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Kapsamlı geriatrik değerlendirme

Yıl 2010, Cilt: 49 Sayı: 3 - Ek Sayı, 19 - 30, 30.09.2010

S Savaş F Akçiçek

Öz

Tüm dünyada 65 yaş ve üzeri yaşlı nüfus giderek artmakta, toplumların yaşlanması ile sağlık hizmetlerinin yaşlı nüfus tarafından kullanımı da artmaktadır. Yaşlı hastanın sağlık durumunun bir bütün olarak değerlendirilmesi, geriatrik değerlendirme ile mümkün olur. Sağlıklı olma durumu, bazıları tıbbi olmak üzere pek çok faktörün etkileşimi ile ortaya çıkan bir sonuçtur. Geriatrik hasta psikolojik, sosyoekonomik, ailesel ve toplum sağlığı açılarından farklı bir yaş grubudur; fonksiyonel kapasitede azalmalar ve kayıplar olmaktadır. Organ sistemlerinde meydana gelen fizyolojik değişiklikler sonucu oluşan yaşlanma ile hastalıklara bağlı bulgular birbirinden ayrılmalıdır. Hastalıklar sık ve atipik seyirlidir. Bu nedenle tam bir fonksiyonel değerlendirme, geleneksel tıbbi değerlendirmeden daha bütüncüldür. Bu değerlendirmenin esas amacı fonksiyonel durumu korumak veya geliştirmektir. Kapsamlı geriatrik değerlendirme;
uygun hastaların taranması, değerlendirmenin ardından önerilerin geliştirilmesi, hekim ve hastanın hemfikir olduğu önerilerin uygulanması şeklinde üç basamaklıdır. Değerlendirmede sıklıkla skalalar kullanılır ve interdisipliner ekip ön plandadır. Geriatrik değerlendirmenin bileşenleri; bilişsel fonksiyonlar, duygudurum, fonksiyonel durum, beslenme, mobilite, inkontinans, görme, işitme, bakıcı yükü, sosyal destek ve fiziksel çevredir. Sonuçlar gelecekteki karşılaştırmalı değerlendirmelerde, tanıda, tedavi izleminde, prognostik bilgi olarak ve ileriye yönelik planlama
sürecinde kullanılır.

Anahtar Kelimeler

yaşlı geriatri geriatrik değerlendirme kapsamlı

Kaynakça

  • Murayama L, Ahmed I. The geriatric patient. Leigh H, Streltzer J, ed. Handbook of Consultation-Liaison Psychiatry. Springer, 2007:341-360.
  • Yavuz BB. Geriatrik değerlendirme ve testler. İç Hastalıkları Dergisi 2007; 14:5-17.
  • Osterweil D. Comprehensive geriatric assessment: lessons in progress. Isr Med Assoc J 2003; 5:371-374.
  • Solomon DH. Foreword. Osterweil D, Brummel-Smith K, Beck JC, ed. Comprehensive Geriatric Assessment. New York: McGraw-Hill, 2000:787-799. (Osterweil D. Comprehensive geriatric assessment: lessons in progress. Isr Med Assoc J 2003; 5:371-374.)’den alınmıştır.
  • Geriatric Assessment Methods for Clinical Decision Making. NIH Consensus Statement, 1987; 6:1-21.http://consensus.nih.gov/1987/1987GeriatricAssessment065html.htm (accessed on September 2009)
  • Cankurtaran M, Halil M. Geriatrik hastaya yaklaşım. Turkiye Klinikleri J Med Sci 2008; 28(Suppl):S262-S266.
  • Fried LP, Tangen CM, Walston J, Newman AB, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56:M146-M156.
  • Halil MG. Geriatrik medikal değerlendirme. Arıoğul S, ed. Geriatri ve Gerontoloji. Ankara: MN Medikal & Nobel, 2006:137-147.
  • Rubenstein LZ, Josephson KR, Wieland D, et al. The effectiveness of a geriatric evaluation unit. N Engl J Med 1984; 311:1164- 770.
  • Wieland D, Ferrucci L. Multidimensional geriatric assessment: back to the future. J Gerontol Med Sci 2008; 63:272-274.
  • Johnston B. Geriatric assessment. Landefeld CS, Palmer RM, Johnson MA, et al eds. Current Geriatric Diagnosis and Treatment. McGraw-Hill, 2004:16-26.
  • Stuck AE, Aronow HU, Steiner A, et al. A trial of annual in-home comprehensive geriatric assessments for elderly people living in the community. N Engl J Med 1995; 333:1184-1189.
  • Cassel CK: Geriatric Medicine. An Evidence-Based Approach. 4. baskı. New York: Springer, 2006:149-211.
  • Reuben DB, Herr KA, Pacala JT et al. Geriatrics At Your Fingertips. 11. baskı. New York: The American Geriatrics Society, 2009:4-11.
  • Soriano RP. The comprehensive geriatric assessment. Soriano RP ed. Fundamentals of Geriatric Medicine. New York: Springer, 2007:20-38.
  • Şimşir IY, Akçiçek F. Geriatrik hastalarda fizik muayene ve laboratuvar değerlendirmesi. Kutsal YG, ed. Temel Geriatri. Ankara: Güneş Tıp Kitabevleri, 2007:121-123.
  • Robbins JA, Bertakis KD, Helms LJ et al. The influence of physician practice behaviors on patient satisfaction. Fam Med 1993; 25:17-20.
  • Elie M, Cole MG, Pimeau FJ, et al. Delirium risk factors in elderly hospitalized patients. J Gen Intern Med 1998; 13:204–212.
  • Sink KM, Yaffe K. Cognitive Impairment and Dementia. Landefeld CS, Palmer RM, Johnson MA, et al eds. Current Geriatric Diagnosis and Treatment. McGraw-Hill. 2004:60-73.
  • Folstein MF, Folstein SE, McHugh PR. Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12:189–198.
  • Tombaugh TN, McIntyre NJ. The mini-mental state examination: a comprehensive review. J Am Geriatr Soc 1992; 40:922– 935.
  • Güngen C, Ertan T, Eker E, Yaşar R ve ark. Standardize Mini Mental Test’in Türk toplumunda hafif demans tanısında geçerlik ve güvenilirliği. Türk Psikiyatri Dergisi 2002; 13:273-281.
  • Lin KN, Wang PN, Chen C et al. The three-item clock-drawing test: a simplified screening test for Alzheimer's disease. Eur Neurol 2003; 49:53-8.
  • Inouye SK, van Dyck CH, Alessi CA et al. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med. 1990; 113:941-948.
  • Wei LA, Fearing MA, Sternberg EJ, Inouye SK. The confusion assessment method: a systematic review of current usage. J Am Geriatr Soc 2008; 56:823-30.
  • Lebowitz BD, Pearson JL, Schneider LS. Diagnosis and treatment of depression in late life. Consensus statement update. JAMA 1997; 278:1186-1190.
  • Eker E, Ütücü N. Yaşlı populasyonda fiziksel hastalıklar ve depresyon. Akad Geriatri 2009; 1:90-97.
  • Lachs MS, Feinstein AR, Cooney LM Jr. A simple procedure for general screening for functional disability in elderly patients. Ann Intern Med 1990; 112:699-706.
  • Mahoney J, Drinka TJK, Abler R, et al. Screening for depression: single question versus GDS. J Am Geriatr Soc 1994; 42:1006–1008. (Cassel CK, Geriatric Medicine. An Evidence-Based Approach. 4. baskı. New York: Springer, 2006:149- 211)’den alınmıştır.
  • Maly RC, Hirsch SH, Reuben DB. The performance of simple instruments in detecting geriatric conditions and selecting community-dwelling older people for geriatric assessment. Age Ageing 1997; 26:223–231. (Cassel CK, Geriatric Medicine. An Evidence-Based Approach. 4. baskı. New York: Springer, 2006:149-211)’den alınmıştır.
  • Yesavage JA, Brink TL, Rose TL et al. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res. 1983; 17:37-49.
  • Burke WJ, Roccaforte WH, Wengel SP. The short form of the Geriatric Depression Scale: a comparison with the 30-item form. J Geriatr Psychiatry Neurol. 1991; 4:173-178.
  • Ertan T, Eker E. Reliability, validity, and factor structure of the geriatric depression scale in Turkish elderly: are there different factor structures for different cultures? Int Psychogeriatr 2000; 12:163-172.
  • Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B. Screening for undernutrition in geriatric practice: developing the shortform mini-nutritional assessment (MNA-SF). J Gerontol A Biol Sci Med Sci 2001; 56:M366-M372.
  • Wyles H, Reh man HU. Inappropriate polypharmacy in the elderly. Eur J Intern Med 2005; 16:311-3.
  • Balducci L, Beghe C. The application of the principles of geriatrics to the management of the older person with cancer. Crit Rev Oncol Hematol 2000; 35:147-154.
  • Saltvedt I, Spigset O, Ruths S et al. Patterns of drug prescription in a geriatric evaluation and management unit as compared with the general medical wards: a randomised study. Eur J Clin Pharmacol 2005; 61:921-928.
  • Bernabei R, Venturiero V, Tarsitani P, Gambassi G. The comprehensive geriatric assessment: when, where, how. Crit Rev Oncol Hematol 2000; 33:45-56.
  • Panel for the Prediction and the Prevention of Pressure Ulcers in Adults. Pressure Ulcers in Adults: Prediction and Prevention. Clinical Practice Guideline, Number 3 AHCPR Publication No.92-0047. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, US Department of Health and Human Services, 1992. . http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=hsahcpr&part=A4409 ( accessed on September 2009)
  • Reuben DB, Wieland DL, Rubinsein LZ. Functional status assessment of older persons: concepts and implications. Facts Res Gerontol 1993; 7:232. (Cassel CK, Geriatric Medicine. An Evidence-Based Approach. 4. baskı. New York: Springer, 2006:149- 211.)’den alınmıştır.
  • Katz S, Downs TD, Crash H, et al. Progress in development of the index of ADL. Gerontologist 1970; 10:20-30.
  • Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969; 9:179-186.
  • Reuben DB, Solomon DH. Assessment in geriatrics of caveats and names. J Am Geriatr Soc 1989; 37:570-572.
  • Mahoney FL, Barthel DA. Functional evaluation: The Barthel Index. Md State Med J 1965; 14:61-65. (Yavuz BB. Geriatrik Değerlendirme ve Testler. İç Hastalıkları Dergisi 2007; 14:5-17)’den alınmıştır.
  • Gary Sinoff G, Ore L. The Barthel Activities of Daily Living Index: Self-Reporting Versus Actual Performance in the Old-Old (≥75 years). J Am Geriatr Soc 1997; 45: 832-836.
  • Ferrer A, Formiga F, Ruiz D. Predictive items of functional decline and 2-year mortality in nonagenarians--the NonaSantfeliu study. Eur J Public Health 2008; 18:406-409.
  • Tinetti ME, Baker DI, McAvay G. A multifactorial intervention to reduce the risk of falling among elderly people living in the community. N Engl J Med1994; 331:821-827.
  • Podsiadlo D, Richardson J. The timed “up and go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991; 39:142-148.
  • Tinetti ME. Performance-oriented assessment of mobility problems in elderly patients. J Am Geriatr Soc 1986; 34:119-126.

Comprehensive geriatric assessment

Yıl 2010, Cilt: 49 Sayı: 3 - Ek Sayı, 19 - 30, 30.09.2010

S Savaş F Akçiçek

Öz

The geriatric population is composed of people aging 65 years and over and is growing throughout the world. The increase in the utilization of health services by the elderly correlates directly with the population aging. Geriatric assessment refers to an overall evaluation of the health status of the elderly patient. The well-being is the result of the interactions among a number of factors, some of which are medical. Geriatric patients differ from adult patients in
terms of psychological and socioeconomical aspects as well as familial situation and community health. They have functional decline and losses. Comorbidity is frequent and diseases occur atypically. Functional assessment is more holistic than the traditional medical evaluation. The ultimate goal of evaluation is to improve or maintain function.
Comprehensive geriatric assessment is a three-step process:(1) screening appropriate patients; (2) assessment and development of recommendations; (3) implementation of recommendations, including physician and patient adherence. Geriatric assessment is interdisciplinary and instruments (i.e. scales) are used frequently. The components of geriatric assessment include the evaluation of cognitive function, affective disorders, sensory impairment, functional status, nutrition, mobility, social support, physical environment and caregiver burden. The results may be used for making diagnoses, monitoring the course of treatment, providing prognostic information,
performing future comparisons and planning future directives.

Anahtar Kelimeler

elderly geriatrics geriatric assessment comprehensive

Kaynakça

  • Murayama L, Ahmed I. The geriatric patient. Leigh H, Streltzer J, ed. Handbook of Consultation-Liaison Psychiatry. Springer, 2007:341-360.
  • Yavuz BB. Geriatrik değerlendirme ve testler. İç Hastalıkları Dergisi 2007; 14:5-17.
  • Osterweil D. Comprehensive geriatric assessment: lessons in progress. Isr Med Assoc J 2003; 5:371-374.
  • Solomon DH. Foreword. Osterweil D, Brummel-Smith K, Beck JC, ed. Comprehensive Geriatric Assessment. New York: McGraw-Hill, 2000:787-799. (Osterweil D. Comprehensive geriatric assessment: lessons in progress. Isr Med Assoc J 2003; 5:371-374.)’den alınmıştır.
  • Geriatric Assessment Methods for Clinical Decision Making. NIH Consensus Statement, 1987; 6:1-21.http://consensus.nih.gov/1987/1987GeriatricAssessment065html.htm (accessed on September 2009)
  • Cankurtaran M, Halil M. Geriatrik hastaya yaklaşım. Turkiye Klinikleri J Med Sci 2008; 28(Suppl):S262-S266.
  • Fried LP, Tangen CM, Walston J, Newman AB, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56:M146-M156.
  • Halil MG. Geriatrik medikal değerlendirme. Arıoğul S, ed. Geriatri ve Gerontoloji. Ankara: MN Medikal & Nobel, 2006:137-147.
  • Rubenstein LZ, Josephson KR, Wieland D, et al. The effectiveness of a geriatric evaluation unit. N Engl J Med 1984; 311:1164- 770.
  • Wieland D, Ferrucci L. Multidimensional geriatric assessment: back to the future. J Gerontol Med Sci 2008; 63:272-274.
  • Johnston B. Geriatric assessment. Landefeld CS, Palmer RM, Johnson MA, et al eds. Current Geriatric Diagnosis and Treatment. McGraw-Hill, 2004:16-26.
  • Stuck AE, Aronow HU, Steiner A, et al. A trial of annual in-home comprehensive geriatric assessments for elderly people living in the community. N Engl J Med 1995; 333:1184-1189.
  • Cassel CK: Geriatric Medicine. An Evidence-Based Approach. 4. baskı. New York: Springer, 2006:149-211.
  • Reuben DB, Herr KA, Pacala JT et al. Geriatrics At Your Fingertips. 11. baskı. New York: The American Geriatrics Society, 2009:4-11.
  • Soriano RP. The comprehensive geriatric assessment. Soriano RP ed. Fundamentals of Geriatric Medicine. New York: Springer, 2007:20-38.
  • Şimşir IY, Akçiçek F. Geriatrik hastalarda fizik muayene ve laboratuvar değerlendirmesi. Kutsal YG, ed. Temel Geriatri. Ankara: Güneş Tıp Kitabevleri, 2007:121-123.
  • Robbins JA, Bertakis KD, Helms LJ et al. The influence of physician practice behaviors on patient satisfaction. Fam Med 1993; 25:17-20.
  • Elie M, Cole MG, Pimeau FJ, et al. Delirium risk factors in elderly hospitalized patients. J Gen Intern Med 1998; 13:204–212.
  • Sink KM, Yaffe K. Cognitive Impairment and Dementia. Landefeld CS, Palmer RM, Johnson MA, et al eds. Current Geriatric Diagnosis and Treatment. McGraw-Hill. 2004:60-73.
  • Folstein MF, Folstein SE, McHugh PR. Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12:189–198.
  • Tombaugh TN, McIntyre NJ. The mini-mental state examination: a comprehensive review. J Am Geriatr Soc 1992; 40:922– 935.
  • Güngen C, Ertan T, Eker E, Yaşar R ve ark. Standardize Mini Mental Test’in Türk toplumunda hafif demans tanısında geçerlik ve güvenilirliği. Türk Psikiyatri Dergisi 2002; 13:273-281.
  • Lin KN, Wang PN, Chen C et al. The three-item clock-drawing test: a simplified screening test for Alzheimer's disease. Eur Neurol 2003; 49:53-8.
  • Inouye SK, van Dyck CH, Alessi CA et al. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med. 1990; 113:941-948.
  • Wei LA, Fearing MA, Sternberg EJ, Inouye SK. The confusion assessment method: a systematic review of current usage. J Am Geriatr Soc 2008; 56:823-30.
  • Lebowitz BD, Pearson JL, Schneider LS. Diagnosis and treatment of depression in late life. Consensus statement update. JAMA 1997; 278:1186-1190.
  • Eker E, Ütücü N. Yaşlı populasyonda fiziksel hastalıklar ve depresyon. Akad Geriatri 2009; 1:90-97.
  • Lachs MS, Feinstein AR, Cooney LM Jr. A simple procedure for general screening for functional disability in elderly patients. Ann Intern Med 1990; 112:699-706.
  • Mahoney J, Drinka TJK, Abler R, et al. Screening for depression: single question versus GDS. J Am Geriatr Soc 1994; 42:1006–1008. (Cassel CK, Geriatric Medicine. An Evidence-Based Approach. 4. baskı. New York: Springer, 2006:149- 211)’den alınmıştır.
  • Maly RC, Hirsch SH, Reuben DB. The performance of simple instruments in detecting geriatric conditions and selecting community-dwelling older people for geriatric assessment. Age Ageing 1997; 26:223–231. (Cassel CK, Geriatric Medicine. An Evidence-Based Approach. 4. baskı. New York: Springer, 2006:149-211)’den alınmıştır.
  • Yesavage JA, Brink TL, Rose TL et al. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res. 1983; 17:37-49.
  • Burke WJ, Roccaforte WH, Wengel SP. The short form of the Geriatric Depression Scale: a comparison with the 30-item form. J Geriatr Psychiatry Neurol. 1991; 4:173-178.
  • Ertan T, Eker E. Reliability, validity, and factor structure of the geriatric depression scale in Turkish elderly: are there different factor structures for different cultures? Int Psychogeriatr 2000; 12:163-172.
  • Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B. Screening for undernutrition in geriatric practice: developing the shortform mini-nutritional assessment (MNA-SF). J Gerontol A Biol Sci Med Sci 2001; 56:M366-M372.
  • Wyles H, Reh man HU. Inappropriate polypharmacy in the elderly. Eur J Intern Med 2005; 16:311-3.
  • Balducci L, Beghe C. The application of the principles of geriatrics to the management of the older person with cancer. Crit Rev Oncol Hematol 2000; 35:147-154.
  • Saltvedt I, Spigset O, Ruths S et al. Patterns of drug prescription in a geriatric evaluation and management unit as compared with the general medical wards: a randomised study. Eur J Clin Pharmacol 2005; 61:921-928.
  • Bernabei R, Venturiero V, Tarsitani P, Gambassi G. The comprehensive geriatric assessment: when, where, how. Crit Rev Oncol Hematol 2000; 33:45-56.
  • Panel for the Prediction and the Prevention of Pressure Ulcers in Adults. Pressure Ulcers in Adults: Prediction and Prevention. Clinical Practice Guideline, Number 3 AHCPR Publication No.92-0047. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, US Department of Health and Human Services, 1992. . http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=hsahcpr&part=A4409 ( accessed on September 2009)
  • Reuben DB, Wieland DL, Rubinsein LZ. Functional status assessment of older persons: concepts and implications. Facts Res Gerontol 1993; 7:232. (Cassel CK, Geriatric Medicine. An Evidence-Based Approach. 4. baskı. New York: Springer, 2006:149- 211.)’den alınmıştır.
  • Katz S, Downs TD, Crash H, et al. Progress in development of the index of ADL. Gerontologist 1970; 10:20-30.
  • Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969; 9:179-186.
  • Reuben DB, Solomon DH. Assessment in geriatrics of caveats and names. J Am Geriatr Soc 1989; 37:570-572.
  • Mahoney FL, Barthel DA. Functional evaluation: The Barthel Index. Md State Med J 1965; 14:61-65. (Yavuz BB. Geriatrik Değerlendirme ve Testler. İç Hastalıkları Dergisi 2007; 14:5-17)’den alınmıştır.
  • Gary Sinoff G, Ore L. The Barthel Activities of Daily Living Index: Self-Reporting Versus Actual Performance in the Old-Old (≥75 years). J Am Geriatr Soc 1997; 45: 832-836.
  • Ferrer A, Formiga F, Ruiz D. Predictive items of functional decline and 2-year mortality in nonagenarians--the NonaSantfeliu study. Eur J Public Health 2008; 18:406-409.
  • Tinetti ME, Baker DI, McAvay G. A multifactorial intervention to reduce the risk of falling among elderly people living in the community. N Engl J Med1994; 331:821-827.
  • Podsiadlo D, Richardson J. The timed “up and go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991; 39:142-148.
  • Tinetti ME. Performance-oriented assessment of mobility problems in elderly patients. J Am Geriatr Soc 1986; 34:119-126.
Toplam 49 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Araştırma Makaleleri
Yazarlar

S Savaş 0000-0003-4836-3786

F Akçiçek 0000-0003-2583-4709

Yayımlanma Tarihi 30 Eylül 2010
Gönderilme Tarihi 12 Temmuz 2010
Yayımlandığı Sayı Yıl 2010Cilt: 49 Sayı: 3 - Ek Sayı

Kaynak Göster

Vancouver Savaş S, Akçiçek F. Kapsamlı geriatrik değerlendirme. ETD. 2010;49(3):19-30.
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