Saltvedt Ingvild, Jordhøy Marit, Opdahl Mo Ellen-Sofie, Fayers Peter, Kaasa Stein, Sletvold Olav
Division of Internal Medicine, Section of Geriatrics, St. Olavs University Hospital, Trondheim, Norway.
Gerontology. 2006;52(4):223-30. doi: 10.1159/000093654.
In two previous publications, we have shown that treatment of acutely sick, frail elderly patients in a Geriatric Evaluation and Management Unit (GEMU) compared to treatment in the general Medical Wards (MW) reduced mortality and improved the chances of living at home in contrast to living in nursing homes or being dead.
The aim of this presentation was to study the impact on function, symptoms of depression and general well-being of treatment in the GEMU as compared to treatment in MW.
Acutely sick, frail patients aged >or=75 years, admitted as emergencies to the Department of Internal Medicine, were randomised either to treatment in the GEMU (n = 127) or the MW (n = 127). In the GEMU the treatment strategy emphasised comprehensive interdisciplinary assessment of all relevant disorders, prevention of complications and iatrogenic conditions, early mobilisation, rehabilitation and discharge planning. The control group received treatment as usual from the Department of Internal Medicine. After discharge neither group received specific follow-up. Activities of daily living (ADL), instrumental ADL, cognitive function, symptoms of depression and general well-being were assessed 3, 6 and 12 months after discharge from hospital.
There was no difference in function, depression or general well-being in the GEMU as compared to the MW group. If the dead were included in the analysis at the highest ADL dependency level, there was better function in the GEMU group at 3 months (p = 0.03).
Treatment in the GEMU had no measurable beneficial impact on function, morale or symptoms of depression. Taken the previously shown mortality reduction into consideration an additional effect on function was less likely and the overall treatment effect was considered to be positive.
在之前的两篇出版物中，我们已经表明，与在普通内科病房（MW）接受治疗相比，在老年评估与管理单元（GEMU）对急性病、体弱的老年患者进行治疗可降低死亡率，并提高居家生活的几率，而非住在养老院或死亡。
本报告的目的是研究与MW治疗相比，GEMU治疗对功能、抑郁症状和总体幸福感的影响。
年龄≥75岁的急性病、体弱患者，作为内科急诊入院，被随机分配到GEMU治疗组（n = 127）或MW治疗组（n = 127）。在GEMU中，治疗策略强调对所有相关疾病进行全面的跨学科评估、预防并发症和医源性疾病、早期活动、康复和出院计划。对照组接受内科常规治疗。出院后两组均未接受特定随访。在出院后3个月、6个月和12个月评估日常生活活动（ADL）、工具性ADL、认知功能、抑郁症状和总体幸福感。
与MW组相比，GEMU组在功能、抑郁或总体幸福感方面没有差异。如果将死亡患者纳入最高ADL依赖水平的分析中，GEMU组在3个月时功能更好（p = 0.03）。
GEMU治疗对功能、士气或抑郁症状没有可测量的有益影响。考虑到之前显示的死亡率降低，对功能的额外影响不太可能，总体治疗效果被认为是积极的。
