Fried L P, Storer D J, King D E, Lodder F
Johns Hopkins Medical Institutions, Baltimore, Maryland.
J Am Geriatr Soc. 1991 Feb;39(2):117-23. doi: 10.1111/j.1532-5415.1991.tb01612.x.
In the standard medical model of diagnosis, there is a 1:1 correspondence between clinical symptoms and signs and a pathological disease process. However, it is believed that this model does not accurately define many illness presentations in elderly patients. The frequency with which the medical model is diagnostically accurate, and the other models that might more effectively diagnose geriatric illness, are unknown. This study was designed to ascertain the frequency with which the medical model of diagnosis pertains in a clinical population of older adults and to develop and validate alternative models for diagnosis of illness presentation in this population. Using a retrospective chart review (n = 86) and a prospective validation in a second sample (n = 56) of geriatric assessment clinic patients, it was found that the medical model of illness fit less than half of the patients. To describe the illness presentations of the remaining patients, four new diagnostic models of illness presentation were identified which incorporate comorbidity, functional, and psychosocial factors. Use of these new models along with the medical model of illness diagnosis may assist in more accurate and complete diagnosis in elderly patients and enhance teaching of effective diagnosis in geriatric medicine.
在标准的医学诊断模型中，临床症状和体征与病理疾病过程之间存在一一对应关系。然而，人们认为这种模型并不能准确界定老年患者的许多疾病表现。医学模型诊断准确的频率以及其他可能更有效地诊断老年疾病的模型尚不清楚。本研究旨在确定诊断医学模型在老年临床人群中的适用频率，并开发和验证该人群疾病表现的替代诊断模型。通过对老年评估诊所患者的回顾性病历审查（n = 86）和对第二个样本（n = 56）的前瞻性验证，发现疾病的医学模型适用于不到一半的患者。为了描述其余患者的疾病表现，确定了四种新的疾病表现诊断模型，这些模型纳入了合并症、功能和社会心理因素。将这些新模型与疾病诊断的医学模型一起使用，可能有助于更准确、完整地诊断老年患者，并加强老年医学中有效诊断的教学。
