Durso Samuel C
Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Md 21224, USA.
JAMA. 2006 Apr 26;295(16):1935-40. doi: 10.1001/jama.295.16.1935.
Increasingly, adults are living to an advanced age. While many enjoy good health, nearly 50% of adults older than 65 years have 3 or more chronic medical conditions. Furthermore, within any age-sex cohort, older adults exhibit widely heterogeneous health status--ranging from robust to frail. This heterogeneity and individual medical complexity makes care for older patients particularly challenging and requires both careful medical judgment and a clear understanding of the patient's personal values and goals. Most current health care guidelines are disease-specific and do not address this complexity and heterogeneity, thus limiting their utility for guiding physicians in the care of older adult patients. The "Guidelines for Improving the Care of Older Persons With Diabetes Mellitus" are the first guidelines to specifically address this complexity and provide guidance to physicians who must prioritize therapies and goals for older adults with diabetes, comorbid medical conditions, and geriatric syndromes. By providing a rationale for prioritizing recommendations and the inclusion of geriatric syndromes that impact the patient's overall health and diabetic care, these guidelines may serve as a model for the development of other guidelines targeting older adults with complex health status.
成年人活到高龄的情况越来越普遍。虽然许多人身体健康，但65岁以上的成年人中，近50%患有3种或更多慢性疾病。此外，在任何年龄-性别队列中，老年人的健康状况差异很大——从强健到虚弱不等。这种异质性和个体医疗复杂性使得照顾老年患者特别具有挑战性，需要仔细的医疗判断以及对患者个人价值观和目标的清晰理解。目前大多数医疗保健指南都是针对特定疾病的，没有涉及这种复杂性和异质性，因此限制了它们在指导医生照顾老年患者方面的效用。《改善老年糖尿病患者护理指南》是首批专门针对这种复杂性的指南，为那些必须为患有糖尿病、合并症和老年综合征的老年人确定治疗和目标优先级的医生提供指导。通过为确定建议优先级提供理由，并纳入影响患者整体健康和糖尿病护理的老年综合征，这些指南可作为制定其他针对健康状况复杂的老年人的指南的范例。
