Fougère Bertrand, Oustric Stéphane, Delrieu Julien, Chicoulaa Bruno, Escourrou Emile, Rolland Yves, Nourhashémi Fati, Vellas Bruno
Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; Inserm UMR1027, Université de Toulouse III Paul Sabatier, Toulouse, France.
Inserm UMR1027, Université de Toulouse III Paul Sabatier, Toulouse, France; Département de médecine générale, Université de Toulouse, Toulouse, France.
J Am Med Dir Assoc. 2017 Jan;18(1):47-52. doi: 10.1016/j.jamda.2016.08.003. Epub 2016 Sep 16.
Aging can be affected by frailty and chronic diseases causing physical, cognitive, sensory, and functional decline evolving gradually to disability. The assessment of older patients is carried out in some geriatric day hospitals (GDHFs). However, it seems difficult to assess all patients in these GDHFs. In this context, a care model, which uses a specialist nurse trained in primary care and geriatric assessment, has been developed. In this article, we describe the organization, details of the evaluation, and provide the main characteristics of the first 200 patients assessed over a 6-month period.
Persons aged 70 years and older were invited to undergo an evaluation at the general practitioner's (GP) office by a nurse if the GP thought that the patient was frail or if the patient had cognitive complaint or for both reasons.
A total of 200 patients from 14 GP offices were assessed. Overall, the mean age was 81.3 (±5.92) years. More than one-half were female (66%), and 32% of participants lived alone. The average Mini-Mental State Examination score was 25.2 (±4.23); 16.7% had dementia; 12% of mild cognitive impairment were identified; 78% of patients were followed by their GP; and 2.5% were referred to a GDHF, 12% to specialized memory center, and 7.5% to geriatric consultation.
This work foreshadows any other ambulatory options for older persons in his/her living area representing an alternative to the GDHF. It seems to meet the needs for this population and demonstrates the feasibility to implement in primary care a nurse trained to assess older patients in a GP office.
衰老会受到虚弱和慢性疾病的影响，这些疾病会导致身体、认知、感官和功能衰退，并逐渐发展为残疾。一些老年日间医院（GDHFs）会对老年患者进行评估。然而，在这些老年日间医院对所有患者进行评估似乎很困难。在这种情况下，已经开发出一种护理模式，该模式使用在初级保健和老年评估方面受过培训的专科护士。在本文中，我们描述了该护理模式的组织、评估细节，并提供了在6个月期间接受评估的前200名患者的主要特征。
如果全科医生（GP）认为患者虚弱或患者有认知方面的主诉，或出于这两个原因，邀请70岁及以上的人由一名护士在全科医生办公室接受评估。
对来自14个全科医生办公室的200名患者进行了评估。总体而言，平均年龄为81.3（±5.92）岁。超过一半为女性（66%），32%的参与者独居。简易精神状态检查表的平均得分为25.2（±4.23）；16.7%患有痴呆症；识别出12%有轻度认知障碍；78%的患者由其全科医生随访；2.5%被转诊至老年日间医院，12%被转诊至专门的记忆中心，7.5%被转诊至老年咨询机构。
这项工作预示着为老年人在其居住地区提供任何其他门诊选择，这是老年日间医院的一种替代方案。它似乎满足了这一人群的需求，并证明了在初级保健中实施一名经过培训可在全科医生办公室评估老年患者的护士的可行性。
