Wiedemann Andreas, Püttmann Jens, Heppner Hans
Ev. Krankenhaus Witten, Urologische Klinik, Witten.
Universität Witten/Herdecke, Lehrstuhl für Geriatrie, Witten.
Aktuelle Urol. 2019 Feb;50(1):100-105. doi: 10.1055/a-0736-3722. Epub 2018 Dec 13.
Since 2015 so-called "ISAR Screening" (Identification of Seniors at Risk) is mandatory for patients older than 75 years being hospitalised in Germany. It remains unclear how these patients identified as suffering from geriatric diseases are further characterised in urology and how this information is applied in the ongoing clinical treatment.
From the July 1st to December 31th 2016, 337 patients older than 75 years were subjected to ISAR-screening. The result ("with or without need for geriatric action") was contrasted with the results of further assessments, such as the assessment of the risk of falls, the risk of developing a pressure ulcer or malnutrition, demographic data (e. g. age, hospitalisation status) and urological diagnoses.
102 of 377 Patients were tested as "ISAR-positive" during the period of examination. These patients were significantly older than "ISAR-negative" patients. Additionally, ISAR-positive patients had a significantly higher risk of falling, developing pressure ulcers or malnutrition and were significantly more frequently hospitalised under emergency conditions. Reflecting their multimorbidity, ISAR-positive patients had significantly more diagnoses than ISAR-negative patients. These diagnoses were dominated by oncological and infectious urological diseases. Whereas most of the patients were screened by ISAR-screening according to the entire process, the subsequent assessment was performed in fewer patients.
The ISAR-screening identifies the "geriatric" patient in urology, who is threatened by his vulnerability, chronification, loss of autonomy and multimorbidity when being hospitalised. The regular implementation of the systemic approach of applying ISAR-screening and the further assessments into the clinical daily routines of urology constitute the major challenge in the future.
自2015年起，德国对75岁以上住院患者实施所谓的“ISAR筛查”（高危老年人识别）。目前尚不清楚这些被确诊患有老年疾病的患者在泌尿外科中如何进一步分类，以及这些信息如何应用于正在进行的临床治疗。
2016年7月1日至12月31日，对337名75岁以上患者进行ISAR筛查。将结果（“是否需要老年病干预”）与进一步评估结果进行对比，如跌倒风险、发生压疮或营养不良的风险、人口统计学数据（如年龄、住院状态）以及泌尿外科诊断结果。
在检查期间，377名患者中有102名被检测为“ISAR阳性”。这些患者比“ISAR阴性”患者年龄显著更大。此外，ISAR阳性患者跌倒、发生压疮或营养不良的风险显著更高，并且在急诊情况下住院的频率也显著更高。反映出他们的多种疾病并存，ISAR阳性患者的诊断比ISAR阴性患者显著更多。这些诊断主要是肿瘤性和感染性泌尿外科疾病。虽然大多数患者按照整个流程接受了ISAR筛查，但后续评估的患者较少。
ISAR筛查可识别泌尿外科中的“老年”患者，这些患者在住院时面临脆弱性、慢性病、自主性丧失和多种疾病并存的威胁。将ISAR筛查和进一步评估的系统方法定期纳入泌尿外科的临床日常工作是未来的主要挑战。
