Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial.  Med Care. 1999;  37 5-14
  CrossrefPubMedGoogle Scholar
• 11 McInnes E, Mira M, Atkin N. et al. . Can GP input into discharge planning result in better outcomes for the frail aged: results from a randomized controlled trial.  Fam Pract. 1999;  16 289-293
  CrossrefPubMedGoogle Scholar
• 12 Pacala JT, Boult C, Reed RL, Aliberti E. Predictive validity of the Pra instrument among older recipients of managed care [see comments].  J Am Geriatr Soc. 1997;  45 614-617
  PubMedGoogle Scholar
• 13 Reuben DB, Frank JC, Hirsch SH. et al. . A randomized clinical trial of outpatient comprehensive geriatric assessment coupled with an intervention to increase adherence to recommendations [see comments].  J Am Geriatr Soc. 1999;  47 269-276
  PubMedGoogle Scholar
• 14 Reuben DB, Maly RC, Hirsch SH. et al. . Physician implementation of and patient adherence to recommendations from comprehensive geriatric assessment.  Am J Med. 1996;  100 444-451
  CrossrefPubMedGoogle Scholar
• 15 Sandholzer H, Breull A, Fischer GC. Early diagnosis and early treatment of cognitive disorders: a study of geriatric screening of an unselected patient population in general practice.  Z Gerontol Geriatr. 1999;  32 172-178
  CrossrefPubMedGoogle Scholar
• 16 Sandholzer H, Hellenbrand W, Renteln-Kruse W. et al. . STEP - standardized assessment of elderly people in primary care.  Dtsch Med Wochenschr. 2004;  129 183-226
  Article in Thieme ConnectPubMedGoogle Scholar
• 17 Sandholzer H, Hellenbrand W, Renteln-Kruse W. et al. . An evidence-based approach to assessing older people in primary care.  Occas Pap R Coll Gen Pract. 2002;  82 1-53
  PubMedGoogle Scholar
• 18 Sandholzer H. Ambulatory geriatric care. Prevalence of impairment and disability, provision of care, risk factors of poor outcome and value of geratric assessment. Hannover: Hannover Medical School 1999
  Google Scholar
• 19 Shah PN, Maly RC, Frank JC. et al. . Managing geriatric syndromes: what geriatric assessment teams recommend, what primary care physicians implement, what patients adhere to.  J Am Geriatr Soc. 1997;  45 413-419
  PubMedGoogle Scholar
• 20 Stuck AE, Aronow HU, Steiner A. et al. . A trial of annual in-home comprehensive geriatric assessments for elderly people living in the community [see comments].  N Engl J Med. 1995;  333 1184-1189
  CrossrefPubMedGoogle Scholar
• 21 Stuck AE, Siu AL, Wieland GD. et al. . Comprehensive geriatric assessment: a meta-analysis of controlled trials.  Lancet. 1993;  342 1032-1036
  CrossrefPubMedGoogle Scholar
• 22 Stuck AE. Geriatric assessment: possibilities and limits.  Z Gerontol Geriatr. 1995;  28 3-6
  PubMedGoogle Scholar
• 23 Vetter NJ, Jonas DA, Victor CR. Effect of health visitors working with elderly patients in general practice: a randomised controlled trial.  Br Med J. 1984;  288 369-372
  PubMedGoogle Scholar
• 24 Vickrey BG, Mittman BS, Connor KI. et al. . The effect of a disease management intervention on quality and outcomes of dementia care: a randomized, controlled trial.  Ann Intern Med. 2006;  145 713-726
  PubMedGoogle Scholar

Korrespondenz

Prof. Dr. med. Gisela Fischer

Emeritus

Hainburgweg 7

30559 Hannover

Email: giselacharl.fischer@t-online.de