Winograd C H
Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Palo Alto, CA 94304.
J Am Geriatr Soc. 1991 Sep;39(9 Pt 2):25S-35S. doi: 10.1111/j.1532-5415.1991.tb05930.x.
Researchers generally agree that Geriatric Evaluation and Management (GEM) Units are effective only when they are targeted at a specific group of frail, elderly patients who are most likely to benefit. Such patients are those who are neither too sick (eg, severely demented or moribund) nor too well. Various strategies for identifying such patients have been employed by investigators with little consensus on the most efficient targeting criteria. Criteria most often use for inclusion in GEM programs are various combinations of patient age, degree of functional impairment, presence of geriatric conditions (eg falls, incontinence, confusion), particular diagnostic conditions (eg, multiple disorders), and psychosocial conditions (eg, living alone, recent bereavement, low income). Commonly used exclusion factors are severe dementia, inevitable nursing home placement, and terminal illness. Outcome studies suggest that beneficial effects of GEM care are most apparent when patients are selected using specific clinical criteria. Future research on targeting should address the potential need for differing criteria in different settings (eg, inpatient vs outpatient GEM units), simplifications of criteria for greatest ease of application, and prospective evaluation of which criteria best predict functional improvement, longer survival, and reduced health care expenditures in response to GEM care.
研究人员普遍认为，老年评估与管理（GEM）单元只有针对最有可能从中受益的特定体弱老年患者群体时才有效。这类患者既不是病得太重（如严重痴呆或濒死）也不是身体状况太好。研究人员采用了各种策略来识别这类患者，但对于最有效的目标设定标准几乎没有达成共识。GEM项目最常使用的纳入标准是患者年龄、功能损害程度、老年疾病（如跌倒、失禁、意识模糊）、特定诊断疾病（如多种疾病）以及社会心理状况（如独居、近期丧亲、低收入）的各种组合。常用的排除因素是严重痴呆、不可避免的养老院安置和晚期疾病。结果研究表明，当使用特定临床标准选择患者时，GEM护理的有益效果最为明显。未来关于目标设定的研究应解决不同环境（如住院与门诊GEM单元）中对不同标准的潜在需求、为便于应用而对标准进行简化，以及前瞻性评估哪些标准最能预测功能改善、延长生存期和降低因GEM护理而产生的医疗保健支出。
