Ramsdell J W, Swart J A, Jackson J E, Renvall M
Department of Medicine, University of California, San Diego, School of Medicine, La Jolla, California.
J Am Geriatr Soc. 1989 Jan;37(1):17-24. doi: 10.1111/j.1532-5415.1989.tb01563.x.
Elderly patients often have problems not easily detected during an office visit. We investigated the yield of a home visit by a geriatric nurse specialist as part of an interdisciplinary assessment process. Compared with the findings of an office-based assessment by a general internist, the home visit resulted in up to four new problems (median = 2, mean = 1.7, 95% confidence interval = 1.5-1.8) and one to eight new recommendations (median = 4, mean = 3.6, 95% confidence interval = 3.4-3.9). Twenty-three percent of the problems could have resulted in death or significant morbidity. The most frequent problems related to psychobehavioral difficulties (23.1% of problems involving 38.3% of patients), safety (21.6% of problems involving 35.7% of patients), and caregiver related problems (20.4% of problems involving 33.8% of patients). The most common recommendations related to safety (30.7% of recommendations involving 81.8% of patients), caregiver well-being (19.8% of recommendations involving 52.6% of patients), and social issues (12.7% involving 33.8% of patients). Baseline clinical information did not predict the yield of the home visit in this sample. We conclude that an in-home assessment contributes unique and meaningful information to the geriatric assessment process.
老年患者常常存在一些在门诊就诊时不易被发现的问题。我们对老年护理专家进行家访的成效进行了调查，将其作为跨学科评估过程的一部分。与普通内科医生在门诊进行评估的结果相比，家访发现了多达4个新问题（中位数 = 2，平均数 = 1.7，95%置信区间 = 1.5 - 1.8）以及1至8条新建议（中位数 = 4，平均数 = 3.6，95%置信区间 = 3.4 - 3.9）。23%的问题可能导致死亡或严重发病。最常见的问题与心理行为困难（23.1%的问题涉及38.3%的患者）、安全问题（21.6%的问题涉及35.7%的患者）以及照顾者相关问题（20.4%的问题涉及33.8%的患者）有关。最常见的建议与安全（30.7%的建议涉及81.8%的患者）、照顾者福祉（19.8%的建议涉及52.6%的患者）以及社会问题（12.7%涉及33.8%的患者）有关。在这个样本中，基线临床信息无法预测家访的成效。我们得出结论，居家评估为老年评估过程提供了独特且有意义的信息。
